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Los terceros molares heterotópicos son dientes que se encuentran incluidos en los maxilares y la mandíbula distantes a su sitio de erupción habitual. Su etiología no está bien definida y existen diversas teorías. Estos dientes pueden aparecer en diferentes zonas de las estructuras óseas, teniendo predilección por la mandíbula. Suelen aparecer entre la segunda y la séptima década de la vida, la mayoría de los casos son hallazgos imagenológicos en la consulta odontológica. El tercer molar mandibular es el diente que presenta heterotopía con mayor frecuencia, siendo su localización habitual en rama mandibular y en la región subcondílea. El quiste dentígero es la patología asociada más común. Presentamos un caso de tercer molar heterotópico en rama mandibular derecha de larga evolución, relacionado a un quiste dentígero, el cual se manejó bajo anestesia regional. Se describe la etiología, técnica quirúrgica y consideraciones especiales relacionados con los dientes heterotópicos (AU)

Heterotopic third molars are teeth that are embedded in the maxilla and mandible, remote from their usual eruption site. Its etiology is not well defined and there are various theories at the moment. These teeth can appear in different areas of the bone's structures, having a predilection for the jaw. They usually appear between the second and seventh decade of life, and in most cases are imaging findings. The mandibular third molar is the tooth with the most frequent heterotopia, being its usual location in the mandibular branch and in the subcondylar region. The dentigerous cyst is the most common associated pathology. We present a case of a long evolution heterotopic third molar in the right mandibular branch, related to a dentigerous cyst which was managed under local anesthesia. The etiology, surgical technique and special considerations related to heterotopic teeth are described (AU)

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This clinical report describes the oral rehabilitation with a mandibular overdenture retained by telescopic crowns and ball attachments on semierupted permanent teeth with a 5-year follow-up. A female patient used an old complete denture in the maxilla and was willing to extract her remaining mandibular teeth to have new dentures. The treatment included preservation of semierupted premolars because of the high surgical risk for mandibular fracture and paresthesia, a new maxillary complete denture, and a mandibular overdenture supported by combined telescopic crowns and ball attachments. The prosthetic rehabilitation restored function and esthetics with high patient satisfaction after 5 years in function.

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Introducción: La falta de un incisivo permanente no solo genera un efecto adverso en la estética facial, también altera la función, en especial, la guía incisiva. Los incisivos superiores pueden sufrir bloqueo mecánico o cambio en su erupción por un diente supernumerario, un golpe u otro factor. El tratamiento de elección es el quirúrgico-ortodóncico. El pronóstico dependerá de la edad, situación, posición del diente, morfología, tamaño, maduración radicular y método de tracción. Conocer el uso de una aparatología ortodóncica que sea fácil de manipular y pueda ser usada desde edades tempranas servirá de valioso aporte. Objetivo: Mostrar el uso exitoso de un cantiléver para traccionar ortodóncicamente un incisivo impactado en posición horizontal. Presentación del caso: Paciente de 8 años con maloclusión clase I, pieza 2.1 retenida en posición horizontal, presencia de supernumerario y persistencia de pieza 6.1. Se opta por extracción de supernumerario, liberación de pieza 2.1 y tracción ortodóncica. Se usó un cantiléver por vestibular confeccionado en arco de acero redondo 0.020" con dos círculos en cada extremo para brindar elasticidad y anclaje. La fuerza utilizada fue de 70 g, pasado 6 meses se alcanzó el plano de oclusión. Se cementaron brackets y tubos, se continuó con la secuencia de arcos, hasta llegar al arco acero 0.021"x0.025" durante 11 meses. Se obtiene una posición final óptima que favorece la formación radicular y cierre apical. Conclusiones: El uso del cantiléver para el tratamiento ortodóncico de incisivos permanentes impactados en posición horizontal demostró ser exitoso, fácil de manipular y controlar(AU)

Introduction: The lack of a permanent incisor not only generates an adverse effect on facial aesthetics but also alters its function, especially the incisor guidance. Upper incisors can suffer mechanical blockage or change in their eruption due to a supernumerary tooth, a blow or another factor. The treatment of choice is orthodontic-surgical. The prognosis depends on the age, tooth position, morphology, size, root maturation and traction method. Knowing the use of an orthodontic appliance, which is easy to handle and can be used from an early age, will be of valuable contribution. Objective: To show the successful use of a cantilever to enable orthodontic traction of an impacted incisor in a horizontal position. Case presentation: Eight-year-old patient with class I malocclusion, specimen 2.1 retained in a horizontal position, presence of supernumerary tooth and persistence of specimen 6.1. Extraction of the supernumerary, release of specimen 2.1 and orthodontic traction is chosen. A buccal cantilever made of a 0.020" round steel arch with two circles at each end was used to provide elasticity and anchoring. The force used was 70 g. Six months after, the occlusion plane was reached. Brackets and tubes were cemented and the sequence of arches was continued until the 0.021"x0.025" steel arch was reached in 11 months. An optimal final position is obtained, favoring root formation and apical closure. Conclusions: The use of the cantilever for orthodontic treatment of impacted permanent incisors in a horizontal position proved to be successful as well as easy to manipulate and control(AU)

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It is necessary to use criteria based on the scientific literature, in order to obtain correct indications for cone beam computed tomography (CBCT). Therefore, the objective of this work is to analyze, through a bibilographic review, the applications of CBCT in oral surgery, mainly addressing surgery for included / impacted teeth. A bibliographic survey was performed in the PubMed database, selecting the keywords impacted teeth AND preoperative planning AND cone beam computed tomography. Twelve studies related to the topic were analyzed, some related to the use of CBCT and conventional radiographs in surgeries of included teeth, seeking to evaluate the influence of CBCT on the diagnosis and planning of cases and on the incidence of postoperative complications such as sensorineural disorders. It has been observed that CBCT is a good indication for surgery of included / impacted teeth when one wants to obtain a precise location of the dental element within the bone structure and its relationship with the adjacent structures, resulting in a better diagnosis and planning of cases, bringing more security and predictability during procedures... (AU)

É necessária a utilização de critérios baseados na literatura científica, para se obter indicações corretas da tomografia computadorizada de feixe cônico (TCFC). Sendo assim, o objetivo deste trabalho é analisar, por meio de revisão bibilográfica, as aplicações da TCFC em cirurgia oral, abordando principalmente a cirurgia de dentes inclusos/impactados. Realizou-se um levantamento bibliográfico no banco de dados PubMed, selecionado os descritores impacted teeth AND preoperative planning AND cone beam computed tomography. Foram analisados 9 estudos relacionados ao tema, alguns relacionaram o uso da TCFC e de radiografias convencionais nas cirurgias de dentes inclusos buscando avaliar a influência da TCFC no diagnóstico e planejamento dos casos e na incidência de complicações pós operatórias como distúrbios neurossensoriais. Foi observado que a TCFC é uma boa indicação na cirurgia de dentes inclusos/impactados quando se quer obter uma localização precisa do elemento dental dentro da estrutura óssea e sua relação com as estruturas adjacentes, resultando em um melhor diagnóstico e planejamento dos casos, trazendo mais segurança e previsibilidade durante os procedimentos... (AU)

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Teeth with root fracture may need orthodontic treatment. This case report presents the management of unerupted canines in a patient with previously-healed/untreated horizontal root fracture in the maxillary left central incisor. The malocclusion was treated maintaining pulp vitality considering the principles to improve the eruption path of maxillary canines and move short-rooted teeth. The root-fractured tooth remained symptomless after orthodontic treatment without significant adverse effects, and stayed stable following 2-year follow-up.

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ABSTRACT Introduction: Teeth frequently fail to erupt and situations arise that prevent the canines from reaching the occlusal plane. Objective: Discourse about the three situations in which the canine does not reach the occlusal plane, and remains unerupted; and at the same time, point how to make a safe diagnosis of alveolodental ankylosis - one of the three causes -, based on tomography. Conclusions: Ankylosis occurs in impacted teeth by atrophy of the periodontal ligament, including the epithelial rests of Malassez. The tomographic signs of alveolodental ankylosis in unerupted canines are the interruption of hypodense periodontal space, discontinuity of the lamina dura and its continuity with the root surface, which gradually loses its regular shape.

RESUMO Introdução: Muitas vezes, a erupção falha, e ocorrem situações que impedem que os caninos cheguem até o plano oclusal. Objetivos: Discorrer sobre quais as três situações nas quais o canino não chega até o plano oclusal, permanecendo não irrompido e, ao mesmo tempo, destacar como se diagnosticar com segurança uma dessas três causas, a anquilose alveolodentária, a partir da tomografia. Conclusões: A anquilose em dentes não irrompidos ocorre pela atrofia do ligamento periodontal, incluindo os Restos Epiteliais de Malassez. Os sinais tomográficos de uma anquilose alveolodentária em caninos não irrompidos são a interrupção do espaço periodontal hipodenso, a descontinuidade da lâmina dura e a sua continuidade com a superfície radicular, que, gradativamente, perde sua regularidade.

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ABSTRACT The principles of orthodontic mechanics strongly influence the success of impacted canine traction. The present study discusses the main imaging exams used for diagnosis and localization of impacted canines, the possible associated etiological factors and the most indicated mechanical solutions.

RESUMO Os princípios vetoriais da mecânica ortodôntica têm influência direta no sucesso do tracionamento dos caninos impactados. O objetivo desse artigo é discorrer sobre os possíveis fatores etiológicos associados à impacção dos caninos, os exames de imagem indicados no processo de diagnóstico e localização das unidades retidas, e as melhores soluções mecânicas para o tracionamento desses dentes.

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RESUMEN: La displasia cleidocraneal (DCC), es un trastorno autosómico dominante poco común, que involucra principalmente a los huesos que se osifican por vía membranosa; afectando el cierre de fontanelas craneales y el desarrollo de las clavículas, además de anomalías dentales y vertebrales. El objetivo de este manuscrito fue reportar el caso de una paciente con DCC que presentó un queratoquiste odontogénico (QQO) intrasinusal. Presentamos el caso de una paciente de 81 años, diagnosticada en su niñez con DDC, que consultó por un desajuste protésico y molestias en relación a la zona del seno maxilar derecho. Clínicamente se observó desajuste de la prótesis y aumento de volumen de márgenes poco definidos en la zona maxilar derecha, color rosa coral; que se extendía por todo el margen hemimaxilar derecho hasta el fondo de vestíbulo; doloroso a la palpación, con un mes de evolución. Se solicitó CBCT, con el que se pudo verificar la presencia de un desarrollo tumoral de contenido similar a dentículos, ubicado en la totalidad del seno maxilar derecho; extendiéndose hasta el piso de la cavidad nasal y orbitaria. Se estableció la hipótesis diagnóstica de "odontoma compuesto". Se le intervino quirúrgicamente, bajo anestesia general, realizándose una excisión de la lesión; la que era de márgenes definidos, con cambios de coloración en tonos oscuros, con la inclusión de tres piezas dentarias; de aspecto maligno. Se logró enucleación completa, dejando remanente óseo limpio. La pieza fue enviada a estudio histopatológico. En informe histopatológico, describió la presencia de una lesion quistica con pared compatible con queratoquiste.

ABSTRACT: Cleidocranial dysplasia (CCD) is an uncommon autosomal dominant disorder that mainly involves bones that ossify via the membrane, affecting the closure of cranial fontanels and the development of the clavicles, as well as presenting dental and vertebral anomalies. The aim of this manuscritpt was to report a case of a patient with CCD who presented an intrasinusal odontogenic keratocyst.We present an 81-year-old female patient, diagnosed with this syndrome in childhood, who comes to our service for a prosthetic misalignment and discomfort of the right maxillary sinus area. Clinically, there was a mismatch of the prosthesis and an increase in the volume of undefined margins under it, coral pink color, which extended all over the right hemimaxillary margin to the bottom of the vestibule, painful on palpation, with a one month evolution. A CBCT was requested, which revealed the presence of a tumor development with content similar to denticles, located in the entire right maxillary sinus, extending to the floor of the nasal and orbital cavity. The diagnostic hypothesis of "compound odontoma" was established. The patient was operated on in the central ward, under general anesthesia performing the excisional biopsy of the lesion, which showed changes in coloration in dark tones, with defined edges, with the inclusion of three teeth showing malignancy aspects. Complete enucleation was achieved, leaving tumor-free clean bone remnant. In a histopathological report, the presence of a keratocyst wall was described, which is not very compatible given the appearance of the lesion, the presence of the dental pieces included in it, and the behavior of the lesion.

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Dente impactado é todo aquele que sofre falha no seu processo eruptivo, ficando sob tecido duro e/ou mole. Dentro da classificação de tais dentes existem os terceiros molares invertidos, poucos descritos na literatura. O objetivo deste artigo é apresentar dois casos de terceiros molares maxilares impactados invertidos, diagnosticados através de exames de rotina odontológica e analisar relatos na literatura sobre terceiros molares invertidos. Foram selecionados artigos anexados à base de dados Pubmed, através de busca pelo termo "Inverted Third Molar", não havendo restrição quanto ao ano de publicação e idioma. Terceiros molares invertidos apresentam rara prevalência, sendo este relato um complemento à literatura previamente publicada(AU)

Impacted tooth is anyone who suffers failure in eruptive process, getting under hard and/or soft tissue. According to this classification there are the third inverted molars, few described in the literature. The aim of this article is to present two cases of inverted impacted maxillary third molars, diagnosed through routine dental examinations and to analyze reports in the literature about inverted third molars. We selected articles attached to the Pubmed database, searching for the term "Inverted Third Molar", there being no restriction regarding the year of publication and language. Inverted third molars present a rare prevalence, being this report a complement to previously published literature(AU)

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OBJECTIVES: Previous studies have suggested a relationship between resorption in second molars and pressure from the eruptive force of the third molar. The aim of this study was to simulate functional forces in a mandible model by means of finite element analysis and then assess the biomechanical response produced by impacted third molars on the roots of the second molar. MATERIALS AND METHODS: A cone beam computed tomography scan presenting an impacted mandibular third molar was segmented (Mimics V17 software). The modeling process was performed using the reverse engineering technique provided by the Rhinoceros 3D 5.0 software. The third molar position was changed in order to produce different inclinations of the impacted tooth. Bite forces were simulated to evaluate total deformation, the equivalent von Mises stress, minimum principal stress on hard tissue, and equivalent elastic strain on soft tissue. RESULTS: Areas of high energy dissipation and compression stress were detected in the second molar root, independently of the inclination of the impacted third molar. In general, the horizontal position was the situation in which major stress and the amount of deformation occurred in the second and third molar regions. CONCLUSION: Impacted third molars in close proximity with the adjacent tooth can generate areas of compression concentrated at the site of contact, which suggests an involvement of mechanical factors in the triggering of resorption lesions. CLINICAL RELEVANCE: The results of these computational experiments contribute to the understanding of the triggering and progression of resorptive lesions in the adjacent second molar.

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The patient in this case is an 11-year-old girl, whose mandibular left canine was transmigrated. The traction to the arch was assisted by using a temporary skeletal anchorage device. After 5 months of poor response to traction, the biomechanics were re-adjusted, obtaining effective traction in to the arch in 12 months. After this period, the treatment was completed with fixed orthodontic appliances.

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Multiple impacted supernumerary teeth without any associated systemic conditions or syndromes are rare. The prevalence rate of supernumerary teeth in the permanent dentition is between 0.1– 6.9 percent as compared to 0.3–0.6 percent in theprimary dentition. In this article, reporting a rare family history of non-syndromic multiple impacted supernumerary teeth,found incidentally during routine radiographic examination. Though the etiologic factor of multiple impacted supernumerary teeth are still not clearly known especially in cases without any syndrome. However, thorough evaluation is necessary toexclude associated systemic conditions.

Son raros los casos de sujetos con múltiples dientes supernumerarios impactados sin ningún tipo de afectación sistémica o síndrome. La tasa de prevalencia de dientes supernumerarios en la dentición permanente varía entre 0,1­6,9 % en comparación con el 0,3­0,6 % en la dentición primaria. En este artículo, se reporta una historia familiar rara de múltiples dientes supernumerarios impactados no sindrómicos, encontrados incidentalmente durante un examen radiográfico de rutina. El factor etiológico de dientes múltiples supernumerarios impactados aún no está claro, especialmente en los casos sin ningún tipo de síndrome. Sin embargo, es necesaria una evaluación a fondo para descartar enfermedades sistémicas asociadas.

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Sagittal osteotomy was primarily described as a treatment for prognathism and retrognathia. It has been rarely reported as an option for the removal of deeply impacted tooth. The principal indication of this approach is when the tooth is deeply impacted on the mandibular ramus or body and it presents intimate relationship between its root and inferior alveolar neurovascular bundles. In this article the author related three rare cases of lower third molar included. Because of the unusual deeply position of these, the SRRO surgery technique was realized to remove them. Sagittal split ramus osteotomy (SSRO) is technically safe and allows the removal of teeth in situations of deeply impacted mandibular ramus, angle or body with minimal trauma in a short time.

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Supernumerary teeth (ST) are uncommon alterations of development that may appear in either of the dental arches and that are frequently associated with syndromes such as cleidocranial dysplasia and Gardner syndrome. Multiple ST in individuals with no other disease or syndrome are very rare. In view of this situation, correct diagnosis, treatment and evaluation of ST with the use of appropriate imaging techniques are highly important. This case report presents radiographic images of a nonsyndromic 12-year-old female patient who presented with 14 supernumerary teeth and was treated under general anesthesia, with the extraction of all ST in a single surgical intervention. During the postoperative period, the patient did not complain of pain nor did she present any signs or symptoms of infection. During late follow-up period, due to difficulty in traction of the maxillary right canine and mandibular left first premolar towards the dental arch, it was necessary to extract these teeth under local anesthesia. Radiographic examination 3 years after surgery revealed the absence of ST and of diseases related to the existence of these teeth.

Os dentes supranumerários (DS) são alterações de desenvolvimento pouco frequentes, que podem aparecer em qualquer das arcadas dentárias e estão frequentemente associadas a síndromes como a displasia cleidocraniana e síndrome de Gardner. Múltiplos DS em indivíduos com nenhuma outra doença ou síndrome são muito raros. Diante dessa situação, o correto diagnóstico, tratamento e avaliação dos DS com estudo de imagens apropriadas são de significativa importância. No presente relato de caso, os autores apresentam imagens radiográficas de uma paciente não sindrômica de 12 anos de idade, gênero feminino, com 14 dentes supranumerários, em que o tratamento cirúrgico foi instituído sob anestesia geral, com extração de todos os DS em uma única intervenção cirúrgica. Durante o período pós-operatório, a paciente não se queixou de dor, como também não houve quaisquer sinais ou sintomas de infecção. Durante o acompanhamento, devido à dificuldade de tração do canino superior direito e primeiro pré-molar inferior em direção ao arco dental, foi necessário remover estes dentes sob anestesia local. O exame radiográfico de 3 anos após a cirurgia revelou a ausência dos DS e de doenças relacionadas com a existência desses dentes.

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La retención dentaria es una anomalía en la que una vez llegada la época normal de erupción, permanecen los dientes en el interior de los maxilares manteniendo la integridad de su saco pericoronario, pudiendo producir en su intento de erupción accidentes patológicos de variado aspecto e intensidad. Una de las causas se debe a que los maxilares de la especie humana son de menor tamaño que los de nuestros antecesores, y de esta manera no es posible alinear armónicamente los 32 dientes. La radiografía panorámica es de gran utilidad para diagnosticar esta lesión, sin manifestación clínica en algunos casos.Sobre una muestra de 1000 pacientes, desde los 6 hasta los 92 años, se diagnosticaron 334 retenidos; 180 en mujeres y 154 en varones. Las retenciones dentarias halladas fueron: 131 correspondieron a terceros molares inferiores, 70 derechos y 61 izquierdos; 107 correspondieron a los terceros superiores, 58 derechos y 49 izquierdos. Caninos permanentes 52: 43 superiores, y 9 inferiores. Premolares: 28, 20 inferiores y 8 superiores. El análisis de varianza nos indicó que hay diferencias significativas entre edades analizados por décadas pero no se halló diferencias entre sexos

An impacted tooth is a dental anomaly in which a dental piece remains enclosed into the jaw after the normal eruption age is reached, despite it usually keeps the physiology of the pericoronal sac; but it is known to cause some pathological accidents of varying kind and intensity during the tooth's attempt of eruption. One of the reasons for this anomaly is probably the fact that the jaws of the human species are smaller in size than those of our ancestors, so it is almost impossible for the 32 teeth to be aligned in a harmoniously way. The panoramic radiography is very helpful to diagnose this abnormality, which in many instances may occur with no clinical manifestations.1000 radiographs, taken from 6- to 92-year-old patients, a total of 334 impacted teeth were found, 180 female and 154 in male; their distributions were as follows: 131 lower third molars, 70 right and 61 left; 107 were upper third molars, 58 right and 49 left; 52 permanent canines were found, 43 upper and 9 lower; 28 premolars, 20 lower and 8 upper.The variance analysis indicated that theres`s a significate difference between the analized ages per decades, but there were no differences found between sexs

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Introducción: los dientes impactados presentan variadas formas de presentación en cuanto a posición, diente involucrado y complicaciones asociadas. Objetivo: mostrar un caso poco frecuente de impactación de dientes continuos con las complicaciones y posibilidades terapéuticas implementadas. Presentación del caso: presentamos el caso de una paciente femenina, 17 años, quien acude a la clínica de cirugía de la Facultad de Estomatología, en IBB, República de Yemen, por presentar dolor en hemiarcada inferior izquierda, al examen clínico se aprecia, 37 parcialmente erupcionado y ausencia de 38 en cavidad bucal. Se completa estudio con análisis radiográfico diagnosticando retención del 37 y 38, se decide exéresis quirúrgica del 37 y seguimiento de erupción del 38, asociado a terapéutica conservadora del 36 con severa lesión cariosa. Conclusiones: la valoración integral del paciente en casos de retenciones múltiples se hace necesaria para lograr el equilibrio funcional y estético como los obtenidos en casos como este.

Introduction: the impacted teeth have several forms of presentation in position, involved tooth, and associated complications. Objective: to show an unfrequented case of impactation in neighbor teeth, with its complications and therapeutic solutions. Presentation of the case: the case is a female patient, 17 years old, who came to service of surgery of dentistry college of IBB university, Yemen; due to she felt pain in left inferior dental arcade, in the clinical examination was observed the 37 partially erupted, and absent of the 38 in the oral cavity. A radiographic exam was done, diagnosing retention in 37 and 38. Surgical extraction of 37 was done and the eruption follows up of the 38, in association with a conservative treatment in the 36 due to severe carious lesion. Conclusions: the integral assessment is necessary in all patient with multiple retention to get the functional and aesthetic equilibrium like a result obtained in this case.

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Los odontomas son entidades odontogénicas mixtas, compuestas por una mezcla de células odontogénicas epiteliales y mesenquimatosas diferenciadas. Por lo inusual del hecho el objetivo de nuestro trabajo fue presentar un caso de asociación de impactación dentaria por un odontoma con la alteración de la fórmula dental. Se trata de un paciente masculino de 26 años, que acudió a la consulta externa de Cirugía Maxilofacial refiriendo dolor. Al examen físico se detectó asimetría facial por aumento de volumen duro elástico del tercio facial inferior derecho. Al examen físico bucal se observó persistencia del 65 y 85, ausencia clínica del 15, 47 y 48 con expansión de las corticales vestibular y lingual en región mandibular posterior derecha (región molar y retromolar) y presencia de una apertura en la mucosa de aproximadamente 8 mm por distal del 46, en la cima del reborde alveolar, de forma redondeada. En el estudio ortopantomográfico se visualizó una imagen radiopaca irregular en sus bordes, de 3 cm, asociada a la oligodoncia del 48 e impactación del 47, por lo que se decidió realizar la exéresis quirúrgica de la lesión conjuntamente con el 47, indicándose estudio histopatológico que confirmó la presencia de un odontoma complejo con áreas de tejido blando periférico que mostraban inflamación crónica. El paciente se mantiene bajo seguimiento clínico e imagenológico en su tercer mes postoperatorio. El objetivo de nuestro trabajo fue presentar un caso de asociación de impactación dentaria por un odontoma con la alteración de la fórmula dental(AU)

The mixed odontogenic odontomas are entities composed of a mixture of differentiated odontogenic epithelial and mesenchymal cells. The objective of this paper was to presente an unusual case of association of dental impaction caused by odontoma and altered dental formula. A male patient aged 26 years, who felt pain, attended the outpatient Oral and Maxillofacial Surgery service. The physical examination found facial asymmetry with facial hard elastic augmentation in the right facial lower third. The Intraoral physical examination showed persistence of oral 65th and 85th , clinical absence of 15th , 47th and 48th with expansion of the vestibular and lingual cortices in the right posterior mandibular area (retromolar and molar regions) and presence of rounded mucosal opening about 8 mm distal to the 46th , on top of the alveolar ridge. In the orthopantomographic study, a ± 3cm radiopaque image with irregular edges, associated with oligodontia of the 48th and impaction of the 47th , were observed. It was decided to surgically remove the lesion together with the 47th and to indicate histopathological study. It was confirmed that the patient had a complex odontoma with peripheral soft tissue areas that showed chronic inflammation. The patient is still followed-up from the clinical and imaging viewpoints after three months of surgery(AU)

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La variada posición anatómica de los terceros molares mandibulares presenta importantes desafíos asociados a su profundidad y grado de inclinación. Las complicaciones más habituales del procedimiento quirúrgico convencional de extracción se relacionan con la extensa osteotomía y poca visualización del sitio quirúrgico, que pueden generar consecuencias post-quirúrgicas como inflamación, dolor, trismus, lesiones reversibles e irreversibles del nervio alveolar inferior (NAI) o nervio lingual, riesgo de fractura y formación de defectos periodontales del segundo molar. La implementación de soportes rígidos en la óptica endoscópica ha permitido utilizar esta tecnología para realizar abordajes mínimamente invasivos para remover terceros molares mediante accesos flapless con una mínima osteotomía de la zona oclusal, conservando la pared bucal y lingual a través de la visualización directa y magnificada del sitio quirúrgico, adaptable a los movimientos del paciente durante la intervención. En este reporte se presenta un nuevo procedimiento quirúrgico mínimamente invasivo a través de asistencia endoscópica para la conservación ósea en la remoción de terceros molares mandibulares con riesgo de lesión del nervio alveolar inferior.

Anatomic variability of the position of mandibular third molars represents significant challenges associated with its depth and angulation. The most common complications of conventional surgical procedure are related to extensive osteotomy and poor visualization, which can cause postsurgical effects such as inflammation, pain, trismus, reversible and irreversible lesions of the inferior alveolar nerve (IAN) or lingual nerve, fracture risk and formation of a deep periodontal defect on the distal aspect of the second molar. The implementation of rigid endoscopy in optics has allowed to use this technology via a minimally invasive approach to remove third molars by a minimally occlusal flapless ostectomy, preserving the buccal and lingual walls through direct and magnified visualization of the surgical site, adaptable to the patient’s movements during the surgery. In this report, we present a new and minimally invasive procedure through endoscopic assistance for bone conservation in the removal of third molars at risk of inferior alveolar nerve injury.

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Due to the great number of structures in the maxillofacial region, cone-beam computed tomography (CBCT) is an important procedure in presurgical planning for removal of impacted teeth. Most of the information provided by this imaging technique cannot be visualized in conventional radiographs. In addition, CBCT reduces patient exposure to radiation in comparison with helical computed tomography and provides dental practitioners with easy access. We report the clinical case of a patient who underwent a surgical procedure for removal of an impacted maxillary premolar. CBCT-assisted presurgical treatment was used, enabling a more conservative surgical access, a less traumatic and less time consuming procedure than conventional surgical intervention.

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Introduction: During the development of a tooth, the pericoronal tissue may develop pathological changes.The clinical dilemma occurs in the early diagnostic of the tissue around the crown of an uneruptedtooth. Objective: The purpose of this paper is to present a clinical case with different diagnoses of a smallradiolucency area around the crown of impacted teeth on the same patient. The histological diagnosis ofthe follicle related to tooth 48 was of dentigerous cyst and the histological finding of follicular tissue associatedto tooth 38 showed some features of unicystic ameloblastoma. The follicles of teeth 18 and 28 didnot present histopathological changes. Conclusion: The radiographic appearance may not be a reliableindicator of the absence of disease in pericoronal tissues. We recommend histopathological analysis onall surgically extracted follicle tissue, even when radiographic and clinical findings are not indicative ofpathological alterations.

Introdução: Durante o desenvolvimento dental, o tecido pericoronário pode sofrer alterações patológicas.O dilema clínico está no diagnóstico precoce dos tecidos em torno da coroa de um dente retido. Objetivo: O objetivodeste trabalho é apresentar um caso clínico em que houve diferentes diagnósticos histológicos relacionadosaos tecidos pericoronários em um mesmo paciente sem a presença de alteração radiográfica característica.Os diagnósticos histológicos dos folículos dos terceiros molares sugeriram cisto dentígero relacionado ao dente48, características de ameloblastoma unicístico ao dente 38, e os tecidos dos dentes 18 e 28 não apresentaramalterações histopatológicas. Conclusão: O aspecto radiográfico neste caso não foi um indicador confiável daausência de doença em tecidos pericoronários. Logo, recomendamos que todos os tecidos pericoronários sejamencaminhados para o exame histopatológico mesmo que os achados radiológicos e clínicos não mostrem alteraçõespatológicas.

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