Root canal treatment of type Ⅱ and ⅢA double dens invaginatus in maxillary lateral incisor: a case report / 华西口腔医学杂志

Dens invaginatus is a rare developmental anomaly of the teeth that is caused by the infolding of enamel organs or the penetration of their proliferations into dental papillae before calcification has occurred. The presence of double dens invaginatus is extremely rare. This paper describes the use of cone beam computed tomography in the evaluation of a maxillary lateral incisor with double dens invaginatus and periapical periodontitis. The tooth was treated through microscopic root canal therapy. The tooth was free of clinical symptoms, and the periradicular lesion narrowed during the follow-up period of 1 year.

Dens in dente Tipo III A: relato de caso / Dens invaginatus type III A: case report

Introdução: dens in dente é uma anomalia rara de desenvolvimento, caracterizada pela invaginação dos tecidos dentários, podendo variar de um ligeiro aumento da fosseta do cíngulo a um profundo sulco, que pode se estender até o ápice dentário. Objetivo: o objetivo do presente artigo foi relatar um caso clínico e descrever as peculiaridades dos achados clínicos e radiográficos de um dens in dente Tipo III A, com ênfase na descrição de sua morfologia completamente atípica, além das dificuldades que foram encontradas no diagnóstico e durante o tratamento endodôntico. Caso clínico: o paciente compareceu ao ambulatório de uma clínica de Endodontia com queixa de dor e leve edema. Ao exame clínico e radiográfico, observou-se imagem sugestiva de dens in dente no elemento #22, sendo, então, proposto tratamento endodôntico convencional, com estudo tomográfico. Resultados: após 1 ano e 6 meses de acompanhamento, o paciente encontrava-se assintomático. Notou-se reparo satisfatório, com formação óssea, apesar da sobre-extensão do cone. Conclusão: foi possível perceber a importância da tomografia computadorizada de feixe cônico como auxiliar no diagnóstico e planejamento da conduta frente a casos de dens in dente, principalmente por aumentar as chances de sucesso, evitando a perda precoce de elementos dentários (AU).

Introduction: Dens invaginatus is a rare dental anomalycharacterized by invagination of dental tissues, which maybe from a slight increase in the pit of the cingulum to a deep groove that may extend to the tooth apex. This report describes clinical and radiographic findings and the morphology of a completely atypical and unique anomaly, and discusses the difficulties in the diagnosis and endodontic treatment of the root canal of teeth with this complex anatomy. Clinical case: Patient seen in the outpatient clinic of the Endodontic Service with a complaint of pain and mild edema. Clinical and radiographic examinations were suggestive of invagination itooth #22, and conservative endodontic treatment and CT scans were indicated. Results: Patient was asymptomatic and had no functional disorders at 18 months of follow-up. Repair and new bone formation were satisfactory, despite cone overextension. Conclusion: Cone-beam CT seems to be an important method of diagnosis and treatment planning in cases of dens invaginatus, especially because it increases the chances of treatment success and prevents the early loss of teeth (AU).

Tratamento com MTA Repair HP de extensa perfuração radicular após iatrogenia: relato de caso / Treatment with MTA Repair HP of extensive root perforation after iatrogeny: case report

Objetivo: relatar um caso clínico de perfuração radicular causada por iatrogenia, em terço cervical e médio de um incisivo central superior, dente 21, com presença de lesão óssea periapical. Relato de caso: clinicamente, pôde-se constatar ausência de edema e fístula. Na avaliação da condição pulpar e dos tecidos perirradiculares, o dente apresentou dor na palpação, ausência de mobilidade e de dor em percussão vertical e horizontal. Após os exames de imagem obtidos por meio de tomografia computadorizada de feixe cônico (TCFC; Prexion 3D), constatou-se lesão perirradicular extensa, canal radicular obliterado e perfuração radicular em face vestibular após tentativa de acesso cirúrgico. Como escolha de tratamento, optou-se por recuperar o trajeto original do canal de maneira a obter acesso intracanal, realização do preparo químico-mecânico e obturação pela técnica do cone único, para posteriormente promover o selamento adequado da perfuração com MTA Repair HP (Angelus, Londrina, PR, Brasil). Após seis meses, o dente apresentava-se assintomático e, radiograficamente, observou-se o reparo da lesão periapical. Considerações finais: o correto planejamento, o conhecimento dos materiais utilizados e a abordagem terapêutica foram de suma importância para o manejo adequado do caso. (AU)

Objective: to report a clinical case of root perforation, caused by iatrogeny in the cervical and middle third of an upper central incisor, tooth 21, with presence of periapical bone lesion. Case report: clinically, there was no edema and fistula. Facing the evaluation of the pulp condition and the periradicular tissues, the tooth presented pain on palpation, absence of mobility and pain on vertical and horizontal percussion. After the imaging exams, obtained by cone-beam computed tomography (CBCT; Prexion 3D), extensive periradicular lesion, obliterated root canal and root perforation were observed in the buccal face after attempted surgical access. As a choice of treatment, we chose to recover the original path of the canal in order to obtain intracanal access, chemicomechanical preparation and obturation by the single-cone technique to later promote proper sealing of the perforation with MTA Repair HP (Angelus, Londrina, PR, Brazil). After six months, the tooth was asymptomatic and, radiographically, the repair of the periapical lesion was observed. Final considerations: the correct planning, knowledge of the materials used and therapeutic approach were of paramount importance for the proper management of the case. (AU)

Five canals on mandibular first molar successfully managed by undergraduate dental student: an educational case report

Undergraduate dental student's eligibility and ability to treat difficult endodontic cases is a new area open for debate. a fifth year undergraduate dental student managed to perform a successful root canal treatment (RCT) on a 42 year old male patient diagnosed as a rare case of mandibular first molar with five root canals. as an educational case report, in a country like Sudan, close supervision and clinical training of undergraduate students in treating difficult endodontic cases is recommended.

Dental anomalies in an orthodontic patient population with maxillary lateral incisor agenesis

ABSTRACT Introduction: The purpose of this study was to evaluate the prevalence of dental anomalies in a subpopulation of orthodontic patients with agenesis of maxillary lateral incisors (MLI). Methods: The material of the present study included the records of the 1964 orthodontic patients. Panoramic radiographs and dental casts were used to analyze other associated eight dental anomalies, including agenesis of other teeth, dens invaginatus, dens evaginatus, peg shaped MLI, taurodontism, pulp stone, root dilaceration and maxillary canine impaction. Results: Out of the 1964 patients examined, 90 were found to have agenesis of MLI, representing a prevalence of 4.6%. The most commonly found associated-anomalies were agenesis of other teeth (23.3%), peg-shaped MLIs (15.6%), taurodontism (42.2%), and dilacerated teeth (18.9%). Conclusion: Permanent tooth agenesis, taurodontism, peg-shaped maxillary lateral incisor, and root dilacerations are frequently associated with maxillary lateral incisor agenesis.

RESUMO Objetivo: o objetivo do presente estudo foi avaliar a prevalência de anomalias dentárias em uma subpopulação de pacientes ortodônticos com agenesia de incisivos laterais superiores (ILS). Material e Métodos: o material do presente estudo incluiu os registros de 1964 pacientes ortodônticos. Radiografias panorâmicas e modelos de estudo foram usados para analisar outras anomalias dentárias associadas, incluindo a agenesia de outros dentes, dens invaginatus, dens evaginatus, ILS conoides, taurodontismo, calcificação pulpar, dilaceração radicular e impacção do canino superior. Resultados: dos 1964 pacientes examinados, constatou-se que 90 tinham agenesia do ILS, o que representa uma prevalência de 4,6%. As anomalias associadas mais comumente encontradas foram a agenesia de outros dentes (23,3%), ILS conoides (15,6%), taurodontismo (42,2%) e dentes com dilaceração (18,9%). Conclusão: a agenesia de dentes permanentes, o taurodontismo, incisivos laterais superiores conoides e dilaceração radicular estão frequentemente associados à agenesia de incisivos laterais superiores.

Mandibular First Molar with Three Roots and Five Canals: A Case Report.

Clinicians may encounter morphological variations in the form of extra roots and extra root canals. Favorable endodontic treatment requires extensive study of the internal anatomy of teeth. The literature reiterates the incidence of more than three canals in mandibular molar. Radix entomolaris (RE) may complicate the root canal treatment of the tooth if left undiagnosed. The middle mesial canal is more common when compared to the middle distal canal. The combination of RE and three distal canals is a rare occurrence. This case report presents a discussion of root canal therapy in a left mandibular first molar with RE and five root canals.

Interradicular dentin dysplasia associated with amelogenesis imperfecta with taurodontism or trichodentoosseous syndrome: A diagnostic dilemma.

Amelogenesis imperfecta is a hereditary disorder with diverse clinical presentation, where enamel is the tissue that is primarily affected either quantitatively or qualitatively. Hypomaturation/hypoplastic amelogenesis imperfecta with taurodontism is a rare variant of amelogenesis imperfecta which is often confused with trichodentoosseous syndrome. We report a rare case of hereditary enamel defect with taurodontism associated with interradicular dentin dysplasia.

Incisivo lateral superior con dos raíces y dos conductos: caso clínico / Upper lateral incisor with two roots and two canals: a clinical case

Las anomalías en la morfología del incisivo lateral superior son de muy baja frecuencia. Las anomalías de desarrollo radicular pueden presentarse como alteraciones tanto en el número de conductos, como en el número de raíces, así como en ambas regiones a la vez. En el presente trabajo, se reporta el caso de un paciente que se presenta a la consulta con malestar en el incisivo lateral superior izquierdo. En laradiografía preoperatoria se detectó la presencia de dos conductos y dos raíces, sin anomalía morfológica de su corona clínica, con requerimiento de tratamiento endodóntico. Concluimos que una correcta interpretación de las imágenes radiográficas preoperatorias es esencial, para poder detectar estas variantes y tomar las consideraciones necesarias para el adecuado tratamiento endodóntico

Abnormalities in the morphology of the maxillary lateral incisor are very low frequency. Root development abnormalities can occur as alterations in the number of ducts and the number of roots, as well as two regions at once. In this paper, we report the case of a patient presenting with discomfort in the upper left lateral incisor. In preoperative radiography, we detected the presence of two channels and two roots, without morphological abnormality in clinical crown, with endodontic treatment requirement. We conclude that a correct interpretation of preoperative radiographic imaging is essential in order to detect these variants and take the necessary considerations for proper endodontic treatment.

Classification of bifid mandibular canals using cone beam computed tomography

The objective of this study was to classify the morphology of bifid mandibular canals and to evaluate their relationship with the roots of third molars, using cone beam computed tomography (CBCT) scans. The CBCT scans of 75 patients were analyzed and the bifurcations were classified according to Langlais et al. (1985). The relationship of bifurcation and third molars was established according to the following classification: class A - uninvolved, class B - close relationship, class C - intimate relationship and class D - absence of third molars. Data were submitted to descriptive statistics, and the results indicated that the patients' mean age was 48.2 (± 13.2) years. Unilateral bifurcation (Type 1) was the most frequent type (72.6%), followed by unilateral Type 2 (19.3%). Class D was the most frequent (57.33%), followed by class C (21.33%), class B (13.33%) and class A (8%). It could be concluded that most cases presented unilateral bifid mandibular canals extending to the third molar or adjacent regions, and when present, the roots seemed to be a continuation of the bifid mandibular canal.

Oral aspects of chronic renal failure

Diseases such as diabetes mellitus, hypertension, chronic glomerulonephritis, uropathy and autoimmune diseases are considered the most frequent causes of renal failure. The aim of this study was to investigate oral manifestations caused by chronic renal failure. Oral manifestations of chronic renal failure include dysgeusia, stomatitis, decreased salivary flow rate, xerostomia and parotitis; moreover, dental oriented conditions include narrowing of pulp chamber, enamel abnormalities, tooth loss and periodontal disease. The most frequent dilemma in patients with Kidney failure is Renal Osteodystrophy. Chronic renal failure could be treated by renal replacement therapy, hemodialysis and peritoneal dialysis. These are methods of removing nitrogenous and other toxic byproducts of metabolized blood. Oral maladies due chronic renal failure occur because of immunosuppressive medications. However, this kind of therapy could be challenging as it causes gingival inflammation due to increased plaque deposition; which in turn affects the periodontal tissues. A good oral hygiene may reduce the risk of oral infections in chronic renal failure patients. The awareness about kidney related diseases is often neglected; however, the number of patients with oral manifestations related to chronic renal failure is miraculous

Management of single-rooted maxillary central incisor with two canals: a case report

The aim of this study was to report the endodontic management of right maxillary central incisor having two canals with type IV Vertucci canal configuration. Internal morphology of root canals is variable and often complex. Therefore, to achieve a technically satisfactory endodontic outcome, the clinician must have adequate knowledge of the internal canal morphology and its variations in order to debride and obturate the root canal system thoroughly

[Dental problems in children with calcium metabolism disorders]

Calcium metabolism disorders can be acute or chronic and chronic disorders can cause different disease states such as dental problems. In this descriptive cross-sectional study done in Children's Medical Center affiliated to Tehran University of Medical Sciences during 2005-2009, all [93] patients with hypoparathyroidism, nutritional rickets, hypophosphatemic rickets and renal osteodysthrophy from the endocrinology and nephrology departments of the Center were referred to a dentist there for orodental examination. Subsequently, the frequency of dental problems including taurodontism, enamel hypoplasia, dental abscess, dental caries and gingivitis were recorded and analyzed. Nutritional rickets was the most common disorder in this study and delay in dentition was the most frequent dental problem in the patients [61.9%]. Most cases of taurdontism and enamel hypoplasia were seen in patients with hypoparathyroidism [33% and 50%, respectively]. Dental abscess, dental caries and gingivitis were more common in patients with renal osteodysthrophia [50%, 90% and 20%, respectively]. In addition, dental caries and delay in dentition were the most prevalent disorders in this study [69.8% and 49.5%, respectively]. According to the above findings, it seems that effective screening, regular periodic examinations, proper diagnosis and timely treatment of dental diseases are the main principles of prevention of orodental problems. Moreover, dentists as well as pediatricians should be aware of the features of the aforesaid disorders which lead to dental problems so that early intervention could prevent subsequent serious and more invasive dental problems

Obturação de canais radiculares em forma de C utilizando o sistema Epiphany e termocompactadores de McSpadden

O objetivo deste artigo foi relatar dois casos clínicos de segundos molares inferiores apresentando sistemas de canais radiculares em forma de C. As etapas dos tratamentos foram descritas e comparadas com as variações encontradas na literatura. Os canais foram preparados com um sistema automatizado de rotação alternada e obturados com o sistema Epiphany com o auxílio dos compactadores de McSpadden

Variaciones anatómicas radiculares y sistemas de canales / Tooth root and pulp canal anatomical variations

El desarrollo dentario resulta de una complicada interacción entre el epitelio oral y el tejido mesenquimático subyacente durante la Odontogénesis. La interacción anormal de estos tejidos podría resultar en el desarrollo y/o erupción de un diente anómalo, ectópico o con variación anatómica. El presente reporte muestra tres casos de variaciones anatómicas radiculares y al sistema de canales: un canino mandibular, un premolar mandibular y un primer premolar maxilar. El diagnóstico en los tres casos se efectuó por medio del análisis de radiografías. El canino y premolar mandibular presentaron dos raíces y dos canales, el premolar maxilar presentó tres raíces y tres conductos. Dada la presencia de una caries penetrante en este último, fue derivado a un especialista en endodoncia para su tratamiento y posterior rehabilitación. Idealizar el sistema de canales como una entidad simple es un error, por lo que es importante considerar estas variaciones anatómicas especialmente ante presencia de dientes con patologías que requieran tratamientos de endodoncia o cualquier procedimiento al interior del sistema de canales, ya que la oportuna y adecuada indicación de exámenes complementarios permite pesquisar y diagnosticar variaciones anatómicas de este tipo, para minimizar la ocurrencia de accidentes durante el tratamiento.

Teeth development results from a complicated interaction between oral epithelium and underlying mesenchematic tissue during odontogenesis. Abnormal interaction between this tissues could result in development and eruption of an ectopical, anomalous teeth or with an anatomical variation. This report shows three cases of teeth with anatomical variations at root and pulp canal in mandibular canine and bicuspid, and maxillary first bicuspid. Diagnosis of these cases was performed through radiographical analysis. Mandibular canine and bicuspid shown two root and two pulp canals, maxillary first bicuspid presented three roots and three pulp canals. Considering that maxilar tooth showed caries closer to pulp chamber, patient was derived to an endodontic specialist to perform an endodontic treatment and rehabilitation. Idealizing root canal as a simple and invariable structure is a mistake. Clinicians always ought to take into consideration potential anatomical variations in teeth, especially in those that require endodontic treatments or any kind of procedure inside root canal system. Timely and adequate indication of imagenological complementary exams allow an adequate diagnosis of anatomical variations that will decrease chances of accidents during treatment.

Spiral CT diagnosis and endodontic management of an anatomically variant palatal root with two canals in a maxillary first molar.

This case report presents the endodontic management of an anatomically variant palatal root with 2 canals (Vertucci type II) in a maxillary first molar, which was confirmed with the help of spiral computed tomography (SCT). This serves to remind clinicians that such anatomic variations should be taken into account during the endodontic treatment of maxillary molars and highlights the invaluable aid of the SCT in accurate diagnosis and in negotiating the complex morphologic variations in root canals, thus enabling successful endodontic management.

A case of unusual anatomy: maxillary central incisor with two root canals / Un caso de anatomía inusual: incisivo central superior con dos canales radiculares

Success in root canal treatment is achieved after thorough cleaning and shaping followed by complete obturation of the canal system. Therefore, endodontic therapy requires specific and complete knowledge of the internal and external dental anatomy, and its variations in presentation. Such treatment may be performed in root canal systems that do not comply with the normal anatomical features described in standard textbooks. The internal anatomy of the maxillary central incisor is well known and usually presents one root canal system. This case report describes an endodontic retreatment of a maxillary central incisor with two canal systems.

El éxito de los tratamientos de endodoncia sólo puede conseguirse mediante una completa asepsia, el modelado y la obturación del canal radicular. Por ello, los tratamientos de endodoncia requieren de un completo y detallado conocimiento de la anatomía interna y externa de los canales radiculares y de sus variantes. Este tipo de tratamiento puede realizarse en canales radiculares que no coincidan con las características anatómicas normales descritas como patrón por la literatura. La anatomía interna de los incisivos centrales superiores es bien conocida, presentando normalmente un canal radicular único. En este relato se describen los tratamientos endodóncicos de incisivo central superior con dos canales radiculares.

Three root canals in the maxillary second premolar.

In this study, we report an endodontic treatment of the maxillary second premolar with three root canals and distinct foramens. The possibility of three root canals in this tooth is quite small; however, it must be taken into account in clinical and radiographic evaluation during endodontic treatment. Many times, their presence is noticed only after canal treatment due to continuing post-operative discomfort.

Curved canals: ancestral files revisited.

The aim of this article is to provide an insight into different techniques of cleaning and shaping of curved root canals with hand instruments. Although a plethora of root canal instruments like ProFile, ProTaper, LightSpeed etc dominate the current scenario, the inexpensive conventional root canal hand files such as K-files and flexible files can be used to get optimum results when handled meticulously. Special emphasis has been put on the modifications in biomechanical canal preparation in a variety of curved canal cases. This article compiles a series of clinical cases of root canals with curvatures in the middle and apical third and with S-shaped curvatures that were successfully completed by employing only conventional root canal hand instruments.

Incidence of three canals in maxillary first premolar-a case report

This paper reports successful endodontic treatment of a maxillary first premolar with three canals. Maxillary premolars have highly variable root canal morphology, but it is rare, especially in the first premolar, to find three canals. However, in everyday endodontic practice, clinicians have to treat teeth with atypical configurations. Extra roots or root canals if not detected are a major reason for failure. Systematic examination of preoperative X-rays and correct access. Ni-Ti rotary instrumentation technique was chosen for root canal preparation, and Canals were obturated with gutta percha cones [Sure-Endo, Seoul, Korea] and Sealapex [Ken, Sybron, USA] root canal sealer using cold lateral condensation filling technique This methology led to efficient preparation and suitable definitive root canal obturation