Interdisciplinary management of an impacted dilacerated maxillary central incisor

ABSTRACT Introduction: Tooth dilacerations are dental anomalies characterized by an abrupt deviation in the longitudinal axis of a tooth. They may occur either in the crown, between the crown and root, or in the root. Although not so common, impacted maxillary incisors exhibiting root dilaceration pose a diagnostic and treatment challenge to the clinician. Description: This case report describes the management of a horizontally impacted and dilacerated maxillary central incisor in a 12-year-old girl. Cone-beam computed tomographic scans were used to accurately localize the position of the dilacerated tooth, and to assess the extent of root formation and degree of dilaceration present in the root. Treatment included surgical exposure and orthodontic traction, followed by root canal treatment and apicoectomy. Results: Through a meticulously planned interdisciplinary approach, the impacted dilacerated central incisor was properly aligned and demonstrated good stability after the long-term follow-up. Conclusion: Taking into consideration the concerns and expectations of the patient, communicative feedback between the oral surgeon, orthodontist and endodontist helped achieving successful esthetic, structural and functional outcome in the present case.

RESUMO Introdução: as dilacerações dentárias são anomalias caracterizadas por desvio acentuado no eixo longitudinal de um dente. Elas podem ocorrer na coroa, entre a coroa e a raiz, ou na raiz. Apesar de não serem muito comuns, os incisivos superiores impactados apresentando dilaceração radicular representam um desafio para o clínico, quanto ao diagnóstico e tratamento. Descrição: o presente relato de caso descreve o tratamento de um incisivo central superior impactado horizontalmente e com dilaceração, em uma menina com 12 anos de idade. Tomografias computadorizadas de feixe cônico foram utilizadas para localizar com precisão a posição do dente dilacerado e avaliar o grau de formação e de dilaceração da raiz. O tratamento incluiu exposição cirúrgica e tração ortodôntica, seguida de tratamento do canal radicular e apicectomia. Resultados: por meio de uma abordagem interdisciplinar meticulosamente planejada, o incisivo central impactado com dilaceração foi devidamente alinhado e demonstrou boa estabilidade em acompanhamento de longo prazo. Conclusão: levando-se em consideração as preocupações e expectativas da paciente, a comunicação interativa adotada entre o cirurgião oral, ortodontista e o endodontista ajudou na obtenção de resultados estéticos, estruturais e funcionais satisfatórios no presente caso.

Endoimplante con lima NiTi: solución novedosa para una complicación radicular antigua

El trauma dental es un problema común en la consulta diaria que no siempre se maneja de forma adecuada. En este artículo se presenta el caso de una paciente que a temprana edad recibió un golpe que afectó el desarrollo radicular de la pieza 1.1. Con el tiempo salió a relucir una serie de complicaciones como: necrosis pulpar, pigmentación coronal, presencia de gran lesión perialpical y aparición recurrente de fístula, lo que le llevó a realizarse una serie de tratamientos que a la larga fracasaron hasta que 37 años despúes, mediante los avances de la tecnología, se logró resolver el caso realizando una cirugía apical con colocación de un endoimplante con lima de níquel titanio (NiTi). Este caso clínico demuestra que con el paso del tiempo, el afán de la paciente por mantener su pieza dental en boca y la aparición de nuevos materiales y técnicas, hoy en día, se pueden llegar a resolver casos sumamente complejos que normalmente estarían destinados a la exodoncia.

The dental trauma is a common problem in daily practice not always handled properly. This article describes the case of a patient who received an early knock that affected radicular development of tooth 1.1. Eventually a number of complications appeared such pulp necrosis, coronal pigmentation, presence of large perialpical lesion and recurrent appearance of fistula, which led the patient to realized a series of treatments that eventually failed until 37 years later, through advances in technology, it was possible to solve the case by making an apical surgery with placement of an endoimplant with a nickel titanium (NiTi) file. This case shows that with the passage of time, the desire of the patient to keep teeth in her mouth and the appearance of new materials and techniques, nowadays, highly complex cases that would normally be destined for extraction can be solve.

Endodontic and Esthetic Management of Hypolplastic Turner’s Teeth with Severely Dilacerated Roots.

Dilaceration refer to an angulation or sharp bend or curve in the root or crown of formed tooth. It is usually occur due to trauma that lead to white or yellow brown discoloration, crown dilaceration, root dilacerations, crown duplication, root duplication, odontoma like malformation etc. This paper elaborated a useful clinical considerations for diagnosis and treatment planning of a severely dilacerated root of malformed tooth having turner’s hypoplasia.

Dysplasia before eruption of permanet maxillary central incisor due to trauma to its predecessor:A case report / 实用口腔医学杂志

One of the most severe consequences of injury to primary teeth is the developmental disorder of permanent successor teeth.Affected permanent teeth may exhibit malformation and impaction,therefore extraction would be indicated in certain cases.In the present report,a case of primary teeth trauma followed by permanent teeth dysplasia is reported.

Primary culture of corneal endothelial cells in vitro and biological identification / 中华实验眼科杂志

Background Corneal blindness is one of the major blinding eye diseases in China.With the development and progress of tissue engineering technology,tissue-engineered corneas offers a new approach to the treatment of corneal diseases.To select and cultivate ideal seed cells is a foundation of construction of tissueengineered corneas.Objective This study was to evaluate the efficiency of stripe off the Descemet membrane with endothelium plus enzymic digestion in the isolation of corneal endothelial cells and analyze the bionomics of rabbit corneal endothelial cells (CECs) in vitro.Methods Descemet membrane was stripped from fresh cornea of New Zealand rabbit under the dissection microscope.Descemet membrane with endothelium was incubated in trypsin and EDTA solution at 37 ℃ and then purified for CECs subculture in vitro.The morphology of the cultured cells was observed under the inverted microscope and marked by CM-Dil dye solution.Then the shape of the cells was observed by hematoxylin and eosin staining and the cells were identified for the expression of neuron specific enolase (NSE) using immunochemistry.The viability of the cells were evaluated by trypan blue staining.The surface structure of the cells were examined under the scanning electron microscope.Intercellular zonula occludens-1 (ZO-1) was identified by immunofluorecsence staining.Results A large number of purified CECs were obtained from Descemet membrane with endothelium through enzymic digestion.Cultured cells grew well and formed monolayer 5-7 days later with the cobblestone stone-like arrangement.The survival rate of the cells was 95％.CECs presented with the red annular fluorescence for CM-Dil with the labeling rate ＞90％.NSE was positively expressed in the cytoplasm.Polygon CECs were seen by hematoxylin and eosin staining and showed the brown staining.Abundant microvilli on the cellular surface and interconnected foot process were seen under the scanning electron microscope.ZO-1 showed the green fluorescence.Conclusions The method of striping off the corneal Descemet membrane with endothelium plus enzymic digestion can obtain abundant CECs.Cultured cells have good biological properties.This study may offer a feasible application in the engineering of corneal transplant membrane.

Dentigerous cyst associated with dilacerated and inverted maxillary central incisor: an unusual case report / Cisto dentígero associado ao incisivo central superior invertido e dilacerado: relato de um caso incomum

One of the most common types of developmental odontogenic cyst is the dentigerous cyst. It encloses the crown of the tooth and is attached at the cementoenamel junction. Although its association with mandibular molars is common, it is rarely associated with the maxillary central incisors. Discussion: The present case report describes an unusual occurrence of dentigerous cyst associated with the impacted permanent maxillary central incisor in an inverted position and showing dilaceration of the root. The cyst was enucleated along with the extraction of the impacted tooth. We have discussed clinical presentation, radiographic features and treatment modalities of this uncommon and rare presentation of this lesion. Conclusion: Trauma to the deciduous teeth should not be overlooked, since it can result in the development of a pathology which could indirectly affect the permanent successors...

Um dos tipos mais comuns de cisto odontogênico de desenvolvimento é o cisto dentígero. Ele inclui a coroa do dente e está conectado à junção cemento-esmalte. Apesar de sua associação com molares inferiores ser comum, ele raramente está associado com incisivos centrais superiores. Discussão: O presente relato descreve um caso raro de cisto dentígero associado ao incisivo central superior permanente impactado em uma posição invertida, apresentando dilaceração da raiz. O cisto foi enucleado durante a extração do dente afetado. Foram discutidas a apresentação clínica, as características radiográficas e as modalidades de tratamento desta apresentação incomum e rara de lesão. Conclusão: O trauma em dentes decíduos não deve ser negligenciado,pois pode resultar no desenvolvimento de uma patologia que pode afetar indiretamente os sucessores permanentes...

Crown dilaceration in permanent teeth after trauma to the primary predecessors: report of three cases

Crown dilaceration of permanent teeth occurs due to the non-axial displacement of the already formed hard tissue portion of the developing crown at an angle to their longitudinal axis due to trauma to the primary predecessors. This is a rare condition, representing only 3% of the total of injuries to developing teeth and usually occurs in permanent maxillary incisors because of the close proximity of their tooth germs to the primary incisors, which are more susceptible to trauma. This alteration frequently results from the intrusion of a primary tooth when the child is around 2 years of age, at which time half of the crown of the permanent successor is already formed. Teeth with dilacerated crowns may either erupt with buccal or lingual displacement or remain impacted. The treatment may involve endodontic, orthodontic, restorative and prosthetic procedures. This paper reports the restorative treatment proposed to reestablish the esthetics and function of the affected teeth in three cases of crown dilaceration in permanent maxillary incisors after trauma to their primary predecessors.

Prevalence of root dilacerations in Central Anatolian Turkish dental patients / Prevalencia de las dilaceraciones radiculares en pacientes dentales turcos de la región de Anatolia Central

OBJECTIVE: The aim of this study was to determine, retrospectively, the prevalence and distribution of the dilaceration of the root for each tooth-type in a sample of Central Anatolian Turkish population by using panoramic radiographs. METHOD: Panoramic radiograhs of 6912 patients (3860 women and 3052 men, mean age 29.04 years, range, 15 to 50 years) were examined for the presence of root dilacerations. Chi-square test was also used to compare the prevalence of dilacerations between male and female subjects and upper and lower jaws. RESULTS: Data showed that 1108 (16.0%) of these subjects had one or more teeth that were dilacerated and these were detected in 466 (15.2%) males and 642 (16.6%) females. Statistical analysis (χ² test) showed a significant difference in the prevalence of dilaceration among male and female patients. Mandibular third molars were dilacerated most often (3.76%), followed by mandibular second molars (1.81%). Dilaceration was found in 1.23% of maxillary second premolars and 1.23% of mandibular second molars. CONCLUSION: Root dilacerations are not uncommon among Turkish dental patients, and their early detection could be important in treatment problems associated with it. However, further larger scale studies are required to assess its prevalence in the general population in order to compare it with other ethnic groups.

OBJETIVO: El objetivo de este estudio fue determinar retrospectivamente la prevalencia y distribución de la dilaceración radicular para cada tipo de diente en una muestra poblacional turca de Anatolia Central, usando radiografías panorámicas. MÉTODO: Se examinaron las radiografías panorámicas de 6912 pacientes (3860 mujeres y 3052 hombres, edad promedio 29.04 años, rango 15 a 50 años) en busca de presencia de dilaceraciones de la raíz. También se usó la prueba de Chi-cuadrado para comparar la prevalencia de dilaceraciones entre los sujetos varones y hembras, y la mandíbula inferior y superior. RESULTADOS: Los datos mostraron que 1108 (16.0%) de estos sujetos tenían uno o más dientes dilacerados, detectados en 466 (15.2%) varones y 642 (16.6%) hembras. El análisis estadístico (prueba χ²) mostró una diferencia significativa en la prevalencia de dilaceración entre los pacientes varones y las hembras. Los terceros molares mandibulares se hallaban dilacerados con mayor frecuencia (3.76%), seguidos por los segundos molares mandibulares (1.81%). Se halló dilaceración en 1.23% de los segundos premolares maxilares y 1.23% de los segundos molares mandibulares. CONCLUSIÓN: Las dilaceraciones radiculares no son poco comunes entre los pacientes dentales turcos, y su detección temprana podría ser importante en el tratamiento de problemas asociados con ellas.

Dilaceración de diente primario asociado a un mesiodens en niño de 4 años / Dilaceration temporary tooth associated with a mesidens in 4 year old

Dilaceración es un término utilizado para describir la distorsión que ocurre en la raíz durante el desarrollo dentario, el cual se manifiesta alterando la normal relación axial entre la corona y la raíz dentaria. La dilaceración radicular es una angulación o curvatura de la raíz dentaria. Esta alteración es frecuentemente observada en dientes permanentes como consecuencia de un traumatismo de su correspondiente temporario, con una incidencia de 3 %. En la literatura hay solamente cinco casos de dilaceración que involucran a incisivos temporarios. El propósito de este artículo fue hacer una revisión y presentar un caso clínico que fue un hallazgo radiográfico

Dilaceration is a term used to describe the distortion that occurs in the root during tooth development, which manifests itself by altering the normal axial relationship between the crown and the dental root. The root is dilaceration, angulation or curvature of the tooth root. This alteration is frequently observed in permanent teeth as a result of trauma to the corresponding temporary, with an incidence of 3%. In the literature there are only five cases involving dilaceration temporary incisors. The purpose of this article was to review and present a clinical case was a radiographic finding

A study of the panoramic radiographic images of the buccolingual dilaceration / 대한구강악안면방사선학회지

PURPOSE: We want to identify the appearance of the buccolingual root dilaceration teeth in the panoramic views and specify the characteristics of these teeth. MATERIALS AND METHODS: One thousand-six patients were examined on the basis of both panoramic and CT image criteria. We diagnosed and excluded certain teeth from the samples; both prosthodontic or pathologic lesion appearing teeth and mesiodistally dilacerated ones. We meticulously discerned buccolingually dilacerated teeth in the CT images and total 48 samples were selected. The degree of severity in dilaceration was standardized by 2 types of criteria. The samples were differentiated into 3 groups and again categorized into six types showing from the panoramic views: irregular view on the root apex area, clear blunt on the root tip, stepping on root tip, double lamina dura or double tip, arrow-target shaped root, bull's eye, normal view. RESULTS: The types of teeth selected from total 48 buccolingual root dilaceration samples were mandibular first and second molar, premolars, canines, and lateral incisors. The direction of dilaceration was an even percentage to each buccal and lingual side for most selected teeth, however, that of both canines and lateral incisors were directed in almost a buccal side. In the panoramic views, the root types of the buccolingually dilacerated teeth were irregular view on the root apex area, clear blunt on the root tip, stepping on root tip and normal types were almost always normal view. The more severity in dilareated degree, the more chances of observation in the panoramic views were clear blunt on the root tip and stepping on root tip. CONCLUSION: As observed in the shape of stepping on root tip or double lamina dura in the panoramic views, there can be much more probability to diagnose as a buccolingually dilacerated root.

Comparação da morfologia de terceiros molares superiores por meio de radiografia panorâmica e pós-exodontia / Comparasion of the morphology of upper third molars through panoramic radiography and after extraction

O uso de radiografias panorâmicas é cada vez mais aceito e rotineiro no dia a dia do cirurgião dentista. Esta também vem sendo muito usada para o planejamento cirúrgico de exodontias de terceiros molares. Porém, alguns trabalhos colocaram em discussão a fidelidade deste exame em detectar pequenas alterações anatômicas e a possibilidade de distorção de imagem do exame. Neste trabalho analisamos 27 dentes extraídos com seus respectivos exames radiográficos panorâmicos prévios à exodontia. Foi detectado que houve diferença significativa no que tange ao critério de número de raízes avaliado no exame radiográfico e no elemento extraído e também no que diz respeito à dilaceração radicular verificada neste exame e no dente.

Panoramic radiography is actually one of the most used imaginologic exams in clinical dentistry. It is also very used for surgical planning of third molars extraction. However, some papers raise some discussion about the accuracy of this exam in detecting small anatomic changes and the possibility of distortion of the image. In this paper, 27 dental elements (all upper third molars) that were extracted were analyzed, and comparison between the real aspect of the root morphology of the teeth that were extracted and the number of roots with the respective image on the panoramic radiography were performed. Significant differences were detected between these two observations in the number of roots and root dilaceration.