Mandibular Central Incisors Research Articles

The curious case of the stuck Ring: An unusual clinical case of avulsion of the primary mandibular central incisor

Traumatic injuries are widespread in children in the younger age group. An avulsion is a type of dental trauma in which complete dislodgment of the teeth occurs from the respective socket. The primary maxillary central incisors are the most common teeth to be avulsed, followed by maxillary lateral incisors and the Primary mandibular central incisors. We present this case because of the unusual avulsion of a primary mandibular central incisor due to a freak accident by accidental engagement of father s ring in the child’s tooth while playing with her. This should be addressed as emotional trauma related to the father and the child as Pediatric Dentist in this case.

Root and Root Canal Anatomy of Primary Mandibular Central Incisor, Lateral Incisor, and Canine in Indian Children: A Cone Beam Computed Tomography Study.

Background A thorough knowledge of root and root canal morphology in primary dentition is essential for success of endodontic therapy. This information also finds importance in anthropological research in reconstructing human population history. Lack of studies of root and root canal morphology in mandibular anterior teeth prompted us to the present study. Methods A total of 109 extracted primary mandibular incisors and canines were collected, out of which 90 teeth were selected for this study and divided into 3 groups: CI, mandibular central incisor; LI, mandibular lateral incisor; C, mandibular canine. All the sample teeth were scanned using cone beam computed tomography (CBCT). Number of roots, number of root canals, length of root, mesiodistal (MD), and buccolingual (BL) width of canal, shape of canal, and presence of accessory canals were assessed. Collected data were statistically compared using one-way ANOVA and chi-square tests. Results All teeth studied displayed single root with single root canal conforming to type I Vertucci's classification. Root length of CI was significantly shorter than both LI and C, with no significant difference between LI and C. Straight root canals were more common in CI and LI, whereas curved canals were more common in C. S-shaped canals were seen in a few CI and C. BL canal width was more than MD width in all teeth, C showing significantly larger dimensions than both CI and LI. Conclusion This study presents root and root canal characteristics of primary mandibular central incisor, lateral incisor, and canine in children from Indian ethnicity.

Relationship between alveolar-bone morphology at the mandibular incisors and their inclination in adults with low-angle, skeletal class III malocclusion—A retrospective CBCT study

ObjectiveTo quantitatively study the effect of the labial inclination of the mandibular central incisors on the surrounding cortical and cancellous-bone morphology among patients with low-angle, skeletal class III malocclusion, by using cone-beam computed-tomography (CBCT) imaging.Materials and methodsThe CBCT images of 60 patients with low-angle, skeletal class III malocclusion were divided into lingual-inclination, upright, and labial-inclination groups. The height of the alveolar bone and the thickness and area of the cortical, cancellous, and total alveolar bone were measured separately on each side of the mandibular central incisors.ResultsThe thickness of the labial cortical bone from 6 mm below the cementoenamel junction (CEJ) to the root apex; the thickness of the labial cancellous bone at the root apex; the total thickness of the alveolar bone at the root apex; the area of labial cortical bone; the total area of labial alveolar bone; and the height of the labial alveolar bone were highest in the labial-inclination group (all P<0.05). All these variables were positively correlated with the labial inclination of the mandibular central incisors (all P<0.05). There were no statistical differences between the groups for any of the measurements on the lingual side of the teeth (P>0.05).ConclusionThe morphology of the alveolar bone on the labial but not the lingual side of the mandibular central incisors was statistically significantly correlated with the labial inclination of those teeth in patients with low-angle, skeletal class III malocclusion.

Comparative Analysis of Incisor Positioning and Alveolar Bone Thickness using Lateral Cephalograms

Objective: To find the comparative analysis of incisor positioning and alveolar bone thickness using lateral cephalograms. Study Design: Cross-sectional analytical study Place and Duration of Study: Department of Orthodontics, Bacha Khan College of Dentistry, Mardan from 4th August 2021 to 31st December 2021. Methodology: Fifty class II malocclusion participants were enrolled having deviation from 1mm of root positioning. Lateral-cephalometric images were taken and compared with standard 50 normal optimal occlusions. L1-lab to L1 ling distance was added for calculating the total mandibular alveolar process thickness and wits calculated. The inclination between maxilla and mandibular central incisor and was measured through formation of acute angle between teeth long axes and perpendicular line with occlusal plane. Results: In cases of class II malocclusions majority of the patient were within the age of 15-30 years with a mean age as 38.3±3.9 years. Wits was -0.72±2.5 in normal optimal occlusion verses 2.47±1.88 in class II malocclusion. Conclusion: A significant variance was observed between alveolar (AV) processes of class II malocclusion patients with their comparative lateral cephalogram imaging of normal optimal occlusion. Key words: Incisor positing, Alveolar bone thickness, Lateral cephalograms

Regenerative Endodontic Treatment Using Periapical Blood or Circulating Blood as Scaffold: A Volumetric Analysis

IntroductionCirculating blood is a readily available scaffold when enough bleeding cannot be induced from periapical tissues during regenerative endodontic treatments (RETs). The aim of this investigation was to compare the radiographic outcome (ie, linear and 3-dimensional volumetric) of RET using periapical blood or circulating blood as scaffolds in sheep immature mandibular incisors. MethodsThirty-two immature sheep mandibular central incisors were randomly assigned to the following groups (n = 8): the positive control groups, the pulps were removed without any treatment; the periapical blood group, RET was performed using periapical blood as the scaffold; the circulating blood group, RET was performed using circulating blood as the scaffold; and the negative control group, intact teeth without any treatment. After 8 months, micro–computed tomographic images of mandibular blocks were taken to assess the following: root length, root thickness at the midroot and cementoenamel junction levels, and the incidence of apical closure. Root structures were segmented, and root volumes were calculated and analyzed statistically. ResultsRET using periapical blood and circulating blood resulted in increases in root length and root wall thickness at the midroot and cementoenamel junction levels, the incidence of apical closure, and root volume (P < .05). There were no significant differences between the RET groups and the negative control group regarding linear measurements (ie, root length, root thickness, and apical closure) (P > .05). The root volumes of the 2 RET groups were similar (P > .05) and were less than those observed in the negative control group (P < .05). ConclusionsThere were no significant radiographic differences between the RET groups using periapical blood and circulating blood as scaffolds. RET resulted in less root volume compared with normal root development.

A Radiographic Study of the Root-to-Crown Ratio of Natural Permanent Teeth in 81 Saudi Adults.

BackgroundThe ratio between a tooth root and its crown is an essential diagnostic parameter that determines treatment options. This radiographic study used panoramic dental radiographs or orthopantograms to measure the mean root (R)-to-crown (C) ratios (R/C) of the permanent teeth in 81 Saudi adults.Material/MethodsA total of 81 panoramic radiographs of Saudi adult patients (40 males and 41 females) previously treated in the College of Dentistry, Saudi Arabia, aged 16–35 years, were selected. The crown height and root length for each tooth were measured on the digital panoramic radiographs. The correlation coefficient (intra-class) was calculated to assess the intra-examiner reproducibility and a good agreement was achieved (ICC=0.79–0.89).ResultsFor both males and females, the highest mean R/C ratio was for maxillary canine (1.91) and for mandibular second premolar (2.0) while the lowest R/C ratio was for maxillary first molar (1.64) and for mandibular central incisor (1.59). Except for the maxillary second premolar, no significant differences in R/C ratios were observed for maxillary arch. In the mandibular arch, the R/C ratio for lateral incisor, both premolars, and molars differed significantly (P<0.05). Among males, statistically significant differences between teeth existed in R/C ratios for central and lateral incisors, second premolar, and both molars (P>0.05). For females, significant differences between teeth in R/C ratios were observed for both premolars and both molars (P>0.05).ConclusionsThis study supports the findings from previous studies that orthopantograms can be used to calculate root/crown ratios, which varies between males and females and the dental arch among Saudi adults.

Treatment of type III dens invaginatus in bilateral immature mandibular central incisors: a case report

BackgroundDens invaginatus (DI) is a developmental anomaly, Oehlers Type III DI is the most complex type and early diagnosis and treatment is complicated and challenging. This report presents a rare case of a type IIIb DI associated with a periapical lesion in bilateral immature permanent mandibular central incisors.Case presentationAn eight-year-old boy referred to our clinic manifesting with pain along with swelling in the mandibular incisors for the past one month. Radiographic examination showed periapical radiolucency exhibiting a scantly defined border, as well as an invagination which had a central invaginated canal extending from the pulp chamber throughout the apical foramen in both mandibular central incisors. We performed two different treatment procedures on the basis of the condition of the main pulp of the mandibular central incisors. in which only the invagination root canal was treated in the right mandibular central incisor, while the invagination and main root canals were treated in the left mandibular central incisor. During the 18-month follow-up period, the teeth were clinically asymptomatic. Imaging examinations indicated complete healing of the periapical lesion and revealed that the wall of the root canal was thickened and the open apex was closed.ConclusionFor young permanent teeth with type III Dens invaginatus, it is particularly important to keep pulp vitality, which could maintain root development and allow a good long-term prognosis.

Crowding teeth and alveolar bone of mandibular central incisors in adults

Objectives: To study the correlation between alveolar bone morphology of mandibular central incisors and crowding of the six anterior mandibular teeth by using little’s Irregularity Index in adults. Materials and Methods: A total of 44 adults' cases (22 females and 22 males), aged 18-38 years. Patients were scanned by CBCT. We evaluated the morphology of alveolar bone around mandibular central incisors, calculated Little’s Irregularity Index of the anterior lower dental arch, analyzed data, performed the statistical analysis, and studied the correlation. Results: The current study showed statistically significant differences according to gender between some sites of alveolar bone surrounding central incisors and found no confirmed correlations between the studied variables. Conclusion: The potential risks, which may occur as a result of orthodontic treatment for adults, require individual planning of each tooth movement after assessing its condition and position within the dental arch, as well as a continuous evaluation of the surrounding alveolar bone, in order to achieve safe treatment results that ensure the integrity of the periodontal tissues.

Assessment of simulated vs actual orthodontic tooth movement with a customized fixed lingual appliance using untreated posterior teeth for registration and digital superimposition: A retrospective study

With the advancement of computer-aided design and computer-aided manufacturing (CAD-CAM), digital setups that simulate the outcome of orthodontic treatment are frequently used. Incognito appliance system is a lingual orthodontic system that uses digital setups. A limitation to previous studies evaluating CAD-CAM simulated outcomes is the lack of stable reference points to superimpose on. The purpose of this study was to compare the simulated vs actual outcomes with the Incognito Lite appliance system. Thirty-four final models were compared with their corresponding setup models exported from the Incognito Web site. Final surface 3-dimensional imaging software was used to digitally measure differences between the simulated and actual treatment outcomes using a digital registration and superimposition method that utilizes the unmoved posterior teeth as reference points. Differences between simulated and actual tooth movement were significant in the translational parameter, with a maximum average discrepancy in the maxillary central incisors of 1.0±0.6mm(P<0.0001) and 0.8±0.4mm(P<0.0001) for mandibular central incisors. Discrepancies between simulated and actual tooth movements decreased from anterior to posterior. The first bicuspids moved the least for both maxillary and mandibular teeth (range of 0.4 mm-0.7mm). The differences for rotational parameters were statistically insignificant with a mesiodistal tip of 1.6°-3.6°, buccal-palatal torque 2.3°-4.4° and rotation around the tooth axis 2.3°-5.0°. Incognito Lite simulated tooth movements were achieved for rotation, tip, and torque (±3°). However, significant discrepancies were found between simulated and actual tooth position for translation (0.6-1.0mm).

Edirne'de Yaşayan Çocuklarda Süt Dişlerinin Sürme Zamanı ve Sıra Polimorfizmi: Kesitsel Bir Çalışma

Objective: Variation in both the sequence and timing of primary tooth emergence across the different societies necessitates population-specific research. The aim of the present study is to determine median emergence times of primary teeth and the sequence polymorphism in Turkish children living in Edirne. Material and Methods: The research was performed on sample of 1315 children (684 boys and 631 girls) aged between 4-42 months, who were born and have been living in city of Edirne. Dental examination was carried out in family medicine centers by one investigator and primary teeth were assigned as 'emerged' when any part of it was appeared from the surface of gingiva. Median tooth emergence times were evaluated by probit regression analysis. Results: The first emerged teeth were mandibular central incisors with a median value of 6.9 months. The tooth emergence sequence was found as follows: mandibular central incisor, followed by maxillary central incisor, maxillary lateral incisors, a group with similar emergence timings; mandibular lateral incisor, mandibular and maxillary first molars, followed by canines and finally second molars in both arches. First molar and lateral incisor reverse sequence was found in 7% of girls in the maxilla, 5% of boys and 10% of girls in the mandible. 52-51 reverse sequence was found in 18% of boys and 9% of girls. 53-54 reverse sequence was detected in 6% of girls. Conclusion: The first standards of the timing and sequence of primary teeth emergence specific to children living in Edirne were provided.

The prevalence and characteristics of external cervical resorption based on cone-beam computed tomographic imaging: a cross-sectional study.

This study investigated the prevalence and characteristics of external cervical resorption (ECR) regarding sex, age, tooth, stages of progression, and portal of entry, using cone-beam computed tomography (CBCT) scans. CBCT scans of 1,313 patients from a Brazilian subpopulation comprising 883 female and 430 male patients (mean age, 55.2 years), acquired using a PreXion 3D CBCT unit, were evaluated. All permanent teeth included in the scans were evaluated for the presence of ECR according to the 3-dimensional classification and the portal of entry. The association between the presence of ECR and the factors studied was assessed using the χ2 test. Intra-observer agreement was analyzed with the kappa test (α = 0.05). In total, 6,240 teeth were analyzed, of which 84 (1.35%) were affected by ECR. A significant association was found between the presence of ECR and sex, with a higher prevalence in male patients (p = 0.002). The most frequently affected teeth were the mandibular and maxillary central incisors. The most common height was the mid-third of the root. For the portal of entry, 44% of cases were on the proximal surfaces, 40.5% on the lingual/palatal surface and 15.5% on the buccal surface. Intra-observer agreement was excellent. The prevalence of ECR was 1.35%, with a higher prevalence in male patients and a wide age distribution. The mandibular and maxillary central incisors were the most commonly affected teeth, and cases of ECR most frequently showed a height into the mid-third of the root and proximal entry.

Root Morphology of Mandibular Anterior Teeth in Mecca, Saudi Arabia

Background: Root canal morphology is of utmost importance to the success of root canal treatment. The present study aim is to determine the variation in root canal morphology of the mandibular anterior permanent teeth using cone-beam computed tomography (CBCT) in a Saudi population in Mecca. Methodology: This is a cross-sectional study which was conducted using CBCT images of 388 patients. Patients were included according to a specific criterion to evaluate the number of canals and their configuration according to the Vertucci's classification. Results: The prevalence of the second canal of mandibular canine was 11% (11.3 in male and 10.7 in female), for mandibular lateral incisor was 22.3% (28.5 for male and 16.7 for female) and mandibular central incisor represented 21% (22% for male 20.1% for female). These differences were non-significant for canine and central incisor but was significant for lateral incisor (p=0.028). There were no significant differences regarding teeth position. According to Vertucci’s classification, type I was the most prevalent followed by type III, II and V for lateral and central incisors while type III, V and II were most prevalent in canines. There were statistically significant differences between male and female for lateral and central incisors morphology (p=0.003 and p=0.013, respectively) while the difference was non-significant for canine (p=0303). Conclusion: Type I Vertucci’s classification was the most common configuration in all mandibular anterior teeth. The presence of second canal is more prevalent in mandibular lateral and central incisors and the morphology of their root canals is significantly different between males and females.

Cone-beam computed tomographic analysis of root canal morphology of permanent mandibular incisors - Prevalence and related factors.

Objectives:To investigate the prevalence of additional canals and the occurrence of oval canals in apical third area of mandibular permanent incisors of Saudi sub-population.Methods:This study was conducted from November 2020 to May 2021 at College of Dentistry, Qassim University. For the investigation purpose of this study, 314 scans were analyzed within the age limits of 13 to 70 years. The root canal morphology, presence of oval canals, number of roots, and prevalence of various canal configurations based on age, gender and bilateral symmetry were recorded. The obtained data was statistically analyzed using SPSS software.Results:The mandibular central incisors (CI) exhibited, significant difference between Type-I, II, III and IV canal configurations and Type-I, II, III and V canal configurations (p < 0.05). For the mandibular lateral incisor (LI), significant difference was found between Type-I, II, III, IV and VII canal configurations (p < 0.05). The cumulative prevalence of oval canals in mandibular incisors was found to be 46.6%. For both mandibular CI and LI, the prevalence of Type-I canals was significantly higher in males as compared to females (p < 0.05). Conversely, significantly higher prevalence of Type-III canals was noted for females as compared to males (p < 0.05). No significant difference was found in the prevalence of different canal configurations on the left and the right side of the mouth.Conclusion:In this study, multiple canals were prominently recognized with Type-III mandibular incisors dominating this feature. Oval canals were predominantly found in single canal especially Type-III. This research suggests variability in canal morphology among different populations. Knowledge of these aberrant canal anatomies is useful for the clinician to achieve a favorable endodontic outcome.

Biometry of width between labial transitional line angles in anterior teeth: an observational study.

PURPOSEThe maximum width between the mesial and distal labial transitional line angles, described as “esthetic width” herein, could significantly influence the visual perception of the teeth and smile. This study aimed to conduct biometric research on esthetic width and to explore whether regular distribution exists in the esthetic width of human teeth.MATERIALS AND METHODSA total of 4,264 maxillary and mandibular anterior teeth were measured using the Geomagic studio software program. The proportions of maxillary to mandibular homonymous teeth and proportions between the adjacent teeth were calculated. Bilateral symmetry and the correlation between the esthetic and mesiodistal widths were both accounted for during the measurement procedures.RESULTSThe mean esthetic widths were 6.773 ± 0.518 mm and 4.329 ± 0.331 mm for maxillary and mandibular central incisors, respectively, 5.451 ± 0.487 mm and 5.008 ± 0.351 mm for maxillary and mandibular lateral incisors, respectively, and 3.340 ± 0.353 mm and 5.958 ± 0.415 mm for maxillary and mandibular canines, respectively. Except for the mandibular canines, no significant difference in esthetic width was found among homonymous teeth from the same jaw. A high linear correlation was found between the esthetic and mesiodistal widths of the same tooth, except for the maxillary canines. Esthetic width proportions among different tooth categories showed some regular patterns, which were similar to those of the mesiodistal width.CONCLUSIONEsthetic width is regularly distributed among the teeth in the Chinese population. This could provide an important reference for anterior dental restorations and dimension recovery in esthetic reconstruction of anterior teeth.

Influence of gestational age on eruption of primary teeth in Indian children - A prospective longitudinal study.

Eruption of primary teeth is the most anticipated event in a child's life. Genetics, gender, socio-economic status, gestational age are a few of the determinants of the primary teeth eruption. However, the effect of gestational age on the timing of primary teeth eruption among the Indian population has not been explored to date. The study was conducted to evaluate the influence of gestational age on time and sequence of eruption of primary teeth among children of Mysore. A prospective longitudinal cohort study design was conducted at 'Baby Oral Health Promotion Clinic' at the Department of Paediatrics, JSS Hospital, Mysore. 150 newborn babies were recruited by simple random sampling and followed up from birth to 36 months. Teeth present during each visit were recorded. Data were statistically analysed and interpreted. Descriptive statistics, t-test for an independent sample, and Pearson's Chi-squared test were applied. The mandibular central incisor was the first tooth to erupt. Statistically insignificant early eruption in males was noted in both term and preterm children. When the chronological ages were compared, the preterm group showed a statistically significant delay in the eruption of all the teeth. However, when the age was adjusted for prematurity, only the central incisors and second molars showed a statistically significant delay. Gestational age has a strong significant association with the eruption of primary teeth and maybe one of the strong predictors for delayed eruption among children of Mysore.

Non-syndromic Concomitant Hypo-Hyperodontia in the Anterior Region of MandibleAn Extremely Rare Phenomenon: Literature Review with Recent Updates

Introduction: Hypo hyperdontia is a numeric mixed anomaly in which teeth may be supernumerary or absent, relative to the normal complement. The occurrence of this condition in the same individual is termed “Concomitant Hypo-Hyperdontia” (CHH). The presence of CHH in the same dental arch is uncommon, especially when it occurs in the front of the mandible in a Nonsyndromic Concomitant Hypo-Hyperdontia (NCHH). Aim: To conduct a literature review of the published articles in the English language, regarding NCHH in the anterior region of the mandible covering the period from October 1977 to December 2021. Materials and Methods: An extensive electronic search was conducted in February 2022, from Google Scholar, PubMed, and Elton B. Stephens Company (EBSCO) databases, using keywords such as mandible, hypodontia, hyperdontia and nonsyndromic. Manual sorting of the preselected literature, revealed only 19 published papers concerning NCHH in the frontal region of the mandible, spanning a period of 44 years. Results: The review analysed the data from 19 published studies, which presented 24 affected patients with a mean age of 12.36 years, with a male/female ratio of 1:1, involving a total of 41 missing teeth, including bilateral mandibular central incisors at 66.66%, followed by missing unilateral central incisor at 29.16% and 1 case (4.16%) displaying absence of both lateral incisors. Regarding 25 presented supernumerary teeth (ST), 72% of cases presented single midline ST, 20% were single unilateral ST, and one case presented double ST (8%) located bilaterally. The majority of ST (84%) were erupted conical-shaped. Conclusion: The study confirmed the exceptionally rare occurrence of NCHH in the anterior region of the mandible. Due to its interference with esthetics and function, the clinician should possess sufficient knowledge regarding NCHH diagnosis and management.

Analysis of the distance between lingual frenal attachment and mandibular incisal edge position in establishing occlusal plane in three different races.

The orientation of the occlusal plane forms the basis for the arrangement of teeth conducive to satisfactory esthetics and function, making it one of the most important clinical procedures in prosthodontic rehabilitation. This study aimed to analyze and compare the vertical distance between the anterior attachment of lingual frenum (AALF) and the incisal edge of mandibular central incisors among three races in Malaysia. The sample consisted of 63 dentate subjects (21 Malays, 21 Chinese, and 21 Indians) who were chosen based on the inclusion criteria. Two models were made using irreversible hydrocolloid impressions, and an average of the value was obtained. Lingual frenum was recorded in function. Casts were fabricated with dental stone. AALF was marked and the vertical distance was measured using a caliper. In Malays, the mean and standard deviation of the vertical distance were 14.2 ± 0.9 mm, with a range of 12.3-16.0 mm; in Chinese were 14.4 ± 0.9 mm, with a range of 12.0-16.9 mm; and in Indians were 15.1 ± 1.0 mm, with a range of 13.0-17.2 mm. The difference among the three races regarding the distance between AALF and the incisal edge of mandibular central incisors was statistically significant (P < 0.05). Among the three races, Malays and Indians have the greatest mean difference. According to the results of the current study, the distance between AALF and the incisal edge of mandibular central incisors might be a proper criterion for the initial adjustment of occlusal rims. The values obtained from three different races were significantly different from one another, hence a different range of values was used to establish occlusal height for different races.

Ameloglyphics Patterns of Primary and Permanent Dentition Using Staining Method: An Observational Study

Background: Forensic Odontology is a branch of Odontology which in the interest of justice deals with the proper handling and examination of dental evidence and with the proper evaluation and presentation of dental findings. Various applications of forensic dentistry include age estimation, bite mark analysis, ameloglyphics, rugoscopy, cheiloscopy, photographic study, genetic material analysis, and PCR for pulp DNA analysis. The aim of this study is to find out the utility of Hematoxylin and Toluidine blue stains in studying enamel rod end patterns of various dentitions in forensic odontology.&#x0D; Results: In our study, Mean and standard deviation value of Hematoxylin and Toluidine blue showed the surface score of 6.4±1.782 and 6.6±1.979 respectively. Both maxillary and mandibular Permanent central Incisors showed lowest scores when compared to remaining dentition included in the study.&#x0D; Conclusion: To conclude, Ameloglyphics patterns can be studied by staining the tooth. The Ameloglyphics pattern can be analyzed using hematoxylin and toluidine blue stains. Ameloglyphics patterns can be used as a valuable tool in personal identification when stained correctly, and they have a bright future in forensic dentistry.

An endo-aesthetic management of a chronic infl ammatory lesion in a dilacerated mandibular central incisor and its rehabilitation with fi ber post: A one year follow-up case report

Necrosis of pulp with periapical changes is common detrimental sequelae of dental traumatic injuries to teeth if not treated early. Conventional endodontic treatment alone may be difficult or ineffective in such cases especially in teeth with morphological deviations (e.g. dilacerated root) wherein traditional treatment approach may be insufficient to eliminate the infection from the complex root canal system. In such cases, a combination of conventional and surgical endodontic therapy is deemed necessary to completely eliminate the periradicular pathosis and promote apical healing. Moreover, prompt placement of coronal restoration is essential in such cases to seal the canal and improve prognosis of endodontically treated teeth. The present case report describes successful endo-aesthetic management of a chronic large periapical lesion in left permanent mandibular central incisor with dilacerated root with combined root canal and surgical endodontic treatment followed by its rehabilitation with fiber post and porcelain fused to metal (PFM) crown. Keywords: Chronic inflammatory lesion, Endo-aesthetic management, Fiber post, Rehabilitation, Surgical endodontics.

Braided Glass Fiber Reinforced Composite Resin Bridge - An Alternative Treatment for Management of Missing Anterior Tooth: A Case Report

Missing anterior teeth is of great concern during a patient's lifetime in many communities. A variety of treatment options, from implants to traditional bridges are often used in order to replace missing anterior tooth. However, it is often accompanied by variety of barriers such as an increased number of chairside visits and better costs. Fibre-reinforced composites (FRCs) have gained increasing and great acceptance in mainstream prosthodontics as viable alternatives to alloy-based restorations recently. In compaison to other restorative systems this is often a conservative approach that carries a minimum risk of pulp exposure or sensitivity and periodontal inflammation, which maintains the health of supporting tissues. Therefore the aim of this case report was to present a clinical case of a congenitally missing mandibular central incisors bilaterally which were replaced by means of a FRC bridge wherein, we employed a semi-direct (direct and indirect) technique. This technique provides a conservative, esthetic, and noninvasive treatment, economically more acceptable, nonirritating, and noniatrogenic. FRC bridges can therefore be considered as a permanent treatment modality.