Permanent Maxillary Left Central Incisor Research Articles

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.

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

Endodontic management of two-rooted maxillary central incisor using cone-beam computed tomography: A case report and literature review

Morphological variations of the pulpal chamber are considered a challenge and may affect successful treatment or prognosis. Maxillary central incisors usually present one canal system and one root. In this report, a 47-year-old Saudi male patient presented with symptomatic permanent maxillary left central incisor with two roots associated with draining sinus tract and buccal groove. The tooth was not mobile but was tender to percussion and palpation. The periapical radiograph demonstrated apical radiolucency of the two-rooted central incisors. The endodontic diagnosis was pulpal necrosis with chronic apical abscess. With aid of periapical radiographs and cone-beam computed tomography evaluation, successful nonsurgical root canal treatment was achieved at 1-year follow-up. Careful preoperative clinical and radiographic examinations to identify any anatomical variations are crucial for appropriate management and successful outcome.

MULTIDISCIPLINARY APPROACH OF IMPACTED PERMANENT MAXILLARY LEFT CENTRAL INCISOR AND CANINE

ABSTRACT Background: The permanent maxillary canines have significant incidence of impaction, being the most affected teeth after the third molars, while impacted maxillary insicor is the third most commonly impacted tooth. Objective: This case report is about a multidisclipinary orthodontic treatment of 12 years old female with chief complaint of unerupted anterior upper teeth. Case: A case with unerupted of permanent maxillary left central incisor tooth and permanent maxillary left canine tooth, with Angle Class 1 molar relation and crowded of mandibular teeth. Panoramic and occlusal radiograph showed impacted 21 tooth with severely root dilacerations and impacted 23 tooth in palatal and horizontal position. Case Management: The patient was treated with Edgewise technique. Surgical approach was applied 3 months after levelling and unravelling stage to extract 21 tooth due to its severely root dilaceration and to bond lingual button on palatal side of 23 tooth. Orthodontic traction of impacted 23 tooth was applied a week after being exposed to the position of 21 tooth. Thirteen months after traction, 23 tooth was totally erupted and need 8 additional months to reach its final position. The crown of 23 was reshaped with porcelain fused to metal crown and 63 tooth was left still and got conservative treatment with composite. Conclusion: Orthodontic traction and reshaping of impacted 23 tooth was succeeded to replace the position of 21 tooth with good occlusion and esthetic. Based on OPG after treatment, all teeth were in good root paralleling. The patient was satisfied with good occlusion and esthetic. Keywords: Impacted maxillary canine, Impacted maxillary incisor, Root dilaceration, Orthodontic treatment, Surgical exposure

COMPARATIVE EVALUATION OF TIMING AND CLOSURE OF IMMATURE ANTERIOR TEETH WITH OPEN APEX USING TWO DIFFERENT REGENERATIVE MATERIAL: A CASE REPORT-12 MONTHS FOLLOW-UP

Regenerative endodontic Procedures provide an unconventional approach which relies on the principle of tissue engineering. Pulp necrosis of immature permanent teeth may impair root development and apical closure of root canals. Completion of root development takes around 3 years after eruption of permanent teeth. Management of immature non vital teeth is very challenging for a clinician because teeth may have wide open apex and thin root canal walls that may diverge towards the apex. Conventional cleaning and shaping of the canals and obturation may not be possible because of the lack of apical stop. Since debridement of pulp canal space is difficult, there is an increased possibility of root perforation and cervical root fracture, besides the presence of an open immature root apex jeopardize the apical seal of a root canal treatment resulting in subsequent failure. 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 Biodentine (Calcium trisilicate cement) and Metapex paste (Calcium hydroxide and Iodoform).

Transnasal Extraction of Mesiodens and Guided Eruption of Unusual Impacted Central Incisor: A Case Report and Review of Literature

Mesiodens is one of the developmental problems in children and adolescents. Mesiodens is a supernumerary tooth in the midline between two central incisors which eventually causes poor aesthetics, food impaction, malocclusion and cyst formation. This is a rare case of a 13-year-old male with unusual impacted inverted permanent maxillary left central incisor and horizontally placed mesiodens lying palatal to the permanent maxillary left central incisor. The patient presented with unerupted permanent upper left central incisor. Although most unerupted teeth require surgical removal, surgical-orthodontic treatment may be needed when maxillary incisors are involved due to the aesthetic impact. Surgical-orthodontic treatment aims at the complete alignment of natural teeth and does not require prosthetic intervention. This case report also reviews current literature on the treatment and multidisciplinary management of this problem. Early diagnosis and treatment are recommended to prevent any orthodontic and pathological complications.

Traumatic dilaceration of permanent central incisor.

A 10-year-old male child was reported to our department with a chief complaint of a nonerupted tooth in the upper front region of jaw. The patient's mother reported positive traumatic history in the upper anterior region of the jaw 4 years back due to a road traffic accident, resulting in the intrusion of the left primary central maxillary incisor. The intruded tooth reappeared spontaneously and exfoliated normally. In the present scenario, clinical examinations showed impacted permanent maxillary left central incisor and the presence of a small hard nodule in the palatal aspect and in the labial vestibule of the same tooth. A Cone-Beam Computed Tomography (CBCT) radiographic examination was carried out in order to diagnose the cause of an impacted tooth and revealed dilaceration of permanent left central incisor along the length of a tooth. Hence, the final diagnosis was made as impacted dilacerated permanent left central incisor (due to trauma). Management of impacted dilacerated permanent teeth was done by surgical exposure with orthodontic traction.

Efficiency and side effects of a novel method for maxillary central root torque (a horizontal box loop of round wire) in comparison with the conventional rectangular wire: A finite element study

Applying root torque using conventional methods (rectangular wire) has side effects such as inverse and destructive forces, undesirable torque on adjacent teeth, heavy forces that are limited in range and duration, and needing too many sessions. We introduce a new method (a horizontal box loop [HBL]) that is designed to reduce many of these side effects; we tested its efficiency and side effects using finite element analysis. An HBL was created from a 0.018-in round stainless steel archwire, in the form of an equilateral triangle of 7mm sides, for the permanent maxillary left central incisor. As a control, a SS rectangular wire (19×25-in) was used. First, a pilot simulation was performed to standardize the torque in both models as 31.099Nmm. The extent of twisting by the rectangular wire, of which the same amount of moment would be applied, was estimated at 28.282°. The main study evaluated the effects of the 31.099N.mm moments applied by both models to the left central incisor on stresses, dental movements (buccolingually, mesiodistally, and extrusive or intrusive), and intercanine or intermolar widths. Under standardized conditions, the HBL causes a greater palatal root torque of the central incisor than the rectangular wire. The HBL does not apply reverse root torque on adjacent teeth, whereas the rectangular wire causes reverse root torque in neighboring teeth. The HBL also causes less extrusion and expansion in the molar area than does the rectangular wire. The HBL increases intercanine width, whereas the rectangular wire might not change it. HBL of round wire seems an appropriate appliance and hence its clinical assessment is recommended.

Reattachment of hydrated fractured fragment of permanent maxillary central incisor, one of its kind (2 year follow up): A case report

Background: Traumatic injuries to maxillary anterior teeth are seen in children and adolescents to major extent resulting into anterior teeth fractures. Different treatment strategies are available for its management, although tooth fragment reattachment is considered to be a feasible treatment option due to its comprehensibility, aesthetics, and functional success. Case Description: Present case reports a case of a 10-year-old girl patient with a fractured permanent maxillary left central incisor (Ellis class II) with emphasis on hydration and reattachment of the fractured fragment. The present paper reports the reattachment of the stored fractured fragment in milk as a hydrating medium. The fragment was reattached using an adhesive bonding system and a resin composite material on the mesioincisal angle of 21 and the distoincisal angle was built up with traditional method. At 2-years follow up tooth maintain its vitality along with aesthetics and function. Conclusion: The retrieved fractured fragment of anterior teeth can be stored in milk till patient report to clinic followed by hydrating the fractured fragment using normal saline in dental office before reattachment. Clinical Significance: Management of available fractured tooth fragment by reattachment technique, offers a feasible and minimal non-invasive option for the dental clinician.

English

Resorption of the tooth represents a multifactorial and a perplexing problem for all clinicians resulting in complete or partial loss of tooth structure. The present clinical demonstration describes management of the permanent maxillary left central incisor (tooth number #21) affected by external root resorption involving the mesial and distal surface of middle one-third of the root. Conventional nonsurgical endodontic treatment followed by MTA (Mineral trioxide aggregate) obturation (PRoRoot MTA, Dentsply, Tulsa Dental Specialties) was planned. The root canal of the affected teeth was debrided with Dual Rinse HEDP (Medcem Weinfelden, Switzerland) containing etidronate powder and chemomechanical preparation of the root canal was performed with XP endo shaper file system (FKG Dentaire, SA, Switzerland). Thirtysix months’ post-operative follow-up revealed complete healing of the external root resorption defect with no clinical and radiological signs and symptoms. In the present case simple non-surgical endodontic management of severe external root resorption was done in a permanent maxillary tooth by using a continuous chelation irrigation technique, intracanal medicament followed by obturation with bio-ceramic material produced satisfactory results in contrast to the recommended surgical management. Resorption of the tooth being a multifactorial and a perplexing problem for all clinicians results in complete or partial loss of tooth structure. According to the Glossary of Endodontic terms, Resorption is defined as a condition associated with either a physiologic or a pathologic process resulting in the loss of dentine, cementum, and/or bone.1 Traditionally resorption can present either as internal or as external resorption.2 External root resorption occurs on the outer surface of the root and are of dissimilar nature such as external surface resorption, external inflammatory root resorption, ankylosis, and external replacement resorption, the most common being external inflammatory root resorption.3 According to the Glossary of Endodontics, “Inflammatory resorption is defined as an internal or external pathologic loss of tooth structure and possibly bone, resulting in a defect; occurs as the result of microbial infection; characterized radiographically by radiolucent areas along the root”.1 It may result due to dental trauma, forceful orthodontic tooth movement, long standing infection of the pulp or periodontal tissues. External resorption presents as a major resorptive condition of the root without any clinical signs and symptoms.2 The non-surgical management of external inflammatory root resorption is based on its aetiology, which needs to be eliminated

Management of a Periodontally Compromised Grade III Mobile Tooth Associated with Pyogenic Granuloma

With current advancements in the field of dentistry, the dental treatments today are focused more on conserving the tooth and supporting the concept of “nothing serves better than the natural tooth itself.” This case report presents a multidisciplinary treatment approach adopted in retaining a Grade III mobile periodontally compromised permanent maxillary left central incisor in a 32-year-old female patient who reported to the Department of Periodontics and Oral implantology with the chief complaint of intraoral swelling, pus discharge, bleeding gums, and tooth mobility in the upper front tooth region. At 1-year follow-up, the tooth was periodontally stable and functional.

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.

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.

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.

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.

A rare case of an immature incisor with horizontal root fracture traumatized at the time of eruption

Dental trauma resulting in root fracture is a rare condition that affects up to 7% of permanent teeth, and injury to immature teeth is even rarer. This case report aimed to show the prognosis of a horizontal root-fractured immature maxillary incisor traumatized at the time of eruption.
 Because of an accident, a 6-year-old boy was referred to our clinic with horizontal root fracture of the permanent maxillary left central incisor associated with an extrusive luxation. The coronal segment was repositioned, and a dental splint was applied for 7 weeks. After 48 months, clinical examination revealed a positive response to electrical pulp testing and an absence color change of the tooth. Continuation of root development and calcification of the coronal pulp space was observed radiographically. It was concluded that fixation of teeth is a conservative treatment for immature teeth with horizontal root fractures, resulting in the pulp vitality and spontaneous healing with no other treatment.
 
 How to cite this article: Erkmen Almaz M, Şaroğlu Sönmez I, Akbay Oba A. A rare case of an immature incisor with horizontal root fracture traumatized at the time of eruption. Int Dent Res 2018;8(2):94-6.
 
 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Three year follow-up and management of a severely dislocated tooth after primary trauma.

Objective: This case report describes the management and a 3-year follow-up of an unerupted and ectopic positioned anterior tooth. Case Report: The patient, a girl (9 years old) was referred due to the lack of a permanent maxillary left central incisor. When she was 2 years old suffered a complete intrusion of her primary maxillary left central incisor, and the tooth re-erupted after 4 weeks. Radiographic examination revealed the impaction and severe dislocation of the permanent maxillary left central incisor. The impacted tooth was surgically exposed and placed in orthodontic traction for alignment over a period of 12 months. Results: After this period the central incisor presented satisfactory periapical and periodontal health, adequate occlusion and a good esthetic outcome. After three years of follow-up, apically rounded and no extensive damage to tooth or tissues structures were observed Conclusion: The orthodontic management had been successfully performed with excellent functional and esthetic results. Treatment of an impacted incisor is a challenge, which should be carefully planned. A clinical and radiographic follow-up by a multi-professional group is of outmost importance.

Early treatment of nonsyndromic oligodontia: a clinical case report

This report aims to describe the clinical case of a 10-year-old male patient (R.C.B.C.), presenting nonsyndromic oligodontia with maternal family trait and absence of 22 permanent teeth. Clinically, the patient had prolonged retention of some primary teeth and presence of permanent maxillary left central incisor, permanent mandibular right central incisor and four first permanent molars. Radiographically, only permanent maxillary second molars and mandibular third molars were developing, whereas all other germs of permanent teeth were missing. Treatment consisted of maxillary expansion followed by moving permanent maxillary left central incisor bucco-mesially, and rehabilitation of spaces with removable denture, where the main goal was to restore function and esthetic harmony. The case has been monitored for the past six years. Nonsyndromic oligodontia is a rare condition that poses significant functional and psychosocial difficulties. Treatment usually requires a multidisciplinary approach among which pediatric dentistry and orthodontics play a major role. In view of its complexity, treatment should be initiated as early as possible to minimize future functional and aesthetic issues. Dental implants are considered as definitive treatment of cases of oligodontia, however, until the patient reached the ideal age, other treatments to ensure aesthetics and function must be performed.

Mesiodens surgery at deciduous and permanent dentition

Introduction and Objective: To report a rare case of a patient who presented two mesiodens and the treatment performed at two moments. Case report: A 7 year-old male patient reported a supernumerary tooth extracted at age 4. The dental clinical exam revealed giroversion of permanent maxillary right central incisor. Cone-beam computed tomography (CBTC) revealed a presence of a mesiodens located at the buccal surface mesially to the permanent maxillary left central incisor and also indicated that the mesiodens was located close tothe f loor of the nasal cavity. The surgery was performed with a conservative intervention and osteotomy by preserving the adjacent structure. The one-year following-up post-operative x-ray indicated new bone deposition and a more favorable eruption position of the right permanent maxillary lateral incisor. Conclusion: It can be concluded that an early diagnosis by CBTC allowed an adequate treatment planning, which avoid the formation of cysts and a prolonged retention of permanent tooth.

Revascularization of an impacted, immature dilacerated permanent maxillary central incisor associated with odontoma and a supernumerary tooth

To intentionally replant an impacted immature permanent maxillary central incisor in the mixed dentition period followed by revascularization in order to achieve apical root closure. A 9-year-old boy presented with retained maxillary left primary incisors. Radiographic evaluation revealed the presence of a supernumerary tooth and an odontoma associated with an impacted permanent maxillary left central incisor, having root dilaceration. Treatment included surgical removal of mesiodens and odontoma. The impacted dilacerated permanent central incisor was removed and intentionally replanted, followed by revascularization of pulp. During the follow-up, root end closure with narrowing of canal space was observed, patient has been asymptomatic and the tooth remains vital. Revascularization of the immature reimplanted tooth showed continued root development and thickening of the lateral dentinal walls through deposition of new hard tissue and narrowing of the canal space.