We treated the malocclusion of two boys having a germinated tooth in the incisor region of maxilla. In case 1, the germinated tooth was located at the right lateral incisor, in case 2, at the left central incisor region of maxilla.
The X-ray and CT examinations revealed that the germinated tooth was united by enamel and dentin and the dental pulp cavity was joined in both cases.
So we carried out treatments to avoid pulpectomy in both cases; the germinated tooth aligned in the upper dental arch without saparating of the twin teeth.
The crown of the germinated tooth was very large, so this tooth was impacted and/or erupted in dislocation due to a shortage of space for the eruption. Therefore, it is necessary in such a patient to establish an individually normal occlusion by controlling the eruption of the permanent tooth, furthermore considering the reshaping, extraction, and the dental prosthesis treatment by the long-term follow up.
Metastatic tumors of the oral region account for about 1-2% of all malignant neoplasms of the oral cavity, and have been reported to be often located in the jaw bone and gingiva, and rarely in the floor of the mouth.
Recently, we encountered an 80-year-old man with suspected metastatic lung cancer of the mouth floor. He visited our department with a chief complaint of a painless swelling on the right side involving the floor of the mouth on December 21, 2007. The initial examination revealed a 15×10-mm indurated mass on the right side of the mouth floor, and plain chest X-ray showed a shadow with irregular margins in the right lung lower lobe. PET-CT showed FDG uptake on the right side of the mouth floor with an SUV of 5.5 and in the right lung lower lobe with an SUV of 6.4. Biopsy of the lesions in the oral cavity and lung led to a diagnosis of adenocarcinoma. The histological features of the oral cavity lesion differed from those of primary adenocarcinoma of the oral cavity, and resembled those of the lung lesion. With a diagnosis of metastatic lung adenocarcinoma of the oral cavity, the patient received chemotherapy at the Department of Respiratory Medicine. However, the primary lesion enlarged, cerebral hemorrhage occurred during treatment, and he died of a deteriorated general condition in May 2008.
One of the purposes of alveolar bone grafting (ABG) on the alveolar cleft is to induce eruption of the permanent tooth adjacent to the cleft portion. We experienced three cases in which difficulties of tooth eruption were expected, and all of which showed improvement in eruption direction and successful final arch alignment after completion of ABG.
All the cases were treated at the orthodontic clinic of Iwate Medical University Hospital Dental Center. The cases included the bilateral cleft of the lip and alveolus, the unilateral cleft of the lip and palate, and the unilateral cleft of the lip and alveolus.
Un-erupted teeth and the pre-/post-surgical conditions of the cleft portions were evaluated using X-ray images and CT images.
Within 17 to 30 months after ABG, all cases showed completion of the eruption of the teeth, including the canine parallel to the nasal floor, the canine adjacent to the lateral wall of the nasal cavity, and the central incisor laterodistal to the nasal floor.
The retention of the bone bridge in the new alveolus after ABG was affected by the existence of the tooth in this portion. Therefore, the genesis of the new bone induced the eruption of the adjacent tooth, and the effect of the occlusion with this tooth was expected to support the retention of the bone bridge.
The induction of eruption will be easier if the malposition of the un-erupted tooth is improved by ABG. We conclude that ABG should be performed in cleft cases with serevely malpositioned teeth.