ABSTRACT: Mesiodens is the supernumerary tooth that originates in the premaxilla, considered the most prevalent or, the most diagnosed due to the multiple alterations that produce and that include malposition of the permanent teeth, formation of gaps, delayed eruption of the upper anterior incisors and cyst formation. The etiology of mesiodens is not fully established, although it is thought that it may be due dental lamina alteration or other genetic factors. Diagnosis is usually late because most remain unerupted, and can generate dentomaxillary complications that are ultimately the reason for patient consultation. The dentigerous cyst is a developmental odontogenic cyst associated with the crown of an included, numerary or supernumerary tooth and its treatment is surgery. Early diagnosis and treatment planning should consider a careful history, clinical examination, and 3D imaging. The surgery must consist of the disinclusion of the offending tooth, the exeresis and curettage of the lesion, with or without immediate bone regeneration of the surgical bed with a graft. Two cases of a dentigerous cyst associated with a mesiodens that were diagnosed as a radiographic finding are presented. The treatment plan consisted in evaluation and endodontic treatment of devitalized teeth, enucleation and curettage of the cyst, together with the disinclusion of the supernumerary tooth, and long-term clinical and radiographic follow-up.

RESUMEN: El mesiodens es el diente supernumerario que se origina en la premaxila, siendo considerado el más prevalente o el más diagnosticado debido a las numerosas alteraciones que producen y que incluyen malposición de los dientes permanentes, formación de diastemas, retraso en la erupción de los incisivos anteriores superiores, y formación de quistes. La etiología de los mesiodens no está completamente comprendida, aunque se piensa que pueda deberse a la proliferación de la lámina dental u otros factores genéticos. El diagnóstico generalmente es tardío debido a que la mayoría permanece sin erupcionar, pudiendo generar complicaciones dentomaxilares que finalmente son el motivo de consulta de los pacientes. El quiste dentígero es un quiste odontogénico del desarrollo asociado a la corona de un diente incluido, numerario o supernumerario y su tratamiento es quirúrgico. El diagnóstico temprano y la planificación del tratamiento debe considerar una anamnesis minuciosa, un examen clínico e imágenes 3D. La cirugía debe consistir en la desinclusión del diente causal, la exéresis y legrado de la lesión, con o sin regeneración ósea inmediata del lecho quirúrgico con injerto. Se presentan dos casos de quiste dentígero asociado a un mesiodens que se diagnosticaron como hallazgo radiográfico. El plan de tratamiento consistió en evaluación y tratamiento endodóntico de los dientes desvitalizados, enucleción y legrado del quiste, junto a la desinclu sión del diente supernumerario, y seguimiento clínico y radiográfico en el largo plazo.

Resumo O desenvolvimento dentário pode apresentar alterações e alterações na forma, tamanho, estrutura e número de dentes. As anormalidades quantitativas incluem dentes supranumerários, que se desenvolvem além do número típico de dentes. Por outro lado, a fusão é uma anomalia da forma que resulta da união de dois germes dentários, que podem ser completos ou incompletos dependendo do estágio de desenvolvimento. A fusão dentária, que pode resultar em dentes duplos ou coroa dividida, é relativamente comum, com prevalência de 0,1% a 2,5%; No entanto, a fusão de três dentes, conhecida como "dente triplo", é uma anomalia rara, com prevalência de 0,02% na dentição decídua. Apresentamos o caso incomum de um menino de 5 anos com uma tripla fusão na dentição decídua entre dois incisivos inferiores e um dente supranumerário.

Resumen El desarrollo dental puede presentar cambios y alteraciones en la forma, tamaño, estructura y cantidad de dientes. Dentro de las anomalías de cantidad se encuentran los dientes supernumerarios, los cuales se desarrollan en adición a la cantidad típica de dientes. Por su parte, la fusión es una anomalía de forma que resulta de la unión de dos gérmenes dentales, pudiendo ser completa o incompleta según el estado de desarrollo. La fusión dental, que puede resultar en dientes dobles o una corona dividida, es relativamente común, con una prevalencia del 0,1% al 2,5%; sin embargo, la fusión de tres dientes, conocida como "diente triple", es una anomalía poco frecuente, con una prevalencia del 0,02% en la dentición primaria. Se reporta el caso inusual de un niño de 5 años con una triple de fusión en su dentición primaria entre dos incisivos inferiores y un diente supernumerario.

Abstract Tooth development can present changes and alterations in the shape, size, structure, and number of teeth. Among the quantity anomalies are supernumerary teeth, which develop in addition to the typical number of teeth. On the other hand, fusion is an anomaly of form that results from the union of two dental germs, which can be complete or incomplete depending on the stage of development. Dental fusion, which can result in double teeth or a split crown, is relatively common, with a prevalence of 0.1% to 2.5%; However, three-tooth fusion, known as "triple tooth," is a rare anomaly, with a prevalence of 0.02% in the primary dentition. We present the unusual case of a 5-year-old boy with a triple fusion in his primary dentition between two lower incisors and a supernumerary tooth.

ABSTRACT Supernumerary teeth are an odontogenic anomaly, involving an increase in the number of teeth compared to the normal amount. Platelet-Rich Fibrin (L-PRF) is a matrix rich in platelets and white blood cells that promotes tissue healing and regeneration. The Extraction of a supernumerary lower third premolar followed by placement of L-PRF membrane. A 27-year-old male patient with a probable lingual supernumerary premolar. Surgery was scheduled, including L-PRF. Blood was extracted to prepare the L-PRF membrane, followed by anesthesia, linear incision, mucoperiosteal detachment, osteotomy, extraction, treatment of the surgical site with L-PRF membrane placement, and interdental suturing. Antibiotic, anti-inflammatory, and analgesic medication was prescribed. The L-PRF technique is simple and cost-effective. Postoperative results were favorable, with good healing, absence of pain, swelling, or infection was observed.

RESUMEN Los dientes supernumerarios son una anomalía odontogénica, consiste en aumento del número dentario con respecto a la cantidad normal. La Fibrina rica en Plaquetas y Leucocitos (L-PRF) es una matriz rica en plaquetas y glóbulos blancos, que promueve la curación y regeneración de los tejidos. La exodoncia de un tercer premolar inferior supernumerario con posterior colocación de membrana de L-PRF. Paciente de sexo masculino de 27 años de edad con un probable premolar supernumerario por lingual. Se programó la cirugía incluyendo L-PRF. Se realizó extracción de sangre para preparar la membrana de L-PRF, anestesia, incisión lineal, despegamiento mucoperióstico, osteotomía, exodoncia, tratamiento del lecho quirúrgico colocando la membrana de L-PRF y sutura interdental. Se prescribió medicación antibiótica, antiinflamatoria y analgésica. La técnica con L-PRF es sencilla y económica. Los resultados postoperatorios fueron favorables, observándose una buena cicatrización, ausencia de dolor, edema o infección.

Abstract Aim To describe the development of an oral squamous cell carcinoma, in which chronic mechanical irritation appears to play a significant role in carcinogenesis. Clinical case A 41-year-old patient, from Argentina, with a history of cleft lip and palate, diabetes mellitus, seizures, cocaine and cannabis use, chronic alcoholism and smoking, comes to the Dentistry Service of the Central Hospital for the evaluation of a painful ulcer on the dorsum of the tongue, which had been developing for several weeks, in close relation to an upper right first premolar and a supernumerary tooth. A biopsy was performed, and the pathological anatomy resulted in the diagnosis of oral squamous cell carcinoma. Possible treatments were offered to the patient, which he rejected, so palliative and symptomatic therapy was initiated instead. As his poor general condition progressed, he died due to complications related to swallowing. Although the role of chronic mechanical irritation in the development of carcinogenesis is not yet fully defined, it has been shown to have a promoting effect on the damage caused by tobacco and alcohol. Although the patient was a smoker and drank alcohol, it can be observed that he developed a squamous cell carcinoma in obvious relation to a chronic trauma, since the lesion develops on the dorsal face of the tongue in close contact with the irritant factor. Still, the current evidence available is limited and discusses the role of chronic trauma, so more studies are needed to evaluate and define the possible causal relationship of chronic mechanical irritation in the development of carcinogenesis.

Resumen Objetivo Describir el desarrollo de un carcinoma oral de células escamosas, en el que la irritación mecánica crónica aparenta tomar un rol protagonista en la carcinogénesis. Caso clínico Un paciente de 41 años de edad, argentino, con antecedentes de fisura labio alvéolo palatina, diabetes mellitus, convulsiones, consumo de cocaína y marihuana, enolismo crónico y tabaquismo, acude al Servicio de Odontología del Hospital Central de Mendoza para la evaluación de una úlcera dolorosa en el dorso de su lengua, de varias semanas de evolución, en íntima relación con un primer premolar superior derecho y una pieza supernumeraria. Se realizó una biopsia y de la anatomía patológica resultó el diagnóstico de carcinoma oral de células escamosas. Se ofreció al paciente posibles tratamientos que rechazó, por lo que se inició terapia paliativa y sintomática. Al avanzar su mal estado general, falleció por complicaciones relacionadas a la deglución. Si bien no está definido el rol de la irritación mecánica crónica en la etiología de la carcinogénesis, ejerce un efecto promotor del daño causado por el tabaco y el alcohol. Si bien el paciente era fumador y bebía alcohol, se puede observar que desarrolló un carcinoma de células escamosas en evidente relación a un trauma crónico, ya que la lesión en la cara dorsal de lengua está en íntimo contacto con el factor irritante. Aun así, la evidencia actual disponible es limitada y discute el protagonismo del trauma crónico por lo que se necesitan más estudios para evaluar y definir la posible relación causal de la irritación mecánica crónica en la carcinogénesis.

RESUMEN Introducción: Los dientes supernumerarios constituyen una anomalía de número en la cual se excede la cantidad normal de piezas dentales. La geminación es una anomalía de forma que se caracteriza por la presencia de una corona bífida y una raíz común. Los dientes supernumerarios geminados son de rara aparición; indicar exámenes imagenológicos son importantes para determinar sus características y su relación con las estructuras vecinas. Objetivo: Presentar el caso clínico de un paciente con un diente supernumerario geminado. Caso clínico: Paciente de sexo masculino de 23 años de edad, acude a la consulta odontológica por presentar una elevación del lado izquierdo en el paladar, sin molestias. En el examen clínico se observa un aumento de volumen de mucosa palatina de piezas dentales 24 y 25. Los exámenes de imagen fueron realizados y se diagnosticó un diente supernumerario geminado retenido, se realizó tratamiento quirúrgico y el paciente evolucionó favorablemente. Conclusión: Los dientes supernumerarios geminados son poco frecuentes, una oportuna y correcta evaluación imagenológica, le permitirá al clínico realizar un adecuado diagnóstico y tratamiento.

ABSTRACT Introduction: Supernumerary teeth constitute an anomaly of number where the normal number of teeth is exceeded and gemination is an anomaly of shape characterized by the presence of a bifid crown, a common root. Geminate supernumerary teeth are of rare occurrence; indicating imaging examinations are important to determine their characteristics and their relationship with neighboring structures. Objective: To present the clinical case of a patient with a geminate supernumerary tooth. Clinical case: A 23-year-old male patient came to the dental office due to an elevation on the left side of the palate, without discomfort. In the clinical examination, an increase in the volume of the palatal mucosa of teeth 24 and 25 was observed. The imaging examinations were performed and a retained geminated supernumerary tooth was diagnosed, surgical treatment was performed and the patient progressed favorably. Conclusion: Geminate supernumerary teeth are rare; a timely and correct imaging evaluation will allow the clinician to make an adequate diagnosis and treatment.

ABSTRACT Objectives: This study aims to determine the prevalence of tooth agenesis and supernumerary teeth and characterize both anomalies in a Portuguese pediatric population. Methods: Clinical records of patients attending Pediatric Dentistry appointments in the Faculty of Dental Medicine of the University of Porto were consulted. Appointments from September 2020 to December 2021 were analyzed. For each patient, sex and age were recorded, along with any relevant data in their clinical history. Statistical analysis of the results was conducted using chi-square tests with a significance level of 0.05. The sample included 144 patients. Results: This study found a prevalence for tooth agenesis of 20.83% (11.81% excluding the third molars) and a prevalence for supernumerary teeth of 1.39%. The prevalence of agenesis was 26.1% for males and 16% for females. No association was established in this regard (p>0.05). The most affected teeth were the third molars, followed by the second premolars. The mandible had 52.63% of agenesis cases, but no association was found (p>0.05). Two cases of supernumerary teeth were found, both in male patients and in the second quadrant. No differences were inferred regarding sex (p>0.05). Conclusions: The results of this study contributed to the existing data regarding the prevalence of dental anomalies of number within a Portuguese population. (Rev Port Estomatol Med Dent Cir Maxilofac. 2023;64(3):99-104)

RESUMO Objetivos: Este estudo pretende determinar a prevalência da agenesia dentária e de dentes supranumerários e caracterizar as duas anomalias numa população pediátrica portuguesa. Métodos: Os registos clínicos dos pacientes pediátricos consultados na Faculdade de Medicina Dentária da Universidade do Porto foram consultados. Foram analisadas consultas desde setembro de 2020 até dezembro de 2021. O sexo e a idade de cada paciente foram registados, assim como quaisquer dados relevantes constantes na história clínica. Foi realizada a análise estatística dos resultados com recurso a testes do Qui-Quadrado, com um nível de significância de 0,05. Foram incluídos 144 pacientes na amostra. Resultados: Este estudo encontrou uma prevalência de agenesias dentárias de 20,83% (11,81% excluindo os terceiros molares) e uma prevalência de dentes supranumerários de 1,39%. A prevalência de agenesias foi 26.1% no sexo masculino e 16% no feminino. Nenhuma associação foi estabelecida a este respeito (p>0,05). Os dentes mais afetados foram os terceiros molares, seguido dos segundos pré-molares. 52.63% das agenesias encontravam-se na mandíbula, mas nenhuma associação foi encontrada (p>0,05). Foram encontrados dois casos de dentes supranumerários, ambos no sexo masculino e no segundo quadrante. Não foram encontradas diferenças quanto ao sexo. (p>0,05). Conclusões: Os resultados deste estudo contribuíram para os dados existentes quanto à prevalência das anomalias dentárias de número na população portuguesa

INTRODUCTION: Supernumerary teeth (SNT) are often associated with malocclusions. Data on SNT in the South African population are not well documented OBJECTIVE: To determine the prevalence, distribution of characteristics and any associated complications of SNT in a South African sample of dental patients DESIGN: The study was retrospective, cross-sectional and descriptive METHOD: Orthopantomographs of 12,005 dental patients were reviewed for the presence of SNT. The number, morphology, location, eruption status and orientation of SNT were assessed. Associated orthodontic problems were noted RESULTS: The prevalence rate was 2.48%. No sexual dimorphism in the distribution of SNT was noted. Types of SNT tabulated were: supplementary, conical, tuberculate and odontoma. Maxilla demonstrated a higher predilection for SNT. Variation in the distribution of SNT in the anterior, premolar and molar regions in each jaw and across jaws was statistically significant. Relationship of eruption status to the morphology and orientation of SNT was of significance. Malocclusions noted were displacement and impaction of adjacent teeth CONCLUSION: From an orthodontic perspective, presence of SNT may compromise tooth movement and space closure in patients. Additionally, as majority of SNT in this population were in the maxillary molar and mandibular premolar regions, caution is advised when planning the placement of orthodontic implants in these regions

Aim Dental number anomalies are a group of congenital developmental disorders divided into two groups supernumerary and missing teeth. This study was conducted to investigate the prevalence of numeric dental anomalies using panoramic images in patients referred to the Hamadan Dental Faculty. Methods In this cross-sectional study, 2,197 panoramic radiographs of patients aged 6-49 years were evaluated. These anomalies are divided into two groups: 1) Supernumerary teeth, including Mesiodens, Distodens, and Peridens, and 2) Missing teeth, including Hypodontia, Oligodontia, and Anodontia. A Chi-square test was performed to assess the relationship between the anomalies. Data analysis was performed using SPSS 16, in which P-value < 0.05 was considered the statistical significance level. Results Of 736 males (32.2%) and 1548 females (67.8%) in this study, 32 (4.3%) and 55 cases (3.8%) had supernumerary teeth, respectively. The prevalence of supernumerary teeth was 0.3%, 0.5%, and 0.6% in males and 0.2%, 1% and 1.2% in females for mesiodens, distodens, and peridens, respectively. Also, 243 males (10.6%) and 655 females (28.6%) had missing teeth anomalies. Hypodontia in the maxilla was the most common anomaly in both genders, while mesiodens was the least common. Conclusion Hypodontia was the most common anomaly, followed by peridens; the least common anomaly was mesiodens. The prevalence of supernumerary teeth was greater in males, though the difference was not statistically significant. In comparison, females had a greater prevalence of missing teeth. Faculty crosssectional cross sectional 2197 2 197 2,19 649 6 49 6-4 evaluated 1 Mesiodens Distodens Peridens Oligodontia Anodontia Chisquare Chi square 16 Pvalue P value 005 0 05 0.0 level 73 32.2% 322 (32.2% 154 67.8% 678 67 8 (67.8% 3 4.3% 43 4 (4.3% 5 3.8% 38 (3.8% respectively 03 0.3% 0.5% 06 0.6 02 0.2% 12 1.2 distodens peridens Also 24 10.6% 106 10 (10.6% 65 28.6% 286 28 (28.6% genders significant comparison 219 19 2,1 64 6- 00 0. 7 32.2 (32.2 15 67.8 (67.8 4.3 (4.3 3.8 (3.8 0.3 0.5 0.2 1. 10.6 (10.6 28.6 (28.6 21 2, 32. (32. 67. (67. 4. (4. 3. (3. 10. (10. 28. (28. (32 (67 (4 (3 (10 (28 (6 ( (1 (2

ABSTRACT: The supernumerary tooth of nasal location is a pathology of low prevalence in the population with different forms and clinical symptoms. It is important to establish a diagnosis regarding its clinical and radiological characteristics in order to carry out adequate surgical treatment planning, with few or no post-intervention complications. Case presentation: This study reports the case of a 10-year-old boy, with no morbid history, who presented a supernumerary tooth, found radiographically in the midline. CBCT showed a mesiodens in the nasal septum, tilted and inverted palatal, partially erupted covered by nasal mucosa, with its crown facing the nasal cavity in relation to the nostrils. The tooth was extracted under general anesthesia using a transoral approach through a vestibulotomy. The nasal supernumerary tooth is a rare pathology. It is important to know its clinical and radiographic characteristics since they will determine the type of approach to be used. The degree of eruption, the distance to the anterior nasal spine and its associated symptoms are essential to determine whether the surgical approach is intraoral or extraoral.

RESUMEN: El diente supernumerario de ubicación nasal es una patología de baja prevalencia en la población con diferentes formas y sintomatología clínica. Es importante establecer un diagnóstico respecto a sus características clínicas y radiológicas para realizar una planificación de tratamiento quirúrgica adecuada, con nula o escasas complicaciones post intervención. Presentación del caso: En el presente estudio se reporta el caso de un niño de 10 años de edad, sin antecedentes mórbidos, que recurre al servicio por presentar un diente supernumerario en la línea media hallado radiográficamente. El CBCT demuestra un mesiodens en el septum nasal, palatal inclinado e invertido, parcialmente erupcionado cubierto por mucosa nasal, con su corona en sentido a la cavidad nasal en relación a las fosas nasales. El diente fue extraído con anestesia general mediante un abordaje transoral a través de una vestibulotomía. El diente supernumerario nasal es una patología poco prevalente. Es importante conocer sus características clínicas y radiográficas ya que determinarán el tipo de abordaje a realizar. El grado de erupción, la distancia a la espina nasal anterior y su sintomatología asociada son fundamentales para determinar si el abordaje quirúrgico es intraoral o extraoral.

Resumen Objetivo Presentar una serie de casos clínicos de mesiodens en niños con dentición temporal y mixta, su tratamiento y seguimiento. Casos clínicos Se muestra el manejo clínico de tres casos de mesiodens en dentición temporal y un caso en dentición mixta, los cuales fueron diagnosticados en un examen radiográfico de rutina.

Abstract Aim To present a series of clinical cases of mesiodens in children with primary and mixed dentition, their treatment and follow-up Clinical cases This paper describes the clinical management of three cases of mesiodens in primary dentition and one case in mixed dentition which were diagnosed in routine radiographic examinations.

ABSTRACT The calcifying epithelial odontogenic tumor is a rare benign neoplasm that accounts for approximately 1% of all odontogenic tumors. Most of the cases occur in the posterior mandible, and a few involve the maxilla. Despite their relatively indolent biological behavior, tumors in the maxilla tend to grow fast. We report the case of a 33-year-old female patient exhibiting swelling in the right maxilla. An isodense area associated with an impacted supernumerary tooth was found on imaging examination. The histopathologic diagnosis was a calcifying epithelial odontogenic tumor. The treatment of choice was surgical removal of the lesion and associated dental elements. The patient has been followed up for 11 months and shows no signs of recurrence. Besides describing this case, we reviewed the literature on the association of calcifying epithelial odontogenic tumors with supernumerary teeth and found two case reports addressing this subject.

RESUMO Os dentes supranumerários representam um desafio para clínicos e odontopediatras quanto ao diagnóstico e tratamento. São assintomáticos, podendo gerar atraso na dentição permanente, alteração do crescimento ósseo e posicionamento ectópico. Assim, o presente trabalho teve como objetivo apresentar um relato de caso de remoção cirúrgica de dentes supranumerários na região anterior da maxila de um paciente infantil, em ambiente hospitalar sob anestesia geral. O paciente do sexo feminino, 6 anos, compareceu ao consultório apresentando como queixa a presença de um dente “estranho” na região anterior. Foram realizados o exame clínico e exames de imagem com a confirmação do diagnóstico de dentes supranumerários na região do incisivo central superior direito (11) e do incisivo central superior esquerdo (21). Tendo em vista o histórico odontológico e comportamental da paciente, optou-se em realizar o tratamento cirúrgico em ambiente hospitalar, auxiliado por equipe multidisciplinar. Dessa forma, ao final dos procedimentos foi verificado que o atendimento em ambiente hospitalar é viável para maior conforto do paciente não colaborador.

ABSTRACT The diagnosis and treatment of supernumerary teeth pose a challenge for dental clinicians and pediatric dentists. These teeth are asymptomatic and may cause the delayed eruption of the permanent dentition, altered bone growth and ectopic positioning. This paper reports a case of the surgical removal of supernumerary teeth in the anterior region of the maxilla of a child under general anesthesia in a hospital setting. A six-year-old female patient visited a private dental office in the city of Garanhuns, Brazil, accompanied by her mother, who reported a tooth with a “strange shape” in the anterior region as the main complaint and also reported that her daughter’s first dental experience was negative. The clinical examination and imaging tests were performed under general anesthesia to confirm the diagnosis. In view of the patient’s dental and behavioral history, surgical treatment was performed in a hospital setting and assisted by a multidisciplinary team. Care in the hospital setting was found to be feasible, providing greater comfort for uncooperative patients.

ABSTRACT 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.

RESUMEN 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.

ABSTRACT The aim of this study was to determine prevalence and describe the clinical and radiographic findings of three-rooted primary mandibular first and second molars in a Mexican population. Intraoral periapical radiograph, orthopantomogram or cone beam computed tomography (CBCT) were obtained. A total 2284 children from the state of Puebla, Mexico were examined, of whom 20 presented an anatomic variant in tooth crown shape. Of the total teeth with crown alterations, 10 first and 5 second primary mandibular molars were found to have supernumerary roots. In one case, it was possible to obtain micro-CT images. The study recorded prevalence, unilateral or bilateral occurrence, and ratio between sexes. Data were analyzed using descriptive statistics. Clinical findings were presence of an anatomical variation (tuberculum paramolare / right and/or left cervical convexity) in primary mandibular first molars. Second molars presented conventional crown morphology. Prevalence of three-rooted primary mandibular first and second molars was 0.44% and 0.22%, respectively. Male: female ratio for presence of threerooted primary mandibular first molars was 4:1, showing genetic predisposition in males, and for second molars it was 1.5:1, with no predisposition according to sex. The clinical and radiographic anatomical variants in primary molars should be considered by pediatric dentists during routine care because they may cause difficulties in restorations.

RESUMEN El objetivo de este estudio fue determinar la prevalencia, así como los hallazgos clínicos y radiográficos de los primeros y segundos molares primarios mandibulares con tres raíces en una población mexicana. Se obtuvieron radiografías periapicales intraorales, ortopantomografía o tomografía computarizada de haz cónico (TCHC). Fueron revisados en total 2284 niños originarios del estado de Puebla, México, de los cuales 20 sujetos presentaron una variante anatómica en la forma de la corona dental. En el total de dientes con alteraciones coronarias, se encontraron 10 primeros y 5 segundos molares primarios mandibulares con raíces supernumerarias. En un caso fue posible la obtención de imágenes de micro tomografía computarizada (micro-CT). Fueron registradas la prevalencia, la ocurrencia uni o bilateral y la relación entre sexos. Los datos se analizaron mediante estadística descriptiva. Los hallazgos clínicos fueron: presencia de una variación anatómica (tuberculum paramolare / convexidad cervical derecha y/o izquierda) en los primeros molares primarios mandibulares. Los segundos molares presentaron una morfología coronal convencional. Entre los hallazgos radiográficos, fue común encontrar un conducto en cada raíz. La prevalencia fue de 0,44% y 0,22% para los primeros y segundos molares primarios mandibulares con tres raíces, respectivamente. La relación por sexo en los primeros molares primarios mandibulares con tres raíces fue de 4:1, indicando una predisposición genética para el sexo masculino, mientras que, en los segundos molares, la razón fue de 1,5:1 sin predisposición por sexo. Las variantes anatómicas clínicas y radiográficas presentes en los molares primarios deben ser tomadas en cuenta por los odontopediatras durante su rutina de atención, ya que pueden ocasionar dificultades para la restauración.

ABSTRACT Introduction: the treatment of impacted teeth is one of the problems that arise in patients requiring orthodontic treatment. Case Report: a 10-year-and-5-month patient having a health history comes to the orthodontic office for presenting alterations in the eruption of the upper incisors. On the oral examination she presented mixed dentition with clinical absence of 21 and the panoramic x-rays showed the retention of the 21 which is associated with a supernumerary tooth. The treatment of choice was the surgical orthodontic combination. Conclusions: with an appropriate interdisciplinary management, leaving the traditional way, and by means of innovative along with economic techniques, it was possible to bring the tooth to the dental arch, correct midlines, reestablish esthetics and function in an uncommon case due to its location in the central teeth, which, being more visible, can affect esthetically and psychologically the children in their interaction with the social environment.

RESUMEN Introducción: el tratamiento de dientes incluidos es uno de los problemas que se presentan en pacientes que requieren tratamiento de Ortodoncia. Presentación del caso: paciente de 10 años, con antecedentes de salud que acude a la consulta de Ortodoncia por presentar alteraciones en el brote de los incisivos superiores. Al examen bucal presenta dentición mixta con ausencia clínica de 21. En rayos X panorámico se observa 21 retenido asociado a diente supernumerario. El tratamiento de elección fue la combinación ortodóncica quirúrgica. Conclusiones: con un manejo interdisciplinario adecuado, mediante técnicas innovadoras y económicas, se logró llevar el diente al arco dentario, corregir líneas medias, restablecer la estética y la función en un caso poco común por su localización en los dientes centrales, que, al ser más visibles, puede afectar estética y psicológicamente a los niños en su interacción con el medio social.