Vittorio Grenga

Private Practice of Orthodontics, Rome, Italy

X-raY oddities
Many times, when we see in our practice a radiograph, we have the opportunity to note images that may or may not inuence directly our diagnosis and our treatment plan. This feature of EJCO gives us the opportunity to show these images and to make some brief observations about them. The style is concise: the images largely speak for themselves. Your suggestions for future topics as well as your comments will be very welcome.

Correspondence: Via Apuania, 3 00162 Rome Italy e-mail: vigrenga@tin.it

The Ghost Bicuspid

The patient, a 9-year-old girl, was seen in October 2000 for the correction of a Class III malocclusion. The OrthoPanTomography (OPT) showed an early mixed dentition with the absence of 35 and 45 (Fig.1). Orthodontic treatment started in January 2001 with an upper removable appliance to expand transversally and sagittally the upper arch. After two years from the start of treatment a new OPM was made. The image showed surprisingly the presence of the lower second right bicuspid (Fig. 2). If you look at the rst OPT carefully you will observe the crypt of the bicuspid near the distal root of the second lower right deciduous molar. OBSERVATIONS One of the most detailed studies on tooth development and emergence has been carried out by Demirjian evaluating panoramic radiographs. Eight stages in tooth development have been dened ranging from the early mineralization of the crown to completion of root formation 1 . Generally there is a marked symmetry in the emergence times between teeth on the right and left sides, as well as the individual stages of tooth development. Local and systemic factors can inuence tooth development and emergence 2 . Local factors are: extractions of pri44
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mary teeth, sequelae of caries in primary teeth. Systemic factors are: genetics, sex, skeletal age, pubertal growth spurt, body weight and height, endocrinological disturbances (hypopituitarism, hypothyroidism, hypoparathiroidism) and nutrition. From the radiographic point of view

the crypt of a non calcied tooth seems a prymary cyst or another isolated radiotransparency3 . CONCLUSION There is a great variability of the odontogenic processes also in the same patient and also for the specular teeth.

Figure 1: OPT of the patient when she was 9 years old.

Figure 2: OPT of the patient when she was 11 years old.

REFERENCE LIST 1. Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum. Biol. 1973;45:211227. 2. Andreasen JO, Petersen JK, Laskin DM. Textbook and color atlas of tooth impactions. Diagnosis, treatment and prevention. Copenhaghen: Munksgaard;1997.

3. Langland OE, Langlais RP, Morris CR. Principi e pratica di radiologia panoramica. Roma: Verduci Editore;1983