Primary Central Incisors Research Articles

Unusual transalveolar and transmuco-gingival root avulsion of a fractured primary central incisor: a case with an 8-year follow-up.

The purpose of this unique case report is to describe a very unusual dentoalveolar fracture associated with avulsion of the near-complete root. A 3-year-old male patient came for consultation after a dentoalveolar trauma with a “fragment that looks like canine” found in his mouth by his mother. This boy suffered root fracture of the upper primary central right incisor, accompanied by transalveolar and transmuco-gingival avulsion of the tooth root fragment, leaving the crown in its position in the dental arch. Clinical and radiological examinations were performed in order to follow up the case: 15 days, one month, and three months after trauma, the crown had a slight mobility without other clinical or radiological signs. After six months, the upper primary central right incisor's crown was exfoliated. Open bite due to the persistence of the pacifier habit favored the crown retention in the mouth. This case emphasizes the importance of primary diagnosis and follow-up of trauma cases. To the best of our knowledge, this kind of dental injury has not been previously described in the literature nor in the current Dental Trauma guidelines for the management of traumatic dental injuries in the primary dentition.

Gemination in primary central incisor

Geminated teeth are the consequences of developmental anomalies leading to the eruption of joined elements. According to the current definitions, gemination occurs when one tooth bud tries to divide, whereas fusion occurs if two tooth buds unite. This article presents one such case report of germination of a primary tooth which was endodontically treated due to deep carious involvement.

Compound odontoma causing impaction of permanent maxillary incisors with associated ghost cell keratinization: A case report

Many times compound odontomas are found associated with unerupted teeth. The canines, followed by maxillary central incisors and third molars are the major teeth which are impacted by odontomas. Herewith, this paper reports a case of compound odontoma associated with impacted permanent right maxillary central and lateral incisors. An 11-year-old girl reported with a chief complaint of retained primary tooth. Intraoral examination revealed that primary maxillary right central and lateral incisors were retained while permanent maxillary left central and lateral incisors were erupted and well accommodated. A non-specific swelling was there on labial aspect of 51 and 52 tooth region, which was measuring about 0.5 cm × 1 cm, enlarging mesiodistally from distal of permanent left central incisor tooth to distal aspect of over retained right primary lateral incisor. Digital orthopantomograph showed calcified masses in the form of toothlike structures present above the root apex and distal aspect of 51 and 52, causing root resorption. On the source of the past, clinical and radiographic assessment a final opinion of compound odontoma was made.

Bilateral Fusion of Primary Mandibular Incisors: A Rare Case Report

A 32-month-old boy accompanied by his parents reported with chief complaint of decayed teeth. The patient did not have any systemic disorder and his medical history was noncontributory. There was no family history of dental anomaly and no consanguinity was reported in the parents. On examining the patient intraorally, bilateral presence of unusually large teeth in the mandibular incisor region was seen. Both side lateral and central incisor were fused to form large tooth [Table/Fig-1]. [Table/Fig-1]: Intraoral view of fused bilateral mandibular central and lateral incisors These bulbous teeth were not affected by dental caries and periodontal problems. Radiographic evaluation of the left and the right sides revealed two distinct roots and root canals and were evident of the fused 71,72 and 81,82 [Table/Fig-2]. The underlying permanent successor tooth were also evident in both the intraoral and periapical and panoramic radiographs [Table/Fig-3]. So, a diagnosis of bilaterally fused mandibular primary central and lateral incisors was made. Now patient is on follow-up. [Table/Fig-2]: IOPA showing bilateral fused mandibular central and lateral incisors [Table/Fig-3]: OPG showing bilaterally fused mandibular incisors and presence of permanent tooth germ The developmental anomaly of union of two deciduous or permanent teeth is called as fusion. There are certain problems associated with fusion namely aesthetic problems, space problems, occlusal disturbances and delayed eruption of permanent teeth. Therefore careful monitoring of the case is required. This case report highlights a rare case of bilateral fusion of primary mandibular incisors in a 32-month-old boy. In the primary dentition various anomalies of number and form may occur [1]. One of such anomaly is fusion which is identified as union of two distinct dental organs. In fusion the number of teeth in the dental arch is reduced. This anomaly is different from gemination because in gemination single tooth germ divides into two. The causes of fusion is still unknown but possible cause can be due to the pressure or physical forces, close contact between two developing teeth occurs [1]. Other contributing factors include genetic predisposition and racial differences. Fused teeth may also present in some syndromes like chondroectodermal dysplasia or achondrodysplasia. In primary teeth, the incidence of bilateral fusion is 0.01-0.04% [2]. In fused teeth, the clinical crown appears as a crown which is double the size of normal crown. On radiographic examination, fused teeth can show separate pulp chambers and root canals or a single common pulp chamber and root canal system. Fused teeth can predispose to caries due to presence of deep fissures and can also lead to periodontal, aesthetic and spacing problems [3]. Fusion occurs when some physical force or pressure brings contact of the two normally separated tooth germs. It occurs during developmental stage of the teeth. When the contact occurs before calcification stage, a single large tooth is produced. When the contact and union of the teeth occurs after the formation of the crown, the incomplete fusion at the root level is formed. Several problems occurred in permanent dentition follow fused primary teeth such as repeated double teeth, hypodontia (missing teeth), supernumerary teeth and peg shaped teeth [1]. Also, double primary teeth may cause delayed resorption of the root because of the big root mass, resulting in delayed or ectopic eruption of permanent teeth [4]. Fused primary teeth are highly correlated with the absence of permanent teeth and the prevalence depends on the combination of fused primary teeth [5].

Case of Horizontally Impacted Maxillary Primary Central Incisor Causing Eruption Disorder of Permanent Successor

Case of Horizontally Impacted Maxillary Primary Central Incisor Causing Eruption Disorder of Permanent Successor

Epulis appeared after exfoliation of natal tooth in infant Japanese boy

Abstract An 8-day-old infant boy was referred to the Clinic of Pediatric Dentistry of Osaka University Dental Hospital for examination of natal teeth. An intraoral examination showed that two natal teeth had emerged into the oral cavity in the region of the mandibular primary central incisors, with the edge of one in the region of the mandibular right primary central incisor found to be in contact with the undersurface of the tongue. The affected tooth displayed severe mobility and the edge appeared to produce sublingual erosion; thus, it was extracted. In addition, a natal tooth in the opposite quadrant appeared to be attached to the surrounding gingiva with moderate mobility. Although we attempted to preserve that tooth, his parents reported that it was spontaneously exfoliated a few days later. Five months later, the patient returned to our clinic with swelling of the gingiva in the mandibular left primary central incisor region and a pedunculated epulis-like lesion was recognized in the gingiva of the mandibular left primary central incisor. A periapical X-ray photograph demonstrated thin radiopaque tissue with the appearance of a root in the area of the previously exfoliated natal tooth. We decided to remove the epulis-like lesion and associated thin hard tissue under local anesthesia. Histopathological analysis demonstrated that the lesion was composed of periodontal fibers covered by a layer of squamous epithelium cells, along with hemorrhage and vasodilatation under the mucosa. Taken together, the pathologist diagnosed the lesion as an epulis with inflammatory change.

Delayed eruption of mandibular primary central incisors in a child with severe lingual inclination and their spontaneous movement to appropriate positions

We previously reported a quite uncommon case of delayed eruption of primary mandibular bilateral incisors with severe lingual inclination identified in a Japanese girl aged 2 years 8 months. An intraoral examination demonstrated the tooth crown morphology of the primary mandibular incisors in the lingual submucosal area, while radiographic examinations of the affected teeth revealed what appeared to be a standard root morphology and the permanent successors located close to the affected teeth. We decided to perform periodical examinations at least until the roots of the permanent successors were sufficiently formed and here report recent findings in this case. At 2Y10M, the edge of the tooth crown of the primary mandibular left central incisor had emerged into the oral cavity and one-third of the tooth crown was identified at 2Y11M. Thereafter, the tooth crown of the primary mandibular right central incisor was identified under the mucosa at 3Y1M. A periapical radiograph taken at 3Y7M demonstrated formation of the permanent successors under development. At 3Y10M, nearly the entire part of the tooth crowns of both affected teeth had emerged and then they started to move gradually in a labial direction. At 4Y2M, the crowns of the affected were nearly within the dental arch, while periapical radiograph images showed straight roots for the affected teeth and the developing permanent successors. We intend to continue to perform periodical examinations to follow the development of the permanent successors until eruption.

Biologic restoration of a traumatized maxillary central incisor in a toddler: A case report

Trauma to the anterior teeth is relatively common in young children and teenagers. Traumatized anterior teeth require quick functional and aesthetic repair, and poses a challenge to the dental practitioner owing to the lack of co-operation ceded and the longer time invested. Reattachment of tooth fragment should be the first choice to restoring teeth when a usable fragment is available, since it gives a psychological and aesthetic advantage over the conventional technique. With the vast improvement in adhesive technology, reattachment is definitely a predictable treatment option for very young children. This paper describes the treatment of a 2½ year old female child who sustained crown-root fracture, extending subgingivally, in primary upper central incisor.

Fusion In Deciduous Mandibular Anterior Teeth – A Rare Case

Fusion Tooth due to the union of two separated tooth germs, it may be complete or incomplete tooth fusion depending on the time of union and stages of tooth development. It may be between two normal teeth or sometimes between normal tooth and supernumerary tooth germ. Here we report a rare case of fusion between right mandibular primary central and lateral incisors in a six year old girl.

A case report : Root canal treatment and prognosis of a maxillary fused primary central and lateral incisor

A case report : Root canal treatment and prognosis of a maxillary fused primary central and lateral incisor

Radicular maturity level of primary teeth and its association with trauma sequelae

This study aimed to investigate the influence of the radicular maturity level of primary teeth on the sequelae of traumatic dental injury (TDI). A longitudinal retrospective study that collected data from dental records and radiographs of patients with TDI in one or both maxillary primary central incisors was conducted. Sequelae such as crown discoloration, pulp canal obliteration (PCO) and inflammatory root resorption (IRR) were evaluated during a 12- to 18-month follow-up period after the trauma. Of the 132 patients included in the study, 103 (78%) had luxations and 29 (22%) had dental fractures. At the initial postinjury examination, 12 teeth (9.1%) were found to have immature roots, 107 (81.1%) had closed apexes and 13 (9.8%) had visible root resorption. Inflammatory root resorption occurred mostly in traumatized teeth that presented with physiological root resorption at the moment of trauma (P = 0.004). The frequency of PCO was higher in teeth with a closed apex at the moment of the injury (P = 0.026). There was also an association between the type of injury and the occurrence of crown discoloration (P = 0.008) as well as between the type of injury and the development of PCO (P = 0.001). The occurrence of TDI sequelae can be determined by the type of injury as well as by the radicular maturity level of the primary teeth at the moment of injury.

A foreign body in disguise

Young children habitually place objects in their mouths to discover and learn about the world and it is considered a normal stage of early childhood development. Ingestion and aspiration of foreign objects predominantly occurs in preschool toddlers with a peak incidence at age three years, and can have serious consequences. A 2-year-old boy presented to the Dublin Dental University Hospital with a tooth-coloured mass tightly adherent to a lower primary incisor. The lesion surrounded the cervical third of the crown on the lower right primary central incisor and extended subgingivally. The tooth was mobile but with minimal inflammation. The tooth was subsequently extracted under general anaesthesia to reveal that the mass was in fact a foreign body, although this was originally thought unlikely as a cause. The patient underwent an unremarkable recovery. The case of a foreign body disguised as a tooth-like abnormality was only identified under general anaesthesia, and even then it was impossible to prise the object from the tooth in situ. Misdiagnosis of impacted foreign bodies in young children presents complicated diagnostic problems.

Volume measurement of crowns in mandibular primary central incisors by micro-computed tomography

Objective. To determine sex differences in the tissue proportions of crowns of mandibular primary central incisors in Chinese children and to quantify the volume of crown components in three dimensions using micro-computed tomography (micro-CT). Materials and methods. The specimens used in this study were 41 mandibular first deciduous incisor teeth with intact crowns (21 males and 20 females) obtained from patients between 5–6 years of age. Each specimen was scanned using micro-CT at a resolution of 0.05 mm and 3D-rendered images were created. The volume of each component of the crown was measured and examined for differences in different sex and ages. Results. The pulp chamber volume decreased with age and the volume ratio of the pulp chamber to the whole crown was significantly smaller in 6-year-olds than in 5-year-olds (p < 0.05). Conclusions. Males had significantly larger tooth crown volumes and dentin volumes than females did (p < 0.001), while the volume of enamel showed no sexual dimorphism.

Horizontal impaction of primary mandibular bilateral central incisors identified in 2-year-8-month-old girl

A girl aged 2 years and 8 months came to our clinic for consultation with regard to unerupted primary mandibular bilateral central incisors. An intraoral examination revealed that the teeth had not emerged into the oral cavity and showed a tooth crown morphology similar to that of the primary mandibular incisors, which appeared in the lingual submucosal area outside of the mandibular dental arch. Periapical radiographs demonstrated that the tooth crowns of both affected teeth were severely displaced to the lingual side. Computed tomography examinations were performed to clarify the three-dimensional positions of the affected teeth and their permanent successors, which revealed that the affected teeth were located in their estimated positions and had a standard root morphology. In addition, the permanent successors, which had not initiated root formation, were located close to the affected teeth. We decided to postpone extraction of the affected teeth and perform periodical examinations until the roots of the permanent successors are sufficiently formed. At the age of 2 years and 10 months, the edge of the tooth crown of the primary mandibular left central incisor was found emerged into the oral cavity. According to her parents, the patient did not complain of the emerging edge and no abnormal conditions were observed around the tooth.

상악 유전치부에 발생한 삼중치 : 증례보고

삼중치는 치아의 형태이상 중 희소한 경우로서 세 개의 치아가 결합된 양상을 보이는 것을 가리키는 용어이다. 그 동안 유치의 결합에 대한 문헌은 많이 보고된 바 있으나 대부분 두 개 치아의 결합에 대한 것이고 세 개 치아에 대한 보고는 드물었다. 삼중치는 치아 우식, 심미적인 문제, 부정 교합, 치주 문제 등을 동반할 수 있어 여러 전문 분야의 협진을 필요로 한다. 이 증례는 1세 11개월 여아의 상악 유전치부에 발생한 드문 증례인 삼중치에 대한 보고이다. 환아는 상악 우측 전치부 순측 치은 종창을 주소로 내원하였으며 3주전 해당 부위에 치아 외상을 입은 병력을 가지고 있었다. 환아의 구강 내 검사 시 상악 우측 유전치부위에 유중절치, 유측절치, 과잉치가 합쳐진 삼중치가 발견되었고 주변으로 누공과 농양이 관찰되었으며 방사선 사진에서 상악 우측 측절치가 결손된 것으로 판단되었다. 해당 치아에 대해 근관치료를 시행하였으며 복합레진을 이용하여 치관부위를 수복하였다. The term 'triple tooth' is used to describe a rare dental abnormality in which three teeth appear to be joined. The literature contains many reports of joined primary teeth; most cases have involved, however, the joining of two teeth, and only rarely three teeth. Triple tooth has clinical problems such as dental caries, esthetic problems, malocclusions, and periodontal problems. Therefore, it may require multi-disciplinary approach. The present study describes rare case of triple tooth between maxillary primary central and lateral incisors and a supernumerary tooth. An one-year, eleven-month old girl was seen for evaluation of swelling in the labial gingiva above a right maxillary triple tooth. She experienced traumatic dental injury in that area three weeks ago. Intraoral examination revealed an abscess and fistula in the region of the triple tooth. A radiographic examination showed that right lateral incisor was missing. Endodontic treatment and composite resin restoration was performed on the triple tooth. After follow-ups of 7 months period, there were no marked complications.

레진 강선 고정을 이용한 유전치 치근 파절의 보존적 치료 : 증례 보고

유치 치근 파절의 치료는 정기 검진을 통해 관찰하거나 발치를 권유하고 있다. 특히 심한 동요도와 변위가 있는 경우 영구치 손상 가능성과 흡인의 위험성 때문에 주로 발치를 시행한다. 하지만 최근 재위치와 고정을 통한 보존적 치료가 새롭게 제시되고 있다. 이른 시기의 유전치 발치는 심미적 문제, 발음 저작 등의 기능적 문제, 공간 소실, 환아와 보호자의 심리 사회적인 문제 등 여러 가지 문제점들을 야기하므로 치근 파절된 유치를 유지하는 것만큼 좋은 치료는 없다. 이 증례 보고는 치근 파절을 보이는 두 증례의 진단, 치료, 평균 27개월의 정기 검진 자료를 토대로 심한 동요도와 변위가 있는 유치 치근 파절의 보존적인 치료 가능성을 제시하고자 하였다. 두 증례에서 발치 대신 재위치와 장기간의 레진 강선 고정을 시행하였고, 후속 영구치가 맹출 할 때까지 정기검진을 시행하였다. 정기검진과정 중에 동통, 치수괴사, 감염, 영구치 치배 변위, 맹출 이상 등의 부작용은 나타나지 않았다. In an intra-alveolar root fracture (IARF) of a primary tooth with severe mobility and displacement, extraction and periodic-follow-up is the choice of recommended treatments because of the fear of aspiration of the mobile tooth and the possibility of damage in the permanent succeeding tooth. However, repositioning and splinting are presented as a fresh proposal recently. In case of extracting a primary incisor, many problems occur; esthetic problems; functional problems such as pronunciation and mastication; space loss; and psychological and social problems. Therefore, the best treatment is conservation of the primary tooth. The aim of this report was to suggest the conservative treatment of an Intra-alveolar root fracture of the primary central incisors with severe mobility and displacement based on two cases that describe the diagnoses, treatments and follow-ups (mean period: 27-month). All cases have been treated by reduction and immobilization by resin wire splint (RWS) (mean period: 6-week). Both cases were followed up until the successors were erupted. There have been no complications such as pain, pulp necrosis, periapical lesion, displacement of permanent tooth germ, eruption disturbance and etc.

A report of an impacted primary maxillary central incisor tooth

Primary tooth impaction is a rare phenomenon when compared to permanent teeth impaction. The purpose of this report is to present a 5-year-old Chinese girl who exhibited impaction of tooth 51, its unusual consequence on the permanent successor tooth and its comprehensive management. Her parents revealed that at 6 months of age, the patient had fallen from her bed and struck her face on the floor; however, there were no teeth present in the oral cavity. The intraoral examinations identified a bony-like projection on the buccal aspect of the alveolus in the 51 region. Radiographic examination revealed that tooth 51 exhibited an unfavourable orientation, with the crown directed towards the palate. Therefore, the impacted tooth 51 was surgically removed, and two years later tooth 11 erupted into the oral cavity with an indentation on its incisal aspect, which resembled the crown of the primary teeth, thus giving the appearance of a tooth within a tooth or 'dens in dente'. Subsequently, enameloplasty and composite resin build-up was performed on tooth 11 for aesthetic reasons. It is very unusual to have the clinical crowns of both primary and permanent teeth in such close proximity within the alveolar bone, and the present case is a good example to emphasize that trauma to the primary teeth is of considerable importance due to the close proximity of the primary teeth to permanent tooth germs.

Opinions of traditional birth attendants in Ibadan, Nigeria, towards reversal of eruption sequence of primary central incisors in infants

Introduction: Traditional birth attendants (TBA’s) have been a good medium for transferring health education messages in culturally acceptable ways. It is believed that they will be a good asset to demystify the misconceptions associated with reversal of eruption sequence in the community. Aim: To assess the opinions of TBA’s towards reversal of eruption sequence of primary central incisors in infants. Methods: A cross sectional study was conducted among all consenting TBA’s in the five urban local government areas in Ibadan, using a pretested 17-item semi structured interviewer administered questionnaire. Results: Forty eight (29.4%) respondents will be astonished at seeing children erupting upper primary central incisors before the lowers, while 25 (15.3%) will regard them as strange. Thirty five (21.1%) respondents felt this condition was due to evil spirits while 13 (8.0%) believed that child’s parents had breached traditional taboos. There was a correlation between negative beliefs about this variation and age (p = 0.038) and education (p = 0.020). Their opinion on the families of the affected children was hideous as (13.5%), (23.3%) and (27.6%) regarded it as a curse, embarrassment and abomination respectively and this was associated with their educational status (p = 0.014). Many (61.3%) of the respondents would advise the parents to hide or get rid of such children whilst (33.7%) advocated for extraction and only 8 (4.9%) felt child and the tooth should be left alone. Conclusion: Many of the TBA’s have dissenting mind-sets towards such children and their families. The practices of many of the TBA’s towards such teeth are disturbing and necessitate urgent intervention. The risks are that wrong advice may be given to such parents by the TBA’s and affected children may be deserted, abandoned, stigmatized and exposed to hazards. Older and less educated TBA’s have a greater tendency to believe these misconceptions.

Comparison of the bleaching efficacy of three different agents used for intracoronal bleaching of discolored primary teeth: An in vitro study

Everyone wants whiter teeth to make them feel younger and to provide beautiful smiles with the accompanying increase in self-esteem. Bleaching is an established, simple, cost-effective and conservative method for improving the color of the discolored teeth. The aim of this in vitro study was to compare the bleaching efficacy of 10% carbamide peroxide, 10% hydrogen peroxide and 2g sodium perborate as bleaching agents on the artificially discolored human primary maxillary central incisors. Forty extracted human primary central incisors with intact crowns were selected for the study. Pulpectomy was performed and each tooth was artificially stained with 2 ml of fresh human blood and centrifuged. --The teeth were randomly divided into four experimental groups of 10 teeth each and the baseline color evaluation was performed. 0.04 ml of the bleaching agent is syringed into the access cavity of the tooth and, in the control group, 0.04 ml of distilled water was syringed into the access cavity and it was sealed with IRM and placed at 37°C in an incubator throughout the experiment. The color of the bleached teeth was determined at 0, 7 and 14 days. The data obtained were analyzed using ANOVA and Turkey's test. There was statistical significance (P = 0.00) among the carbamide peroxide, sodium perborate, hydrogen peroxide and control groups after 7 and 14 days and a significance of P = 0.013 among the carbamide peroxide, sodium perborate and hydrogen peroxide after two bleaching sessions (day 14) was seen. The bleaching efficacy of 10% hydrogen peroxide gel was more effective than 10% carbamide peroxide and sodium perborate in bleaching the artificially discolored primary teeth.

Triplication of deciduous teeth: A rare dental anomaly

Fusion of teeth is the union of two or more tooth germs, which are usually separated. Depending upon the stage of odontogenesis, it can be complete or incomplete. The present case describes fusion between the maxillary primary right central and lateral incisor with a supernumerary tooth. Clinical and radiographic examination revealed the presence of fused triple teeth. The fused teeth were extracted, sectioned and were visualized under stereomicroscope at three levels and the diagnosis of fusion of three teeth was confirmed histologically.