Permanent Maxillary Central Incisor Research Articles

Conservative Management of Facial Talon Cusp in a Permanent Maxillary Central Incisor: A Case Report

Conservative Management of Facial Talon Cusp in a Permanent Maxillary Central Incisor: A Case Report

Orthodontic-Surgical Management of Triple Impacted Mesiodens and Maxillary Incisors - A Case Report

Abstract Rationale: Mesiodens are supernumerary teeth located in the pre-maxilla between the two central incisors with a prevalence rate of 0.15–1.9%. An impacted mesiodens may cause delayed eruption of permanent incisors, ectopic eruption, pathological disturbances and malalignment of teeth. Patient Concerns: The patient complained of missing upper front teeth associated with pain in the same region for two weeks. Diagnosis: Upon clinical and radiographic examination, it was diagnosed as triple impacted mesiodens with impacted permanent maxillary central incisors. Treatment: The clinicians in the study approached the issue by surgical removal of the impacted mesiodens and orthodontic treatment for extrusion of the impacted permanent maxillary central incisors. Outcomes: The patient was relieved of the pre-operative concerns and followed up regularly for the eruption of permanent maxillary central incisors. Take-away Lessons: The authors advocate the importance of timely diagnosis and proper management of such rare pathologies.

Treatment of Dento-alveolar Traumatic Injuries in a Child with Autism Spectrum Disorder (ASD)

This case report details the multidisciplinary management and follow-up of a 9-year-old boy diagnosed with autism spectrum disorder (ASD). He presented with severe intrusion injuries after a fall to his permanent maxillary central and lateral incisor teeth. The patient was initially seen in the emergency department by the maxillofacial team. Owing to the complexity of the dento-alveolar injury, it was felt that a multidisciplinary approach would improve patient outcomes. In theatre, both maxillofacial and paediatric dental teams managed the acute trauma. The paediatric dental team continued to review and follow-up with the child. A multidisciplinary team is ideal for managing paediatric patients with severe dental trauma and complex behavioural needs. This approach ensures the best care for patients and favourable outcomes. CPD/Clinical Relevance: Multidisciplinary management is important in paediatric dento-alveolar trauma.

Surgical Management of Palatally Impacted Mesiodens in a Pediatric Patient: A Case Report

Supernumerary teeth are additional teeth or tooth-like structures that can develop either erupted or unerupted, beyond the normal complement of 20 primary teeth and 32 permanent teeth. A mesiodens is a specific type of supernumerary tooth located in the midline between the two central incisors. The presence of these extra teeth can lead to various clinical complications. This paper presents a case involving a palatally positioned, impacted mesiodens that was associated with an unerupted permanent left maxillary central incisor. Surgical removal of the mesiodens was performed, resulting in the successful eruption of the permanent incisor.

CT-Assisted Management with Biodentine Obturation and Aesthetic Rehabilitation of a Geminated Maxillary Central Incisor with Mid-Root Fracture: A Rare Case Report

Gemination, a rare aberration in tooth development, results from the incomplete division of one tooth germ into two. In this case report, a true geminated permanent maxillary central incisor tooth with a horizontal mid-root fracture is successfully treated by non-surgical endodontic treatment. To elucidate the intricate root canal anatomy of this rare geminated incisor, we employed computed tomography imaging technology, enhancing our understanding of this complex case. Utilizing biodentine for obturation proved pivotal, as its capacity to accelerate reparative dentin formation facilitated prompt healing, particularly beneficial in fracture cases. This was followed by aesthetic rehabilitation to achieve a pleasing mesio-distal dimension for both the central incisors using a zirconia-reinforced porcelain crowns. Keywords: Computed Tomography (CT), Gemination, Horizontal root fracture, Biodentine Obturation

Clinical Features of Molar Root-Incisor Malformation: A Retrospective Study

This study aimed to identify the clinical characteristics of molar root-incisor malformation (MRIM) and provide clinical considerations for treatments. Panoramic radiographs and electronic medical records of 64 patients with MRIM were retrospectively reviewed. Age, gender, follow-up period, medical history, complications, distribution of MRIM teeth, treatment, and prognosis were analyzed. Females were affected 1.56 times more than males, and the average age was 8.2 years. Dental complications, including periapical lesions, abscesses, and alveolar bone loss, were observed in 71.9%, and eruption disturbance of adjacent teeth was noticed in 37.5%. Most patients had medical histories in the first year of life. The most prevalent history was prematurity or low birthweight, followed by neurological conditions, surgeries, medications, and infections. All patients had MRIM on permanent first molars. The primary second molars were the second most frequently involved, followed by maxillary permanent central incisors and primary first molars. The prevalence was low on permanent lateral incisors and canines. Extraction was the most prevalent treatment done on MRIM-affected teeth, and most extraction sockets were managed by the eruption of permanent second molars. Few cases received endodontic treatment but with low success rates. Early detection of MRIM and prompt, appropriate treatment are important to avoid unnecessary discomfort from complications.

Management of Ellis Class II Fracture in Young Permanent Maxillary Central Incisor

Background: Tooth fracture is a condition of missing or lost fragments of a complete tooth. Tooth fracture usually occurs simultaneously with another oral injury. Objective: This case report discussed the management of Ellis class II fractures on an immature permanent central incisor of a patient who reported to Jenderal Achmad Yani University (Unjani) Dental Hospital. Case: An 11-year-old girl revealed a broken upper left tooth, sensitive to cold drinks that interfered with her appearance one year ago. The patient had a good general condition, no abnormalities during an extraoral examination, and a history of pain on the lower back tooth since a year ago. Case Management: Management of Ellis class II fracture in young permanent central incisor was conducted by using a class IV composite resin restoration. Conclusion: The management of Ellis class II fracture should be conducted holistically and systematically with subjective, intraoral, extraoral, and adjunctive examinations which should be performed correctly and considering the child’s psychology.

Reattachment of Fractured Tooth Segment in Minimally Invasive Way - A Case Report

Dental trauma frequently results in coronal fractures of the front teeth. Root canal therapy followed by reattaching the fractured segment with fiber post reinforcement is a viable alternative in cases of complex fractures where the fractured segment is present and there is close approximation of the segment to the intact tooth. Reattaching a fractured piece is a quicker, less involved process that offers immediate relief, better aesthetics, and function restoration. The present case report is of a 11-year-old boy with an uncomplicated crown fracture of permanent maxillary right central incisor and a palatal uncomplicated crown–root fracture of his permanent maxillary left central incisor . The fractured fragment was reattached using nano-filled dual-cure composite resin and tooth restored with composite resin. The fragment showed opaque discoloration that reduced over time but still persisted after 1 year. During the follow-up period, no unfavorable radiographic changes were seen. The prognosis of the teeth was favorable with good esthetic results. Keywords: Fragment reattachment, Fragment rehydration, Periodontal health, Root fracture, Uncomplicated crown.

Surgical and orthodontic management of impacted maxillary central incisor in children: A case report

Impaction of maxillary permanent central incisor is a frequently reported case in dental practice, and its treatment is challenging because maxillary central incisors are of great important for both aesthetic and functional aspects, since they provide support of the lip and facial muscles. Early detection of such teeth is most important if complications are to be avoided. In this article, we report a case of a 12-year-old girl, in the Pediatric Dentistry Specialist, Dental and Oral Hospital, Airlangga University. Combined approach with surgical exposure and the application of an orthodontic force brought the impacted left maxillary central incisor down to its proper position in the dental arch.

Age Estimation Using the Pulp-to-Tooth Area Ratio in an Indian Population Using Cone-Beam Computerised Tomography (CBCT): A Retrospective Study.

Age estimation, whether for living or deceased individuals, is crucial in forensic sciences. Traditionally, the pulp-to-tooth area ratio determined from periapical radiographs has been employed as a non-invasive method for estimating age. Cone-beam computed tomography (CBCT) represents a newer technique, providing three-dimensional images of teeth in living individuals. This study aims to estimate age using the pulp-to-tooth area ratio of four teeth (the permanent maxillary central incisor, lateral incisor, canine, and first premolar. The study included ninety subjects ranging in age from 18 to 70 years. This study concluded that the correlation between actual age and estimated age varied across different tooth types. There was a strong positive correlation between the maxillary right central incisor and maxillary right canine tooth, while the maxillary left canine tooth exhibited a slightly weaker but still positive correlation. This indicates that the maxillary right central incisor and maxillary right canine tooth are the most reliable for estimating age. Additionally, the study found that the linear regression results for estimating age based on the pulp-to-tooth area ratio, categorised by sex and each type of tooth, showed strong associations between age and the ratio for the maxillary left central incisor and maxillary left canine teeth in males, and for the maxillary left central incisor in females.

Computerised assessment-a novel approach for calculation of percentage of hypomineralized lesion on incisors and its correlation with aesthetic concern

IntroductionMolar-incisor hypomineralization (MIH) is a localized, qualitative, demarcated enamel defect that affects first permanent molars (FPMs) and/or permanent incisors. The aim of present study was to introduce a novel computerised assessment process to detect and quantify the percentage opacity associated with MIH affected maxillary central incisors. MethodologyChildren (8–16 years) enrolled in the primary study having mild (white/cream or yellow/brown) MIH lesion on fully erupted maxillary permanent central incisor. 50 standardised images of MIH lesions were captured in an artificially lit room with fixed parameters and were anonymized and securely stored. Images were analysed by AI-driven computerised software and generates output classifications via a sophisticated algorithm crafted using a meticulously annotated image dataset as reference through supervised machine learning (SML). For the validation of computerised assessment of MIH lesions, the percentage of demarked opacity was calculated using ADOBE PHOTOSHOP CS7. ResultsThe percentage of MIH lesion was calculated through histogram plotting with the maxima ranging from 7.29 % to 71.21 % with the mean value of 34.51 %. The validation score ranged from 10.29 % to 67.27 % with the mean value of 35.32 %. The difference between the two was statistically not significant. Out of 50 patients; 11 patients had 1–30 % of surface affected with MIH and 2 had aesthetic concern; 24 had 30–60 % of surface affected and 13 had aesthetic concern; 15 had >60 % of surface affected and 12 had aesthetic concerns. ConclusionsThe proposed approach exhibit sufficient quality to be integrated into a dental software addressing practical challenges encountered in daily clinical settings.

Treatment For Type II Dens Invaginatus in a Mandibular Lateral Incisor: A Report of Rare Case

Dens invaginatus is one of the developmental abnormities of the tooth which occurs with an invagination of the enamel organ into the dental papilla during tooth development. This abnormity presents a wide spectrum of morphological variations. According to Oehlers classification, in dens invaginatus type II the invagination invades above the cemento-enamel junction, connecting to the pulp; however, there is no connection with the periodontal ligament. This abnormity presents significant challenge when root canal treatment is necessary. The most frequently affected teeth are permanent maxillary lateral incisors, followed by permanent maxillary central incisors. There are limited case reports of mandibulary central incisors; however, there is no publication of mandibular lateral incisors with dens invaginatus type II. This case report aimed to present cone-beam computed tomography aided diagnosis and treatment for type II dens invaginatus in a mandibular lateral incisor with a talon cusp and a large periapical lesion.

Management of avulsion-induced external root resorption of permanent maxillary left central and lateral incisors - a one-year follow-up case report

The presented case elicits the successful management of external root resorption in an avulsed permanent central and lateral incisor due to failure to initiate root canal treatment (RCT) at the right time and prolonged splinting. A 13-year-old female child reported a complaint of pain in her upper anterior teeth region. The child gave a history of avulsed 21 and 22, which was replanted. External inflammatory root resorption in (21 and 22) and peri apical abscess (11) was noted in the radiograph. External inflammatory root resorption was treated endodontically with corticosteroid-antibiotic medicaments and obturated with mineral trioxide aggregate (MTA). Obturation was done only after restoring tooth stability and symptom resolution. Replacement resorption was noted radiographically during the follow-up visit. This case underscores the importance of meticulous endodontic care and adherence to treatment timelines, providing valuable insights for clinicians managing similar challenging cases.

Treatment of a challenging case of impacted, severely dilacerated & deflected maxillary central incisors: A case report with 10 years follow up

Impaction, dilaceration, and internal deflection of both maxillary permanent central incisors are not frequently reported in dental practice. The treatment approach is essential as it plays a pivotal role in contributing to the facial aesthetics and occlusion in permanent dentition of the individual. This is a case of a 10-year-old male diagnosed radio graphically with impacted, severely dilacerated, and deflected both the Maxillary central incisors. The management of the case was carried out surgically and orthodontically. By combining two stages of surgical exposure, orthodontic traction and alignment, the impacted dilacerated and deflected incisors were successfully moved into the desired position. A ten-year follow-up of the stability and periodontal health showed that the tooth placed in the occlusion maintained both esthetics and function.

Clinicopathological comparison of periapical cyst and periapical granuloma in a cohort of Tamil population

Aim: The aim of this study was to present and analyze detailed clinicopathological data of periapical cysts (PCs) and periapical granuloma (PG) in a cohort of 135 cases from the South Indian Population. Methodology: The present study included 135 cases of PC and PG out of 2696 biopsies submitted over 3 years. The clinicodemographic data which included age, gender, location, radiographic appearance, and treatment were collected along with the histopathological examination of the biopsied specimen. Data were entered in a Microsoft Excel spreadsheet, 2021, and analyzed using SPSS software ver. 26. Results: There were 71 cases of PG and 64 cases of PC. The mean age of occurrence in PG was slightly lower than cases in PC. Irrespective of the group, there was a clear male preponderance, and maxillary permanent central incisors were most commonly affected. However, no significant difference was noted. Radiographically, PC significantly showed more well-defined corticated radiolucent lesions compared to PG where most cases were ill-defined (69.01%). Histologically, all cases showed classic features for diagnosis with additional histological characteristics which may aid in diagnosis. Conclusion: PG was more common than PC. There was a predilection for the male gender in both lesions. The actual incidence of these lesions would be actually high, as some cases are lost to private practitioners, and not all the lesions are submitted for histopathological examination.

A study of macrodontia of the permanent maxillary central incisors among Delta State University students in Abraka, Nigeria

Macrodontia (or megadontia) is a rare dental anomaly characterized by excessive enlargement of all tooth structures, and in few cases may be associated with morphological anomalies. The goal of this study was to find out how common macrodontia of the maxillary central incisors was among Delta State University students in Abraka. The Research and Ethical Committee of the Department of Human Anatomy and Cell Biology, Delta State University, Abraka, gave approval for this study. A descriptive cross-sectional survey with a representative sample of 102 subjects was conducted (58 female and 44 male). The method used was a simple random sampling technique. The age and sex of each subject were obtained using a data form, and intra-oral measurements of the mesio-distal width of the maxillary right central incisors were taken. Results were arranged according to age and sex to ascertain the occurrence of sexual dimorphism; independent sample t test and chi-square test were used as inferential statistical tools. The prevalence of macrodontia was 35.3%; there was a significant sex difference, as p value was <0.05; there was no significant difference within the age groups, as p-value was > 0.05. The mean mesio-distal width was 8.54±0.25 mm in those who did not have macrodontia and 9.63±0.54 mm in those who did have macrodontia. Macrodontia of central incisors is dominant amid Delta State University learners in Abraka.

Conservative management of lateral canal biofilm-related persistent intraoral sinus and other complications in traumatized, immature incisors: A case report with 30 months’ follow-up

Conservative or regenerative endodontic treatments are the preferred approaches for managing traumatized (vital or necrotic) immature permanent teeth in growing patients. Diagnosing pulp vitality preoperatively using sensitivity tests can be challenging, especially if multiple teeth are traumatized, potentially leading to the failure of the chosen endodontic treatment. Unexpected complications, such as persistent intraoral sinus related to the lateral canal (often not visible on conventional radiographs) and delayed periradicular bone healing, may also arise. This case report presents the successful conservative management of three traumatized incisors with such complications. A novel intracanal dressing method was used to treat a persistent intraoral sinus related to the lateral canal in the permanent maxillary left central incisor, which was unresponsive to traditional dressing materials and methods, thereby avoiding surgery or extraction. Additionally, delayed bone healing in response to revascularization treatment in the permanent maxillary right central incisor, and the initially involved vital permanent maxillary right lateral incisor, was addressed with re-revascularization and root canal treatment, respectively. This article discusses tailored management strategies and possible reasons for associated complications in traumatized teeth. It emphasizes the importance of high-quality radiographic images, pulp vitality tests based on blood oxygenation, understanding the presence of biofilm in lateral canals, modified dressing methods, appropriate dressing vehicles, and the necessity of patience in treating traumatic dental injuries. Keywords: Biofilm; Conservative Management; Pediatric Dentistry; Root Canal Medicaments; Teeth Injuries

An in vitro evaluation of Icon resin infiltrant penetration into demineralized enamel lesions using an indirect staining technique with confocal laser scanning microscope analysis in dual fluorescence mode.

White spot lesion is the first clinical sign of a caries lesion and represents mineral loss from the enamel subsurface. The aim of this study was to evaluate the penetration depth (PD) of Icon resin infiltrant into artificially demineralized enamel lesions using confocal laser scanning microscope (CLSM) analysis in dual fluorescence mode. The design of the study was an in vitro study. 22 extracted human permanent maxillary central incisor teeth were collected, and enamel sections were obtained from the coronal middle third. All enamel specimens were exposed to demineralization and remineralization solutions for 14 days. On positive confirmation of enamel demineralization by scanning electron microscope analysis, 20 specimens were then subjected to Icon resin infiltration following manufacturer instructions. Specimens were processed with indirect staining technique using rhodamine B and sodium fluorescein dyes and examined under CLSM at ×10 magnification in dual fluorescence mode using ImageJ software to evaluate PD of resin infiltrant into demineralized enamel lesions. Obtained data were analyzed using an independent t-test. P ≤0.05 was considered statistically significant. The maximum depth of demineralized enamel lesion was 590 μm, and the mean depth was 290.78 ± 14.80 μm. The maximum depth of resin infiltrant penetration was 580 μm, and the mean depth was 279.08 ± 13.88 μm; P = 0.006. The percentage penetration of resin infiltrant was 95.99%. Icon resin infiltrant was highly effective in its depth of penetration into demineralized enamel lesions. The use of indirect staining and CLSM analysis in dual fluorescence mode is more reliable and accurate technique to evaluate the PD of resin infiltrant.

Dental Developmental Defects: A Pilot Study to Examine the Prevalence and Etiology in a Population of Children between 2 and 15 Years of Age.

Dental development defects (DDDs) are quantitative and/or qualitative alterations produced during odontogenesis that affect both primary and permanent dentition. The etiology remains unknown, being associated with prenatal, perinatal, and postnatal factors. The aims were to identify the possible etiological factors, as well as the prevalence of DDDs in the primary and permanent dentition in a pediatric population. Two hundred twenty-one children between 2 and 15 years of age, patients of the master's degree in Pediatric Dentistry of the Complutense University of Madrid, were reviewed. DDDs were observed in 60 children. Next, a cross-sectional, case-control study was carried out (60 children in the control group and 60 children in the case group). The parents or guardians completed a questionnaire aimed at identifying associated etiological factors. The prevalence of DDDs in patients attending our master's program in both dentitions was 27.15%. Otitis, tonsillitis, high fevers, and medication intake stood out as the most relevant postnatal factors among cases and controls. The permanent maxillary right permanent central incisor and the primary mandibular right second molar were the most affected; there were no differences in relation to gender. One out of three children who presented DDDs in the primary dentition also presented DDDs in the permanent dentition. Prenatal and postnatal etiological factors showed a significant relationship with DDD alterations, considered risk factors for DDDs in both dentitions.

Analyzing the Impact of Different Bonding Protocol Strategies to Improve the Fracture Resistance of Uncomplicated Crown Fractures on Tooth Fracture Reattachment in Permanent Anterior Teeth: An In-vitro Study.

Objective This study aims to analyze three different bonding protocol strategies in determining the fracture resistance on the reattachment of fragments in permanent anterior teeth. Methodology This study evaluated the ability of three bonding methods (Group A, total-etch technique; Group B, selective-etch technique; and Group C, self-etch technique) to enhance the fracture resistance of reattached tooth fragments. Sixty permanent maxillary central incisors were chosen, segmented at 3 mm from the incisal edge, and randomly distributed among the three groups. Tooth fragments were stored for 24 hours in GC Tooth Mousse (GC Corporation, Tokyo, Japan), and then reattachment was done using respective bonding techniques. Fracture resistance was gauged using a universal testing machine. Results The mean fracture resistance values were as follows: total-etch (419.5995 N), selective-etch (359.1448 N), and self-etch (192.0887 N). One-way analysis of variance (ANOVA) and post hoc Tukey tests revealed a statistically significant difference between the groups. It was inferred that the total-etch technique exhibited the highest fracture resistance, while the self-etch technique resulted in the lowest fracture resistance (P < 0.05). Conclusions The choice of bonding technique for reattaching tooth fragments should be made based on clinical context and patient needs. Total-etch provided the highest fracture resistance, but selective etch can be preferred for anterior teeth with lower occlusal loads to prevent sensitivity.The self-etch technique may not provide sufficient strength and should be used cautiously. More clinical studies are required to validate these findings and guide clinical decision-making in traumatic dental injury management.