Maxillary Left Lateral Incisor Research Articles

Characteristics and distribution of dental anomalies in a Brazilian cleft population

PURPOSE: To determine the prevalence of dental anomalies in 200 cleft patients undergoing orthodontic treatment at the Cleft Rehabilitation Center (CERLAP) of the Pontifical Catholic University of Rio Grande do Sul. METHODS: Data regarding patient age, race, gender, cleft type (lip and alveolus, complete lip and palate, or cleft palate), affected side (unilateral or bilateral), agenesis and supernumerary teeth in both arches were assessed from orthodontic records comprised by panoramic, cephalometric, occlusal, and periapical radiographs, study models, intra- and extraoral photographs, obtained at the beginning of the treatment, providing needed information to make an accurate diagnosis of dental anomalies. The collected data were registered in spreadsheets. RESULTS: The mean patient age was 13.5 years old; 86% were white; and 57% male. Complete cleft lip and palate was found at a higher frequency (83%); the left side was most affected (48.5%). Agenesis were found in 66.5% of patients. Maxillary lateral incisors were the most absent teeth (78.5%). Supernumerary teeth were found in 35.5% of patients. CONCLUSION: Male individuals demonstrated a greater tendency to present clefts and manifest both agenesis and supernumerary teeth. Complete cleft lip and palate prevailed, and the left maxillary lateral incisor was the most absent tooth. Supernumeraries were located distally to the cleft.

Gingival Abscess Due to an Unusual Nail-Biting Habit: A Case Report

Nail-biting is one of the most frequent deleterious oral habits in children. It can result in systemic diseases or oral traumatic lesion. This report describes a case of gingival abscess in a child due to a fingernail-biting habit. A 5-year, 6-month-old female presented gingival swelling and fistula in the primary maxillary left central and right lateral incisors as an unusual sequelae to the periodontal tissues from fingernail-biting. A periodontal curette was used to remove the fragments and to curette the area. After the curettage, an exudate of blood and pus was drained. Then the area was irrigated with 0.12% chlorhexidine solution; applying finger pressure controlled the secretion. After one week, the patient returned with gingival swelling present in the same teeth. The same curettage procedure was performed. It was suggested that the deleterious habit was related to emotional tension and anxiety behaviors and the patient was referred for psychological treatment. When the patient returned one month later, she was still biting her fingernails, but she had stopped placing fragments into the gingival crevice. No more gingival inflammation or swelling was observed. his paper presents an unusual case report of a gingival abscess due to a fingernail-biting habit in a child, probably related to an emotional condition. The fingernail-biting habit can induce a periodontal traumatic injury yielding a more serious complication such as a gingival abscess.

Morphological examination of impacted tooth in maxillary lateral incisor region using computed tomography for consideration of treatment modalities

A 10Y2M-old girl was referred to our clinic by a general practitioner for consultation regarding an impacted supernumerary tooth identified in the maxillary left incisor region. Our intraoral examination revealed a maxillary left lateral incisor with a tubercle morphology, with slight swelling identified in the labial gingival area between the lateral incisor and primary canine. The dental age of the patient was calculated to be 1 year behind her chronological age based on root formation observed in orthopantomographs. X-ray photographic examinations revealed an impacted tooth on the labial side, with the root apex presumably directed into the palatal side. Computed tomography (CT) was used to produce three-dimensional reconstruction images in order to obtain morphological information for the impacted tooth, which had a tuberculate shape and an appearance that differed from that of the tooth on the opposite side, which showed a typical morphology of a lateral incisor. Periodical examinations were performed thereafter, which confirmed the developmental progress of the root formation of the impacted tooth. At 11Y8M, the tooth had emerged into the oral cavity and was extracted under local anesthesia. Based on this case, we concluded that effective use of CT is beneficial for consideration of treatment modalities in patients with an impacted tooth.

Ultrasonic irrigation of a maxillary lateral incisor with perforation of the apical third of the root

We describe the successful use of a combination of nonsurgical root canal treatment and ultrasonic irrigation for collaborative management of a maxillary left lateral incisor with perforation of the apical third of the root. During the endodontic treatment procedure, the ultrasonically activated tip was used for intracanal irrigation. The area of perforation in the apical third of the root and the main root canal space were obturated with gutta-percha and root canal sealer, using a lateral condensation method. A follow-up clinical and radiographic examination at 5 years after treatment showed an asymptomatic tooth with excellent osseous healing.

Palato-Radicular Groove and Localized Periodontitis: A Series of Case Reports

The aim of this report is to present the management of three cases of different magnitude affecting the periodontal attachment apparatus due to the presence of a palato-radicular groove (PRG). The palato-radicular groove is a developmental anomaly often associated with localized periodontitis and pulpal necrosis. The authors present three cases involving the management of teeth with a palato-radicular groove. In the first case, a 20-year-old woman presented with a 5mm periodontal pocket associated with the maxillary right central incisor but no evidence of pulpal involvement. In the second case, there was extensive bone loss and pulpal necrosis of the maxillary right lateral incisor in a 35-year-old man. The third case involved severe localized periodontitis of the right and left maxillary lateral incisors of a 47-year-old man. This report describes the diagnosis and periodontal management of these three clinical situations. Periodontal complications due to a palatal-radicular groove are relatively rare. However, when they do occur, the diagnosis of a pulpal or localized periodontal lesion can sometimes present a dilemma for the general dentist, particularly if a palato-radicular groove is the etiologic factor. This is because a radicular groove can act like a "funnel," aiding microbial plaque accumulation, and lead to gingivitis, localized periodontitis, and even pulpal necrosis. But with a timely diagnosis and proper clinical management, the tooth or teeth involved can be treated and often retained. Thorough examination of the morphological anomalies associated with the lateral and central incisors, in particular, aided by appropriate diagnostic aids, can lead to accurate diagnosis and management of a tooth or teeth with a palato-radicular groove.

Prótese parcial removível com eixo de inserção rotacional: relato de caso

This case report presents the aesthetic benefits of the rotational path removable partial denture in face of the characteristic challenges and limitations of this kind of prosthetic rehabilitation. The patient complained of instability and little retention of his removable partial dentures, besides the bad appearance of his smile, compromised by the exposure of a metallic portion of the upper framework and the fracture of the artificial maxillary left lateral incisor. For this arch, the rotational prosthesis allowed the placing of rigid components of the metallic framework at mesial undercuts of the canines, dispensing with facial retention clasps at these places. The authors intend to contribute for the diffusion of the technique, which requires high clinical and laboratory skills but affords satisfactory aesthetic results.

Editor's Summary and Q&A: In-vitro comparison of 2 cone-beam computed tomography systems and panoramic imaging for detecting simulated canine impaction-induced external root resorption in maxillary lateral incisors

Introduction The introduction of cone-beam computed tomography (CBCT) in dentomaxillofacial radiology has created new diagnostic challenges, including some potential opportunities for evaluating impacted teeth. The diagnostic accuracy for detection of simulated canine-induced external root resorption lesions in maxillary lateral incisors was compared between conventional, 2-dimensional panoramic radiographic imaging and two 3-dimensional CBCT systems. Methods A child cadaver skull in the early mixed dentition was obtained from the Department of Anatomy, Hasselt University, Diepenbeek, Belgium, with ethical approval. This skull had an impacted maxillary left canine and allowed a reliable simulation. Simulated root resorption cavities were created in 8 extracted maxillary left lateral incisors by the sequential use of 0.16 mm diameter round burs in the distopalatal root surface. Cavities of varying depths were drilled in the middle or apical thirds of each tooth root according to 3 setups: slight (0.15, 0.20, and 0.30 mm), moderate (0.60 and 1.00 mm), and severe (1.50, 2.00, and 3.00 mm). The lateral incisors, including 2 intact teeth, were repositioned individually in the alveolus of the pediatric skull with approximal contacts to the impacted maxillary left canine. Three sets of radiographic images were obtained with panoramic Cranex Tome (Soredex, Helsinki, Finland), Accuitomo-XYZ Slice View Tomograph (J. Morita, Kyoto, Japan), and Scanora 3D CBCT (Soredex, Tuusula, Finland) for each tooth setup. Eight observers examined the 3 sets of 10 radiographs for resorption cavities. Results The differences in correct detection of simulated root resorption for all cavity sizes were significantly different ( P Conclusions These results suggest that the CBCT radiographic method is more sensitive than conventional radiography to detect simulated external root resorption cavities.

In-vitro comparison of 2 cone-beam computed tomography systems and panoramic imaging for detecting simulated canine impaction-induced external root resorption in maxillary lateral incisors

The introduction of cone-beam computed tomography (CBCT) in dentomaxillofacial radiology has created new diagnostic challenges, including some potential opportunities for evaluating impacted teeth. The diagnostic accuracy for detection of simulated canine-induced external root resorption lesions in maxillary lateral incisors was compared between conventional 2-dimensional panoramic radiographic imaging and two 3-dimensional CBCT systems. A child cadaver skull in the early mixed dentition was obtained from the Department of Anatomy, Hasselt University, Diepenbeek, Belgium, with ethical approval. This skull had an impacted maxillary left canine and allowed a reliable simulation. Simulated root resorption cavities were created in 8 extracted maxillary left lateral incisors by the sequential use of 0.16 mm diameter round burs in the distopalatal root surface. Cavities of varying depths were drilled in the middle or apical thirds of each tooth root according to 3 setups: slight (0.15, 0.20, and 0.30 mm), moderate (0.60 and 1.00 mm), and severe (1.50, 2.00, and 3.00 mm). The lateral incisors, including 2 intact teeth, were repositioned individually in the alveolus of the pediatric skull with approximal contacts to the impacted maxillary left canine. Three sets of radiographic images were obtained with panoramic Cranex Tome (Soredex, Helsinki, Finland), Accuitomo-XYZ Slice View Tomograph (J. Morita, Kyoto, Japan), and Scanora 3D CBCT (Soredex, Tuusula, Finland) for each tooth setup. Eight observers examined the 3 sets of 10 radiographs for resorption cavities. The differences in correct detection of simulated root resorption for all cavity sizes were significantly different (P <0.05) between the panoramic and both CBCT systems. CBCT imaging performance was significantly better than that of panoramic radiography for determining root resorption in the categories of slight and severe resorption. These results suggest that the CBCT radiographic method is more sensitive than conventional radiography to detect simulated external root resorption cavities.

Autotransplantation of an Intruded Lateral Incisor Replacing an Avulsed Central Incisor—A Case Report

Oral injuries cause aesthetic, psychological, social, and therapeutic problems and also affect a large number of people, causing irreparable dental loss not only at the accident time but also during post-treatment. Missing permanent teeth by trauma in children is a particular challenge, especially in the anterior region of the maxilla. In the past few decades, tooth transplantation has been successfully researched for the treatment of anterior tooth loss in young individuals. The present case describes transplantation of an excessive intrusive maxillary left lateral incisor into the socket of avulsed maxillary left central incisor The lateral incisor tooth was extracted and placed into the socket of avulsed tooth. Splinting was maintained for 2 weeks. After the root canal treatment, the crown of the lateral incisor tooth was reshaped with composite resin in central tooth form and performed an interim prosthesis both preventing movement of the canine tooth into the space of the transplanted lateral incisor tooth and providing aesthetic. The treatment provided is considered to be an interim solution for space maintenance, with time the child patient may reach an age that allows alternative, more definitive treatment as implant.

Endodontic and Esthetic Management of Maxillary Lateral Incisor Fused to a Supernumerary Tooth Associated with a Talon Cusp by Using Spiral Computed Tomography as a Diagnostic Aid: A Case Report

The aim of this case report is to present an endodontically and esthetically managed maxillary left lateral incisor fused to a supernumerary tooth associated with a talon cusp. This case report describes a multidisciplinary approach involving endodontic and restorative considerations for a successful, functional, and esthetic rehabilitation of the fused tooth. In the present case, we have used spiral computed tomography for better understanding of the complicated root canal morphology of the fused tooth and successful management of this rare case.

Endodontic re‐treatment associated with the elimination of amalgam root‐end filling through sinus tracts: A report of two cases

Two patients presented with complaints of recurrent drainage of purulent exudate from sinus tracts, inflammation and pain after endodontic re-treatment of the maxillary left (Case 1) and right (Case 2) lateral incisors. The periapical lesions persisted after apical curettage, apicectomy and root-end filling with silver amalgam. Radiographic examination exposed the poor quality of the endodontic treatments and the silver amalgam root-end fillings, which were associated with periapical radiolucent areas in both teeth. The sinus tract persisted after root canal cleaning and shaping, followed by a calcium hydroxide root canal dressing. The root-end fillings were periapically dislodged with endodontic K-files, and showed progressive displacement by sinus tracts up to elimination in the oral cavity. Follow ups of 42 and 65 months post procedure revealed clinical disappearance of the symptoms, sinus tracts and exudates, and radiographs revealed that the repair process of the periapical radiolucent areas was quite advanced.

Uncomplicated crown fracture, complicated crown-root fracture, and horizontal root fracture simultaneously treated in a patient during emergency visit: a case report

Complicated crown fractures are not uncommon in cases of severe trauma or sports related injury. Such patients report with pain because of exposed pulp and need emergency care. Because of impaired function, esthetics, and phonetics, such patients are quite apprehensive during their emergency visit. Successful pain management with immediate restoration of function, esthetics, and phonetics should be the prime objective when handling such cases. This article describes immediate treatment of oblique crown root fracture of maxillary left central incisor, horizontal root fracture of maxillary left lateral incisor, and uncomplicated crown fracture of maxillary right central incisor. Maxillary left central incisor was treated with reattachment procedure using light-transmitting fiber post (D.T. Light Post; Bisco, Schaumburg, IL, USA); maxillary left lateral incisor subsequently healed after splinting for 7 weeks, and direct composite build-up was done on maxillary right central incisor. After 2 years, the reattached fragment had satisfying esthetics and excellent function and pulp was still vital in maxillary left lateral incisor and maxillary right central incisor. Various treatment modalities for traumatically injured incisors are shown in this article.

An Alternative Method for Flapless Implant Placement and an Immediate Provisional Crown: A Case Report

The aim of this case report is to present a description of bone mapping as an alternative method to determine the dimensions of bone prior to placement of a flapless implant and an immediate provisional crown. The use of a temporary removable partial denture (RPD) or "flipper" during healing following an extraction is not acceptable for some highly demanding patients. As a result, flapless implant placement is gaining popularity because it offers some advantages such as less bleeding, less swelling, and the protection of soft tissue contours. A 65-year-old woman missing a maxillary left lateral incisor was treated using flapless implant placement and an immediate provisional acrylic crown. Under local anesthesia, the bone anatomy was mapped by inserting a standard periodontal probe in the gingiva. By using the recorded measurements, the thickness of soft tissue was removed from the cast. A surgical guide based on this adjusted model was fabricated prior to surgery. The guide was seated on the teeth when actual surgery was performed to facilitate bone drilling and then the implant was placed. Utilizing the previously fabricated acrylic tooth index, the temporary acrylic crown was fabricated on the adjusted temporary metal abutment and delivered to the patient the same day. In this case report the missing maxillary left lateral tooth was restored using flapless implant placement and an immediate provisional single crown. The dimension of the bone at the implant recipient area was determined by an alternative bone mapping method. This case report suggests the use of flapless implant placement using the bone mapping method and immediate provisional crowns for single crowns when esthetics are a high priority and preserving ideal soft tissue contours and papillary heights are critical.

A Report of Treatment of a Fused Permanent Central Incisor and Supplemental Lateral Incisor

A 9-year-old boy presented with a fused maxillary right permanent central incisor and displacement of the right permanent lateral incisor palatally. An unerupted supplemental maxillary left permanent lateral incisor was noted radiographically. The maxillary fused right permanent central incisor was sectioned under general anaesthesia. The distal portion was extracted as planned; a vital partial pulpotomy was carried out on the distal aspect of the retained portion. Fixed orthodontic treatment commenced after 28 months to align the maxillary anterior segment. After completion, the maxillary right permanent central incisor was built up with composite to resemble the adjacent incisor. This case highlights the treatment options of a fused tooth and the need for multidisciplinary planning and treatment.

Anatomic and Microbiologic Challenges to Achieving Success with Endodontic Treatment: A Case Report

This article describes a case of persistent apical periodontitis that required several nonsurgical and surgical approaches for resolution. A 28-year-old woman presented with a large symptomatic apical periodontitis lesion associated with the maxillary left lateral incisor that persisted in spite of previous nonsurgical and surgical endodontic treatment. Root canal retreatment was accomplished, but the lesion only showed a slight decrease in size after 18 months. Forty-six months after retreatment, the patient returned because of reemergence of symptoms. Radiographically, the lesion remained relatively unaltered. Periradicular resurgery was performed, and a biopsy specimen consisting of the lesion and the apical part of the root was collected for analysis. Radiographic and clinical reevaluation after 4 years revealed complete healing. Histopathologic and histobacteriologic observations demonstrated that the lesion was a cyst, and that the probable reason for failure was the occurrence of bacteria within dentinal tubules and in a lateral canal slightly coronal to the amalgam root-end filling. This case report clearly illustrates the difficulties imposed by anatomic complexities in attaining a disinfection level that is compatible with periradicular tissue healing.

A clinical analysis of tooth size discrepancy (Bolton index) among orthodontic patients in Wuhan of Central China

The purpose of this study was to determine the total Bolton index (TBI) and anterior Bolton index (ABI), evaluate the clinical significance of tooth size discrepancies and the influence of gender variation of mesiodistal tooth width on Bolton Index and estimate which tooth has the greatest influence on Bolton Index. A total of 110 pairs of pretreatment dental study casts (41 male and 69 female) were selected from patients treated in Department of Orthodontics of Union Hospital in Wuhan, China. A sliding dental Vernier caliper was used for the measurement of the mesiodistal tooth width. Descriptive statistical mean values, standard deviation, standard error of the mean values, coefficient of variance and the t-test were used for the statistical analysis of the data. The study found that TBI, ABI and the total sum of teeth width had no significant difference between male and female. Male group indicated that Bolton Index (BI) was mostly influenced by the width of lower right second premolar, whereas female group showed that BI was mostly influenced by the width of both the right and left maxillary lateral incisor.

Evaluation of 3-dimensional tooth crown size in cleft lip and palate patients

The aims of this study were to evaluate 3-dimensional (3D) tooth crown sizes in patients with cleft lip and palate (CLP) and to compare them with those of a Class I control group. Orthodontic dental casts were used of 72 subjects with CLP (20 bilateral [BCLP], 34 unilateral left [ULCLP], 18 unilateral right [URCLP]) and 53 adolescents in the permanent dentition stage with Class I occlusion. Mesiodistal (MD), labiolingual (LL), and occlusogingival (OG) measurements were recorded by the same examiner using a digital caliper. Statistical analyses were conducted, including repeatability, analysis of variance (ANOVA), and the Duncan tests. Maxillary and mandibular premolar MD dimensions were larger in the CLP groups than in the control group. The smallest MD dimensions were those of the maxillary right lateral incisors in the BCLP group (P <0.05). The maxillary left lateral incisor MD dimensions in the ULCLP group were smaller when compared with other CLP groups (P <0.001). In general, all LL and OG measurements were smaller in the CLP groups than in the Class I group in both dental arches. In general, MD, LL, and OG dimensions of CLP patients were smaller than those of the Class I subjects, not only in the affected maxillary dental arch, but also in the mandibular dental arch. Variations in 3D tooth dimensions were found among all CLP types. The lateral incisor in the cleft region was the smallest. A 3D tooth-size evaluation should be included in the diagnostic records to determine precise treatment planning and final occlusion in CLP patients.

Use of Biomaterials in Periradicular Surgery: A Case Report

This article reports a case of periradicular surgery in which biomaterials, such as mineral trioxide aggregate (MTA), human lyophilized bone, and calcium sulfate, were used. A 21-year-old female patient was referred to our endodontic clinic as a result of recurrent episodes of acute exacerbation of a chronic process involving the maxillary left lateral incisor. There was complete destruction of the buccal bone plate at the apical third, leaving this portion of the root exposed to the oral cavity. After conventional root canal therapy carried out under special tooth isolation conditions, apicoectomy was performed, and a root-end cavity was prepared and restored with MTA as a retrofilling material. Because of the exposure of the root-end resection to the mouth, osteoinductive and osteoconductive materials (human lyophilized bone and calcium sulfate, and calcium sulfate alone, respectively) were used, with the goals of modeling the lost bone structure, preventing invasion of the oral epithelium, and avoiding the occurrence of secondary infection. Two years after the periradicular surgery, there were no clinical or radiographic signs suggestive of treatment failure, but instead the patient’s follow-up has shown that the case management has been successful as indicated by lesion regression and periodontal repair. On the basis of the review of literature and the clinical-radiographic outcomes hereby presented, it might be concluded that (1) large bone destructions caused by periradicular lesions might and should be filled with recognizably effective bone-replacing materials during regenerative tissue process. MTA, human lyophilized bone, and calcium sulfate seemed to have an important role in alveolar bone induction, remodeling, and repair. (2) Because of its characteristics of promoting excellent marginal sealing and stimulating osteoblastic adherence to the retrofilling surface, MTA has been considered as the retrofilling material of choice.

Multidisciplinary approach in the treatment of subgingivally fractured anterior teeth

With the advances in adhesive technology, dentists have gained great popularity with their esthetics treatment options. The enamel and partially dentin adhesive systems have proved their potential effect. This study presents the multidisciplinary approach in the treatment of subgingivally fractured anterior teeth. Empress II crowns were cemented entirely on the prepared root portion of a left maxillary lateral incisor and canine after orthodontic eruption. The clinical results after 2 years were successful.

Survey of Talon Cusps in the Permanent Dentition of a Turkish Population

Talon cusp is the name given to the accessory tubercles located on the lingual faces of anterior teeth. The occurrence of talon cusps has been reported among Europeans and Asians. However, there are few reports of this anomaly in Caucasians as well as a paucity of literature on its characteristics. Today there are seven million Turkish citizens of Caucasian origin that have settled in the Marmara, Central-Anatolia, East-Anatolia, and Black Sea regions of Turkey. The aim of this study is to present 27 Caucasian cases with 33 taloned teeth. This study is the first that was undertaken to investigate the characteristics of talon cusps in a group of Turkish people. A survey of 27 patients examined in the Department of Oral Diagnosis and Radiology at Ondokuz Mayis University in Samsun, Turkey between January, 2003 and June, 2006 was conducted. Their ages ranged from seven to 33 years. A total of 33 talon cusps were diagnosed in the 27 patients. The patients' records and radiographs were evaluated and the following variables were studied: age, sex distribution, affected tooth, type of talon cusp, radiographic evidence of pulp extension, and associated dental anomalies and complications. There were 13 male and 14 female patients with a gender ratio of approximately 1:1. Ten of 33 talon cusps (30%) were seen in maxillary right central incisors while four cases (12%) were in maxillary left central incisors and nine cases (27%) were in maxillary right lateral incisors. Eight cases (24%) were seen in maxillary left lateral incisors, one case (3%) was in a mandibular right central incisor, and one case (3%) was in a mandibular left canine. Fifteen (15) of the 33 talon cusps were Type 1 talons (45%), while eight cases (24%) were Type 2 talons and ten cases (30%) were Type 3 talons. Twelve of the 33 talon cusps (36%) showed radiographic evidence of pulpal extension into the tubercule on periapical radiographs. One patient had gemination (3%) on the maxillary permanent incisors and two patients had mesiodens (6%) in the maxillary anterior region. The talon cusp remains as one of the more uncommon dental anomalies worldwide and in Turkey and presents with different clinical features. The talon cusp may be more likely to be associated with other odontogenic anomalies and some systemic conditions; early recognition of this anomaly is essential to provide proper treatment.