1. day. New horizons in prevention and treatment of tooth impaction and tooth retention. Friday March 7 th, 2014

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1 1. day Friday March 7 th, 2014 New horizons in prevention and treatment of tooth impaction and tooth retention registration and coffee/bread Classification of tooth eruption in disturbances and eruption experiments. Jens Ove Andreasen What do we know today about the etiology of normal and pathologic eruption process. Inger Kjær In the past numerous theories of tooth eruption has been proposed and have involved almost all tissues in or near an erupting tooth. Lately experiments in dogs and rats have shown that the dental follicle plays a very significant role. In this presentation the results of the crucial experiments performed by two researchers PR Cahill and S Marks will be presented. Furthermore experiments in monkeys on the eruption process will be shown. Even though tooth eruption is a central physiological process in odontology, very little research exists in the field. The mechanism behind eruption is not fully understood. Research interests have been concentrated on the tooth follicle, but the follicle cannot explain the entire eruption process. This presentation will focus on three key factors for the eruption mechanism. The first key factor concerns the elevation from below - which depends on the innervation in the root membrane covering the apical part of the root. The second factor is the ongoing change and rebuilding in the periodontal membrane during the eruptive movement. The third factor deals with the dental follicle breaking down the overlying bone and/or primary tooth for creation of an eruptive path coffee break/fruit Prediction and prevention of pathological eruption Inger Kjær Timing and sequence of development and eruption as demonstrated by a newly developed web-based development and eruption tool Mark Hector Various pathological eruptive processes in the primary and permanent dentition will be presented. Clinical cases presenting pathological eruption will be demonstrated, and the different diagnoses highlighted. It is often a dilemma for the clinician to decide what to do in cases with pathological eruption. The question is: shall I observe the condition, shall I perform a surgical exposure of the tooth in question, or is an extraction of the primary or the permanent tooth the correct treatment? The treatment choice depends on the etiology behind the condition, and this will be exemplified through cases followed solely by observation and cases followed after various treatments. Based on a unique material of prenatal and postnatal skeletal remains of known age and archives of dental radiographs of 524 living individuals an Atlas of Human Tooth Development and Eruption has now been released on the internet. The use of this Atlas will be demonstrated questions and answers lunch Optimizing radiographic examination of eruption failures. Louise Hauge Matzen Knowledge of the position of impacted teeth in relation to neighboring teeth and other anatomical structures is very useful for treatment planning e.g. the relation between the roots of the mandibular third molar and the alveolar dental nerve. Conventional imaging methods are available e.g. panoramic imaging and lately cone beam computer tomography (CBCT) has been developed for dental use. In this presentation the value of CBCT will be described analyzing the relation between the roots of impacted mandibular third molars and the mandibular canal. Also the value of the use of CBCT to other types of tooth impactions will be presented. 2

2 Friday March 7 th, day continued Eruption failures and their clinical implications Jette Daugaard-Jensen. Delayed tooth eruption may be one of the first discovered sys tems of a systemic disorder, therefore signifacant deviations from the established norms of tooth eruption should lead to intervention from the clinician. Delayed eruption teeth diagnosed in the clinic and familial inheritance of primary failure of eruption will be discussed coffee break Eruption disturbances in various syndromes and their treatment. Sven Kreiborg. A number of syndromes have pathologic eruption events as part of their combination of symptoms and clinical appearances. In this presentation examples of pathologic follicle activity (e.g. Hurler syndrome and Cherubism) abnormal osteoclast activity (e.g. Osteopetrosis and Tricho-Dento-Osseous syndrome) and formation of supplementary teeth (Cleidocranial dysplasia and the Kreiborg- Pakistani syndrome) will be described. Especially Cleidocranial dysplasia has been extensively studied and a special Copenhagen treatment approach has been developed combining 3D visualization of the multiple tooth impactions and a combined surgical and orthodontic approach to assist the eruption process and realign the displaced dentition questions and answers 3

3 Saturday March 8 th, day registration and coffee/bread Treatment of impacted or retained incisors Jens Ove Andreasen, Orthodontic and surgical treatment of impacted canines Karin Becktor & Jonas Becktor Incisor impaction and retention is predominately linked to the precense of supernumerary teeth or traumatic related changes in the anatomy of crown and/or the root. The presence of supernumerary teeth in the maxilla represent follicle collisions and a small mesiodens can prevent the eruption of much larger central or lateral permanent incisor. In this presentation various techniques for mesiodens removal will be presented as well as proper timing to limit the risk of sequelae for the developing incisor. The most frequent cause of trauma related tooth retention appears to be crown dilaceration combined with follicle damage. Treatment approaches will be presented which will lead to normal eruption and restorative procedures will be shown which will eliminate the risk of subsequent pulp pathology. Impaction of canines is a relatively common phenomenon and is usually related to an ectopic eruption path. Most impacted canines can be successfully treated however the combined surgicalorthodontic approach is lengthy and can result in different complications. During this presentation treatment of palatal as well as buccal impacted canines will be presented. The importance of precise diagnostics and treatment planning will be emphasized. It will be demonstrated that CBCT is a useful tool in the treatment of impacted canines. During this presentation various surgical exposure techniques will be presented as well as their advantages and disadvantages coffee break/fruit Treatment of premolars Jens Ove Andreasen, It is usually the second premolars which become impacted. In the maxilla the second premolar tend to become trapped in a palatal position between the mesial tilted first molar and the first premolar. In the mandible an ectopic eruption path of the second premolar usually lead to impaction lingually. In this presentation the results of three techniques will be presented and compared to upright ectopic placed second premolars Surgical and orthodontic treatment of impacted and retained first and second molars. Helen Torkasvand & Simon Storgård Jensen Eruption disturbances of first and second molars have been studied for decades without reaching consensus regarding diagnostics and preferred treatment. The most frequent cause for lack of/arrested eruption of first molars seems to be primary or secondary retention, while, non-erupted second molars often are retained due to collision with developing third molars. The treatment of choice has often been extraction of the affected tooth to allow spontaneous or orthodontically guided mesialization of the more distal teeth. More recently, surgically assisted skeletally anchored orthodontics has been proposed as an option to bring molars, previously considered hopeless, into occlusion. A combined surgical and orthodontic decision tree in case of eruption disturbances in the first or second molar region will be suggested and discussed questions and answers Lunch/ coffee and fruit 4

4 Saturday March 8 th, day continued Vertical distraction of multiple retained teeth Thomas Kofod Vertical distraction is a newly developed method to move a combined tooth alveolar fragment in coronal direction. Such a method may be indicated in cases where multiple retained or impacted teeth are found in infraocclusion. Examples of this new treatment procedure will be presented and an indication for its use will be given To remove or preserve impacted third molars Søren Hillerup Removal or preservation of third molars bas been debated for a century and many arguments can be justify each treatment approach. Lately, a more conservative attitude has been adopted in appreciation of which approach is in the best interest of the patient being the bearing argument. In this presentation the optimal time for treatment decision making will be presented based on the patient's history and clinical and radiographic examination To avoid or repair nerve damages after third molar removal Søren Hillerup One of the most devastating complications after third molar surgery is damage to the inferior alveolar- or the lingual nerve. In this presentation, radiographic techniques will be presented to illustrate positions of impacted third molars which has a high risk of nerve damage through removal as well as strategies with focus on prevention of nerve injury. The so called decoronation/coronectomy technique was presented some years ago to reduce or prevent damage to the inferior alveolar nerve. This technique consists of removal of the crown only of an impacted molar, primary closure, and thereafter leaving the root portion in the socket. The results of this treatment procedure will be presented. Finally, long-term results of microsurgical nerve repair will be presented, based on a large clinical material questions and answers 5

5 presentation of the speakers Jens Ove Andreasen is a dental consultant at the Resource Centre for Rare Oral Diseases, University Hospital, Copenhagen". Furthermore he has been involved in various, normal and pathologic tooth eruption projects. In 1997 he published the Textbook and Color Atlas of Tooth Impactions together with Jens Kølsen Petersen and Daniel M Laskin. In addition he is the initiator of the web-based Dental Trauma Guide, which is now in use in 180 countries. jens ove andreasen inger kjær mark hector louise h.matzen jette d-jensen Inger Kjær is professor and head of the Postgraduate Program in Orthodontics at the University of Copenhagen. Her experience in research is based on 25 years of collaboration with medical professionals specialized in normal and fetal pathology. Here she found the key to understanding cranial and dental malformations. She has written over 200 scientific articles in international journals. She has a medical and odontological doctoral thesis. Additionally, she has spent 11 years with clinical work and administration at community dental clinics. Today, she also serves as a consultant for dentists at the University Hospital and for practicing dentists in several countries. Mark Hector graduated in Dentistry in 1981 from Guys Hospital, London. There followed three years at the University of Bristol and Kings College, London, after which he received his PhD. In 1987 he was recruited to The London Hospital Medical College as a lecturer in Child Dental Health. He gained his Readership in 2001 and in 2002 became Professor of Oral Health of Children at Barts and The London School of Medicine and Dentistry. He is now Dean of Dentistry at the University of Dundee and is Professor of Oral Health of Children, and in Hon Consultant in Oral Health of Children with Tayside Health Board. He has held these positions since Louise Hauge Matzen (DDS, PhD) graduated from Aarhus Dental School in She has been working part-time in the community dental health care system and in private practice. Recently, she obtained her PhD degree in the field of Oral Radiology and Oral and Maxillofacial Surgery and is presently employed as a scientific assistant at the Section of Oral Radiology, Department of Dentistry, Health, Aarhus University and in private practice in Aarhus. Her scientific focus is cone beam CT examination and its impact on patient treatment in cases of impacted teeth. Jette Daugaard-Jensen graduated from the School of Dentistry, University of Copenhagen in 1967 and in 1972 she became M.S. in Pedodontics, University of Michigan, Ann Arbor, USA. From 1973 Assistant Professor at the Department of Pediatric Dentistry, School of Dentistry, University of Copenhagen in combination with employment in private practise and in the Danish Municipal School Dentistry. Since 2003 she has been the Head of the Resource Centre for Rare Oral Diseases, University Hospital, Copenhagen. sven kreiborg Sven Kreiborg (DDS, PhD, Dr.Odont.) is professor and Head of Pediatric Dentistry and Clinical Genetics at School of Dentistry, Faculty of Health and Medical Sciences, University of Copenhagen since He is also the Head of the Copenhagen Craniofacial Unit at Copenhagen University Hospital. He is a certified specialist in orthodontics. He has published extensively within the fields of normal and abnormal craniofacial development, syndromology, clinical genetics and 3D craniofacial imaging. 6

6 presentation of the speakers karin becktor Karin Becktor works as a dental consultant specializing in ortodontics at the District Dental Care unit in the Capital Region of Denmark. In this capacity Karin Becktor works with patients experiencing sequelae of post trauma-related tooth loss. From her thesis on Aetiologic aspects of Dental Eruption Karin Becktor has comprehensive knowledge of growth processes and deviations in jaw-bone growth. jonas becktor simon s. jensen Jonas Becktor recieved his University Dental Degree in 1989 at the Faculty of Odontology, University of Lund, Sweden. In 2001 he became a Specialist in Oral Surgery at the Maxillofacial Unit, Länssjukhuset, Halmstad, Sweden. He is the author of more than 25 scientific papers in the field of Oral & Maxillofacial Surgery. In 2008 he was awarded the Medicine Doctor Degree(PhD). Since 2011 he has been Docent and Head of Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Sweden. Simon Storgård Jensen is a consultant in Oral and Maxillofacial surgery at the Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital. He received his DDS from the School of Dentistry, University of Copenhagen 1996, and became certified specialist in Oral and Maxillofacial Surgery in After an ITI scholarship for one year at the Dept. of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern in 2001 he has attained a part-time research fellowship at the same department. Main research and focus areas are: Experimental evaluation and clinical performance of bone grafting materials, bone augmentation procedures, growth factors and surgical endodontics. Helen Torkashvand, DDS. Dr Helen Torkashvand qualified in 1995 as dentist at the School of Dentistry, University of Copenhagen, and obtained degree of Specialist in Orthodontics in 2002 from Royal Dental Collage in Aarhus. She is currently working at the Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital. At the same time, she is a consultant in community clinic and in private office. helen torkasvand Thomas kofod søren hillerup Thomas Kofod graduated as D.D.S from Aarhus University in He became board certified specialist in Oral and Maxillofacial Surgery in 2004, from Department of Oral and Maxillofacial Surgery, Aarhus University Hospital. In 2005, he defended his PhD-thesis, at Aarhus University, on Distraction Osteogenesis. In 2007 he was appointed Consultant in Oral and Maxillofacial Surgery at Department of Oral and Maxillofacial Surgery, Rigshospitalet, in Copenhagen. Since 2011 appointed as Head of Department at Department of Oral and Maxillofacial Surgery, Rigshospitalet, Copenhagen University Hospital. Søren Hillerup, D.D.S., ph.d., dr.odont. Graduated as a D.D.S. in 1971, ph.d. in 1978, board certified Oral and Maxillofacial Surgeon in 1983 and he has been a Consultant in Oral and Maxillofacial Surgery since He became dr.odont. in From he has been a consultant at Rigshospitalet and Professor in Maxillofacial Surgery, University of Copenhagen. He is now in private practice and giving lectures. 7

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