Permanent Maxillary Central Incisor Research Articles

Apexification with apical growth and closure using Metapex in a Necrotic Immature Permanent Tooth with Periapical abscess: A Case Report with 16 months follow-up.

The purpose of this report is to present the case of a patient wherein apexification of an immature permanent maxillary left central incisor tooth was induced by the Metapex paste (Calcium hydroxide and Iodoform). It has been reported in the literature of dentistry that apexification treatment in teeth with open apex is more than 40 years old. Apexification procedures had been carried out in different ways using various techniques and materials. Regardless of the type of materials used for apexification method by different authors, apexification procedures appear to be the most subtle and accepted clinical practice in non-vital young permanent teeth. In our case, radiographic examination showed the start of apical closure 6 months after the completion of the treatment protocol. The growth of root end and complete apical closure was confirmed 16 months after the treatment, indicating the implausible potential of Metapex to induce apical growth and closure in young permanent tooth with periapical lesion.

A 13-year follow-up multidisciplinary management of replanted avulsed permanent incisor: Case report

Background: Permanent teeth avulsion represents a high rate among all dental trauma injuries and their rapid management is very important for prognosis. The aim of the present study is to report the multidisciplinary treatment and 13-years follow-up of a case of the replantation of a permanent maxillary central incisor after dental avulsion.Clinical presentation: A 8-year-old male patient presenting avulsion of right maxillary central incisor (11) and subluxation associated with uncomplicated crown fracture of left permanent central incisor (21) was treated with immediate replantation of the #11. Due to anterior open bite, severe crowding of teeth in the trauma region and Angle's Class II profile, an orthodontic approach was performed. Long-term follow-up at 12-years after the trauma, and 7-years after the beginning of orthodontic treatment, appliance was removed, and permanent root canal filling of right maxillary central incisor was performed.Clinical Relevance: The treatment of choice for a dental avulsion is to replant the tooth as soon as the trauma has occurred for a better prognosis, addressing the guidelines of the International Association of Dental Traumatology (IADT) associated with orthodontic management.Conclusion: Clinical results after 13-years follow-up showed that this approach controlled the progressive resorption and allowed orthodontic movement maintained the patient’s health over time.

A three dimensional finite element analysis of fiber post and dentin post in permanent maxillary central incisors: An in-vitro study

: Endodontically treated teeth are generally weakened as a result of loss of tooth structure due to decay, previous restorative procedures and endodontic access preparation. Ideal coronal reconstruction of endodontically treated tooth is still a challenge for restorative dentistry. Post and core system is a widely used method for treatment of structurally weakened teeth. Two extracted, caries-free maxillary central incisors with straight root canal were collected and mounted. Post space preparation were done and restored with fiber post and dentin post respectively. The model is simulated using the software “Creo” and this data is then transferred to software “Hypermesh” to create a Finite Element model i.e., a mesh of nodes and elements. This mesh is programmed to contain the material properties which defined how the structure will react to loading conditions at different angles. The Analysis is carried out using the Ansys software.: The FEA results showed that the Dentin post have better fracture resistance. The comparison between fiber and dentin posts exhibited a better stress resistance of dentin post over fiber post. Further research in this regard is required to support the findings of this study results.

Orthodontic extrusion of a subgingivally fractured maxillary central incisor using 'J' hook: A Multidisciplinary case report.

Traumatic injuries to permanent maxillary anterior teeth are seen commonly in children. Restoration of these traumatically injured teeth are always a clinical challenge for a predictable aesthetic outcome. This case report describes a multidisciplinary approach of a subgingivally fractured maxillary permanent central incisor by endodontic therapy, orthodontic extrusion using J-hook, fiber post placement, core build-up followed by surgical gingival recountouring using electro-cautery to reestablish the biological width. Finally esthetics was restored using porcelain fused to metal crown.

MTA Cvek Pulpotomy Followed by Fragment Re-Attachment in Traumatized Young Permanent Maxillary Left Central Incisor – A Case Report

Most common form of dental trauma in children are the fractures of crown mainly in anterior teeth. A case of complicated crown fracture treated with Cvek pulpotomy using MTA followed by fragment re-attachment with careful follow-up is presented here. Tooth fragment re-attachment provides feasible conservative alternative approach to restore esthetics and tooth function. Successful outcomes have been shown by the long term follow up of the treatment with the preservation of pulp vitality and continued development of root. Clinical results have also shown good esthetics and functional results of presented technique. KEYWORDS: Complicated crown fracture, Cvek pulpotomy, MTA, fragment re-attachment HOW TO CITE: Zalan AK, Zubairy KK, Zaman H, Maxood A, Gul A, Anser M. MTA cvek pulpotomy followed by fragment re-attachment in traumatized young permanent maxillary left central incisor – A case report. J Pak Dent Assoc 2021;30(1):70-73.

An eight-year-old boy with large complex odontoma inmaxillary anterior area associated with unerupted tooth

Odontomas are the most common odontogenic benign tumors composed of dental tissue. The term odontoma was first coined by Broca (1866); he defined odontoma as a tumor formed by an overgrowth of complete dental tissues. They can be thought of as “tooth hamartomas” with the lesion consisting of various tooth components. Histologically Odontomas are divided into complex and compound odontomas. In this paper we are describing the case of a complex odontoma in an eight -year-old boy diagnosed due to the retention of the permanent left maxillary central and lateral incisor. A surgical excision was performed without distressing the unerupted central and lateral incisor. The results obtained indicate that early diagnosis of odontomas enables adoption of less complex treatment, a better prognosis, and displacement or devitalisation of adjacent tooth. Keywords: Odontomas, Hamartoma, Denticles, Odontogenic tumour.

Aesthetic Rehabilitation of Discoloured Anterior Teeth with Facial Talon’s Cusp: A Case Report

Talon’s cusp is described as a process of horn-like shape curving from the base downwards to the cutting edge. Ripa and Mellor later described this phenomenon as talon cusp resemblance to talon of eagle. Talon cusp is a well-defined extra addition cusp like structure which extends from half of the cementoenamel junction to the incisal edge on the surface of an anterior tooth. The aetiology is unknown for the formation of the talon cusp. A talon cusp is often diagnosed during routine dental examination as an incidental finding and usually does not show any symptoms. In such cases, careful clinical and radiographic examination is mandatory for correct diagnosis and treatment planning. Due to limitation of 2 D (two dimensional) radiographs, these images are unable to recognise the complicated anatomy of the tooth.Use of Cone-Beam Computed Tomography (CBCT) has become common in dentistry. CBCT has been useful in producing a three dimensional (3 D) image without distortion of the teeth, maxillofacial skeleton and related tissues. Scan of CBCT help to plan treatment and also provide valuable information about dental anatomy. This paper describes a case of 23-year-old female patient with a facial talon cusp on the permanent maxillary left central incisor, which was endodontically managed and followed by aesthetics rehabilitation with a follow-up for a period of one year.

Effect of preconditioning the fractured coronal fragments with remineralizing agents on fracture resistance of re-attached teeth.

Fragment re-attachment has been considered as one of the treatment modalities for the management of fractured anterior teeth. Hydration of fractured fragments aids in inhibiting the loss of ions and maintains vitality and esthetics. The study aimed to evaluate the effect of preconditioning the fractured fragments with remineralizing agents on fracture resistance of re-attached teeth. This was an in vitro study. Sixty freshly extracted noncarious human permanent maxillary central and lateral incisors were randomly allocated into three Groups of 20 each: Group 1: 2% sodium fluoride (2%NaF), Group 2: casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and Group 3: self-assembling peptide P11-4 (SAP). These were further divided into two subgroups of 10 teeth each, based on contact time with remineralizing agents, i.e., 30 min and 2 h. Fractured fragments were treated with remineralizing agents for a specified contact time and then re-attached with flowable composite resin. Force required to fracture the re-attached tooth was recorded in Newtons using universal testing machine. Unpaired t-test, one-way analysis of variance test, and post hoc Tukey test were used for the statistical analysis. A higher fracture resistance was noticed in fragments treated with 2% NaF (30 min- 215.6 N, 2 h- 188.5 N) compared to CPP-ACP (30 min- 141.3 N, 2 h- 111.1 N) and SAP (30 min- 134.8 N, 2 h- 149.5 N). At 30 min interval, it was found to be more in 2% NaF and CPP-ACP groups compared to 2 h. However, it increased with time in the SAP group. A statistically significant difference was found between the groups at both time intervals (P = 0.007 and 0.017). Preconditioning of fractured coronal fragments with 2% NaF showed higher fracture resistance compared to CPP-ACP and self-assembling peptide P11-4. Samples treated with SAP P11-4 exhibited good fracture resistance at 2 h contact time.

Surgical Management of Super Numerary Tooth and an Impacted Maxillary Permanent Central Incisor: A Case Report

Impaction of Maxillary Permanent incisor due to super numrary tooth is not a common entity encountered in dental practice but when present, it poses a disturbing esthetic dilemma to children and their parents. Early diagnosis and interception in these cases is the best way for their management. The purpose of this report is to describe the diagnosis and the clinical management of an impacted supernumerary tooth, which impeded the eruption of the permanent maxillary central incisor.

Management of Avulsed Permanent Maxillary Central Incisors: A Case Report

Management of Avulsed Permanent Maxillary Central Incisors: A Case Report

Multidisciplinary Approach to the Treatment of an Unusual Crown Fracture after Trauma: Alternative Technique Proposal

This case report presents multidisciplinary management of a sub gingival crown-root fracture of a 15-year-old patient referred to the dental trauma clinic with an extensive tooth fracture of the permanent maxillary central incisors after a traumatic injury during a volleyball game. This work aimed to present an alternative approach for complicated dental fracture after trauma obtaining immediate resolution. A unique aspect of the case was that the patient was referred from the semiology clinic without pain and with signs of extensive cracking after 13 days of trauma. However, no endodontic involvement was observed either clinically or radio graphically. After examining a probe, the fracture trace dislocated with pulp exposure and sub-gingival extension. An alternative isolation technique was presented to enable immediate endodontic treatment and restoration of fractured teeth.

Evaluation of the Apical Sealing Ability of Resin and Silicon Based Sealers by Dye Extraction Method: An In Vitro Study

Introduction: Thorough, chemo-mechanical preparation of the root canal is required to completely eliminate microorganisms from the dentinal tubules. Faulty obturation in the apical area is the pathway from which bacteria and their toxins pass on to the periapical area and this leakage can be studied by sealability studies. Aim: To evaluate the apical sealing ability of three sealers i.e., AH Plus, Roekoseal and Adseal using passive dye penetration test and a dye extraction test with Methylene blue dye to evaluate the apical leakage. Materials and Methods: The present study was an experimental in-vitro study, carried out at MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India over a period of 10 months (from August 2013 to May 2014). Eighty freshly extracted human permanent maxillary central incisor teeth were obtained. The crowns of the teeth were sectioned at/below cemento-enamel junction and divided into five groups: Groups I, II and III were obturated with gutta-percha and three different sealers, and groups IV and V were the two control groups. Passive dye penetration test was performed to evaluate penetration of the dye by means of capillarity followed by dye extraction test. At the end of dye extraction procedure, the supernatant solution obtained was analysed using an Ultraviolet spectrophotometer. Significance was set at 5%. Statistical analysis was performed by using IBM Statistical Package for the Social Sciences (SPSS) statistical software version 20 (Armonk, New York, United States). The normality of data in each group was tested using Shapiro-Wilk test. The mean absorbance values of the five groups were compared using one-way ANOVA. Further to compare the level of absorbance of dye among various groups, Tukey’s post-hoc test was applied. Results: The mean values of dye absorbance of all groups were as follows, AH Plus (0.02638), Roekoseal (0.06713), Adseal (0.03575), positive control group (1.36250) and negative control group (0.01894). One-way ANOVA showed p<0.001, thus indicating there was a significant difference between the dye absorbance values of all the groups. Tukey’s post-hoc test showed statistically significant difference in dye absorbance of the experimental groups when compared to positive control group. There was no significant difference in dye absorbance when experimental groups were compared to each other. When AH Plus was compared with Roekoseal, the p-value was 0.568 and 0.997 with Adseal whereas when Roekoseal was compared with Adseal the p-value was 0.778. Conclusion: The mean dye absorbance value of AH Plus was found to be least and that of Roekoseal was highest in the experimental groups. AH Plus gave the best results, as least dye was extracted from this group, indicating least dye penetration and minimum microleakage followed by Adseal and Roekoseal.

Management of Delayed eruption of Permanent Maxillary Central

Supernumerary teeth are those which are additional or in excess of the normal number. They can be present anywhere in the dental arch with predilection for the premaxilla. They can cause many complications, the most common being the delayed eruption of permanent teeth. Early diagnosis and management can minimize the potential complications caused by supernumerary teeth and the extent of surgery and orthodontic treatment. Aim: This case report highlights the problem of delayed eruption of permanent maxillary left central incisor in a 9-year-old boy due to a supernumerary tooth. After surgical removal and 18 months of follow up, the left permanent central incisor erupted.

Maturogenesis by Pulp Revascularization in an Immature Necrotic Permanent Tooth in a Pediatric Patient: A 15 Month Follow-up Case Report

Endodontic treatment of immature necrotic permanent teeth is clinically challenging and poses a risk of inducing dentin wall fracture or extending gutta-percha into the periapical tissue during root canal filling. Pulp revascularization is a promising alternative for the treatment of such immature necrotic permanent teeth offering great potential to avoid the need for traditional apexification with calcium hydroxide or the need to achieve an artificial apical barrier with mineral trioxide aggregate. Pulp revascularization allows the stimulation of the apical development and the root maturation of immature teeth by physiologically strengthening the canal walls. The present case report describes the case of successful revascularization of the necrotic infected pulp space of an immature permanent maxillary central incisor induced in vivo by stimulation of a blood clot from the periapical tissues into the canal space. Thickening of the canal wall and complete apical closure were confirmed 15 months after the treatment.

A second attempt at pulp revascularisation on an immature traumatised anterior tooth: a case report with two‐year follow‐up

This report describes the second attempt at pulp revascularisation, using an association between 2% chlorhexidine (CHX) and calcium hydroxide (CH) as intracanal dressing, in an immature traumatised anterior tooth with pulp necrosis. A 21-year-old woman complained of pain and dental crown darkening of a permanent maxillary right central incisor. Her medical records presented a history of dental trauma, and at age 15, the first attempt at revascularisation was performed, using triple antibiotic paste (TAP) as the intracanal dressing. Recent radiographs then showed a periapical lesion associated with an immature root, which demonstrated the failure of the first attempt. The second pulp revascularisation was performed, using an association between CHX and CH as intracanal medication. The case was followed up for 24months. Observations showed evidence of root development, dentinal wall thickening and periapical healing. In this case, the association between CHX and CH showed favourable results as an intracanal medication.

Management of an unusual foreign body in periapical tissues of immature permanent maxillary central incisor

Root canal treatment of an immature tooth is a significant challenge because of the size of the canal, the thin and fragile dentin walls, and the large open apex. The present report describes a clinical case of apical surgery with a 3-year clinical and radiographic follow-up in an immature permanent maxillary central incisor with persistent apical periodontitis caused by a foreign body in the periapical tissues. Surgical endodontic treatment should be seen as the best choice for treating persistent apical periodontitis. This treatment can manage the infection source and provide a direct hermetic seal of the apical area.

English

English

Aesthetic Restoration using Direct Composite Resin

Anterior Crown fractures are common among schoolchildren. This will impact on their functional, aesthetic and psychological behaviour, as the aesthetic zone clinician must propose the exact and minimally invasive treatment plan. Achieving promising result in both aesthetic and strength is the greatest desire for the patient as well as for parents. This is the case of fractured permanent maxillary central incisors treated using Direct Composite Resin Restoration. Key Words: Anterior Crown, Fracture, Aesthetic, Maxillary central incisors, composite restoration

Permanent Maxillary and Mandibular Central Incisor Width as Predictor of Permanent Maxillary Canine Width in a Kurdish Population: A Pilot Study.

Background: Estimation of the mesio-distal width of permanent maxillary canines (PMCs) is a critical part of mixed dentition space analysis. The aim of this pilot study is to find a specific prediction equation for the estimation of the mesio-distal width of PMCs depending on the width of permanent maxillary and mandibular central incisors (PMMCIs) in a Kurdish population. Methods: A hundred study casts were collected. The mesio-distal widths of the PMMCIs and PMCs were measured by digital caliper. Linear regression tests were applied to find the prediction equation using the sum width of PMMCIs as predictors. Results: The mean age of the subjects was 17.2 ± 2.39 years old. Statistically significant differences in the mesio-distal widths of PMMCIs and PMCs were found between males and females (p = 0.0001). Furthermore, statistically significant correlations were identified between the widths of PMMCIs and PMCs in both males (r = 0.633, p = 0.0001) and females (r = 0.717, p = 0.0001). Likewise, the mesio-distal width of PMMCIs was found to be a significant predictor of the width of PMCs in both males (R2 = 0.403, p = 0.0001) and females (R2 = 5.14, p = 0.0001). Conclusion: For the first time, regression equations were developed for a Kurdish population and can be useful as a part of a mixed dentition space analysis in Kurdish children.

“A COMPARATIVE EVALUATION OF FRACTURE RESISTANCE OF BADLY MUTILATED ANTERIOR TEETH RESTORED WITH THREE DIFFERENT NOVEL POST CORE SYSTEM: AN IN VITRO STUDY”

Aim A study was aimed to compare the fracture resistance and the mode of failure of endodontically treated teeth reestablished with various fiber post-center frameworks. Method 60 extracted permanent maxillary central incisors selected and biomechanical preparation performed by Conventional step back technique and Obturated by manual lateral condensation technique with guttapercha using AH plus root canal sealer .Teeth randomly assigned into four experimental groups The access cavities were sealed with packable composite restoration.Crown preparation with shoulder of 1mm was prepared followed by reduction of crown high to 8mm from shoulder margin. The post space arrangement was finished with Peeso-Reamer up to number 4 size to a profundity of 10 mm. The fiber present was then applied on a stature of 4 mm over the tooth edge. Post was solidified with oneself fix glue tar concrete. The example with tempered steel square was mounted on an uncommon apparatus on a PC controlled Universal Testing Machine. The compressive burden was applied with 1 mm width, ball-finished steel compressive head at an edge of 130 to the long hub of the tooth. Result The results showed that the fracture resistance of group C (DT light post and Core Flo DC) was significantly higher than the other two groups. Group a (Control) had the least fracture resistance. Conclusion DT lightpost and Core Flo DT post-core system, making it one of the best combinations to be recommended for the treatment of badly mutilated teeth.