Mesiodentes

A mesiodent is an extra tooth in the maxillary anterior incisor region. Mesiodentes are the most common supernumerary teeth, occurring in 0.15% to 1.9% of the population. The etiology of mesiodens is unclear, but is twice prevalent in males (possibly an autosomal recessive gene), and there is a familial trait. Proliferation of the dental lamina and genetic factors have been implicated. Mesiodentes can cause delayed or ectopic eruption of the permanent incisors, which can further alter occlusion and appearance.

Mesiodens sometimes interfere with eruption of permanent teeth and cause other alignment problems with the existing teeth. Only a small portion of supernumerary teeth eventually erupts.

To prevent additional damage such as misalignment and delayed eruption of the permanent central incisors early intervention is suggested. Usually it is preferred to wait until the root of the central and the lateral teeth are completely formed before mesiodents are removed.

Mesiodens have been found in certain syndromes such as cleft lip and palate, cleidocranial dysostosis, and Gardner's syndrome. Supernumerary teeth in general have associations with Ehler-Danlos syndrome, Apert syndrome, and Down's syndrome as well.

The concerns associated with mesiodens are listed below and removal is often needed

1. Delayed eruption of permanent teeth

2. Cyst formation

3. Crowding

4. Diastemas

5. Resorption of the roots of adjacent teeth

6. Eruption of mesiodens  in to the nasal cavity..

Below see two cases that show the mesiodents erupting in to the nasal cavity.

 

 

 

Glubomaxillary cyst or Periapical cyst?

Globulomaxillary cyst has been considered to be a developmental cyst that arises from entrapped nonodontogenic epithelium in the globulomaxillary suture. In recent years existence and histogenesis of this lesion has been disputed. It had been argued that the anterior maxilla was formed by merging of growth centers rather than fusion of facial processes and therefore,  ectodermal entrapment was ruled out. Recent embryologic studies have demonstrated that Fusion of facial processes does occur, and epithelium is entrapped in areas that later will lie between the maxillary lateral incisors and canines. At the present Globumaxillary cyst has been removed from WHO classification of non odontogenic cyst and some argue that it needs to be reinstated as a developmental non odontogenic cyst.

 Below see a case which could potentially be argued both ways. 40 year old male presented with swelling of the space between maxillary left canine and lateral incisor. Patient had been treated with a root canal treatment years go on teeth #8, 9, and 10 and does not recall why. He denies history of trauma to the anterior maxilla.   Panoramic x ray disclosed  potentially an endodontic lesion in apex of #10 and cystic lesion that has resulted in root divergence in the area of tooth #10 and 11. Tooth #11 has tested vital and has been ruled out as a potential source of the lesion.   Pathology was consistent with both periapical lesion arising from tooth#10 and a non odontogenic cyst.

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BIlateral Mandibular swelling

34 year old female was referred from her dentist for mandibular swelling. Patient was complaining of lower jaw pain and swelling of 2 days duration and has been febrile for the past week. Health questionnaire was also negative for any systemic disease and patient claimed no past surgical history. Examination of the face was consistent with  lower facial swelling not extending beyond the lower mandibular border and skin was flushed and warm to palpation.  Bilateral mandibular body and chin and all lower teeth were tender to palpation and all lower teeth have plus 2 mobility. No decay was observed on any of the lower teeth.   Panoramic x-ray was taken and no odontogenic source for the infection was identified. Periodontal exam was also negative. A Cone beam CT was taken and a silicone mandibular implant was identified spanning from right mandibular body to the left. The  implant had resorbed the cortical bone.   Upon further questioning about past surgical history patient said she was embarrassed and did not disclosed the implant placement since her husband might find out!!
IV antibiotic was given and the implant was removed under general anesthesia.

 

 

 

Odontoma

Most common odontogenic tumor is an Odontoma.  Odontomas are considered to be hamartomas rather than neoplasms. These lesions are composed of tissues native to teeth: enamel, dentin, cementum and pulp tissue. 

Odontomas are classified based on their gross and radiographic features into compound (small tooth like structures) or complex (a conglomeration of dentin, enamel and cementum)  Clinical symptoms are uncommon, however, an affected patient may present when a permanent tooth or multiple teeth that fail to erupt.

Usually, odontomas can be confidently subclassified based on the Xray appearance. Compound odontomas appear as a collection of small teeth. Complex odontomas appear as a radioopaque mass  which may result in a wider differential diagnosis.

Below is a case of a 16 year old male who was referred  for removal of his wisdom teeth. Panoramic x ray was consistent with compound odontoma. CT scan was obtained to assess best access point to remove the lesion.  

Traumatic Bone Cyst

The traumatic bone cyst is an uncommon non epithelial lined cavity of the jaws. The cyst is mainly diagnosed in young patients most frequently in their teen. Most of these lesions are located in the mandible.  These lesions are asymptomatic in the most of cases and are often discovered on routine dental X-rays. Since epithelial lining is non existent,  microscopic diagnosis may be difficult.

Below see a Ct scan of a 15 Year old male athelete presenting to our office with large cystic lesion of left mandibular body which was discovered on panoramic x ray when he was consulting an orthodontist.

At surgery, we discovered a large cystic lesion devoid of any epithelium. Scrapings of the cyst was consistent with diagnosis of Traumatic bone cyst per pathologist.

The  recommended treatment for this lesion is surgical exploration followed by curettage of the bony walls.

The surgical exploration serves as both a diagnostic  and as definitive therapy by producing bleeding in the cavity. Blood clot formation in the cavity is eventually replaced by bone.

Eight years after his personal cell phone number went
public, Dr. Gabbaypour and his wife are pleased with his
decision. “Whether we’re having dinner in a restaurant or
he is in the office seeing a patient, he always makes time to
return the call,” she says. “People have been very respectful.
They appreciate knowing they can get in touch with him.
He has a special way of calming people and putting them
at ease.”
An oral and maxillofacial surgeon at Beverly Hills Oral
Surgery on Roxbury Drive, “Dr. G,” as his patients and
colleagues call him, offers solutions for most complex
problems relating to the face, facial skeleton, and oral cavity.
He performs complex reconstructive surgery of the facial
skeleton, corrective jaw surgery, implant tooth replacement
and removal of wisdom teeth. He also uses the latest cutting
edge technology to treat snoring and sleep apnea.
Dr. Gabbaypour’s training as a medical doctor and
dentist enhances his skills to treat the most difficult
oral surgery cases.
Dr. Gabbaypour holds special interest in treating
congenital and acquired craniofacial deformities in
children, craniofacial trauma, as well as treatment of
temporomandibular joint disorders (TMJ). He provides
these services safely and comfortably, using the latest in
loc al and intravenous anesthesia.

Dr. Gabbaypour was born and raised in Iran, but decided
as a teenager to risk his life to flee to the United States
during the height of the Iran-Iraq War. Smuggled out of the
country, the 16-year-old spent a year in Austria and Pakistan
while awaiting approval for political asylum in the U.S.
“When I think about it now, it is very scary to travel on
your own without family, and to have no idea what is next,”
he says. “At that age, you just don’t realize what lies ahead.
I was fortunate that I wasn’t fully aware of the danger, but
also that I understood the opportunities. I’m proud that I
have been able to take full advantage of the opportunities
this country has offered me.”
In 1992, soon after moving to Southern California, Dr.
Gabbaypour began undergraduate studies on scholarships
at the University of California. He had known since
childhood that he wanted to pursue a career in dentistry
or medicine, patterning himself after uncles who
remained in his homeland. He chose dentistry because
he was good with his hands (in fact, although he has
little free time now to pursue his hobby, Dr. Gabbaypour
is an accomplished woodworker).
“I did different rotations in dental school and discovered
that the surgical aspect of dentistry was what I loved,” he
says. After graduating with high honors from the UCLA
School of Dentistry in 1996, Dr. Gabbaypour studied until
2000 to obtain his Doctor of Medicine at UCLA’s School
of Medicine. This was followed by a one-year internship in
general surgery, and then another year was spent as chief
resident at three hospitals to earn his specialty certificate in
oral and maxillofacial surgery in 2002.
“UCLA is a tertiary care center and all of the big cases
that couldn’t be dealt with elsewhere came to us, based
on our affiliations with county hospitals and local trauma
centers, ” he says. “This gave me first-hand experience in
treating a wide range of conditions, as opposed to having to
learn it during a weekend conference and returning to the
office to try something new.”