Non-surgical management of dens invaginatus type IIIB in maxillary lateral incisor with three root canals and 6-year follow-up:A case report and review of literature

BACKGROUND The presence of dens invaginatus(DI)complicates treatment of any tooth,from diagnosis to access cavity and biomechanical preparation and obturation.Reports of successful non-surgical management of DI type IIIB in maxillary lateral incisor are rare.Here,we report such a case,with three root canals and a long follow-up.CASE SUMMARY A 13-year-old female patient presented with mild pain in the maxillary right lateral incisor(#7)for 10-15 d.On examination,the tooth was slightly rotated,with slight tenderness on percussion and grade I mobility but with no caries,pockets or restorations and non-vital pulp(via vitality tests).Radiographic examination revealed unusual configuration of the tooth’s root canals,with an enamel-lined invagination extending to the apex,suggesting the possibility of DI Oehler’s type IIIB and a periapical radiolucency.Widening the access cavity lingually revealed one distinct buccal orifice and two distinct palatal orifices;under higher magnification of a dental operating microscope(DOM),the mesio palatal and disto-palatal orifices were observed as connected by a C-shaped groove.The root canals were prepared with hand K-files following a step-back technique,and obturated using a combination technique of lateral condensation and vertical compaction.At the 6-year follow-up,the patient was asymptomatic,and the periapical radiography displayed significant healing around the apical end of the root.CONCLUSION Proper knowledge of unusual root canal anatomy is required in treating DI.Conventional methods of root canal treatment can successfully resolve such complex cases,facilitated by DOM and cone-beam computed tomography.

Clinical Management of Mid-Root Fracture in Maxillary Central Incisors:Case Reports

Management of mid-root fractures presents a formidable challenge for clinicians because of the difficulty of achieving a stable reunion of fracture fragments. This article presents two varied treatment options for mid-root fractures. A 15-year-old female reported an impact injury to the maxillary anterior teeth 2 days after its occurrence. Clinically,the maxillary left central incisor was palatally-extruded with a negative vitality response and radiographic evidence of an oblique fracture at the middle third of the root. An endodontic implant was employed which utilized an open technique and has been on follow-up for ten months. A 32-year-old male reported an injury,which resulted in a mobile maxillary right central incisor,three months after its occurrence. Through clinical and radiographic means,a discolored,extruded,and non-vital maxillary right central incisor with an oblique root fracture at the alveolar-crest level was observed. Exploratory surgery was performed; an apical barrier was created with a mineral trioxide aggregate and obturated with gutta percha. The fragments were stabilized with a fiber post and patient has been on follow-up for five months. Short-term follow-up for both of the cases showed promising results both clinically and radiographically.

Contour changes in human alveolar bone following tooth extraction of the maxillary central incisor

The purpose of this study was to apply cone-beam computed tomography （CBCT） to observe contour changes in human alveolar bone after tooth extraction of the maxillary central incisor and to provide original mor- phological evidence for aesthetic implant treatment in the maxillary anterior area. Forty patients were recruited into the study. Each patient had two CBCT scans （CBCT I and CBCT II）, one taken before and one taken three months after tooth extraction of maxillary central incisor （test tooth T）. A fixed anatomic reference point was used to orient the starting axial slice of the two scans. On three CBCT I axial slices, which represented the deep, middle, and shallow layers of the socket, labial and palatal alveolar bone widths of T were measured. The number of sagittal slices from the start point to the pulp centre of T was recorded. On three CBCT II axial slices, the pulp centres of extracted T were oriented according to the number of moved sagittal slices recorded in CBCT I. Labial and palatal alveolar bone widths at the oriented sites were measured. On the CBCT I axial slice which represented the middle layer of the socket, sagittal slices were reconstructed. Relevant distances of T on the sagittal slice were measured, as were the alveolar bone width and tooth length of the opposite central incisor. On the CBCT II axial slice, which represented the middle layer of the socket, relevant distances recorded in CBCT I were transferred on the sagittal slice. The height reduction of alveolar bone on labial and palatal sides was measured, as were the alveolar bone width and tooth length of the opposite central incisor at the oriented site. Intraobserver reliability assessed by intraclass correlation coefficients （ICCs） was high. Paired sample t-tests were performed. The alveolar bone width and tooth length of the opposite central incisor showed no statistical differences （P〈0.05）. The labial alveolar bone widths of T at the deep, middle, and shallow layers all showed statistical differences. However, no palatal alveolar bone widths showed any statistical differences. The width reduction of alveolar bone was 1.2, 1.6, and 2.7 mm at the deep, middle, and shallow layers, respectively. The height reduction of alveolar bone on labial and palatal sides of T both showed statistical differences, which was 1.9 and 1.1 mm, respectively.

Management of the palato-radicular groove with a periodontal regenerative procedure and prosthodontic treatment:A case report

BACKGROUND Palato-radicular groove(PRG)is defined as an anomalous formation of teeth.The etiology of PRG remains unclear.The prognosis of a tooth with a PRG is unfavorable.The treatment of combined periodontal-endodontic lesions requires multidisciplinary management to control the progression of bone defects.Some researchers reported cases that had short-term observations.The management of teeth with PRGs is of great clinical significance.However,to date,no case reports have been documented on the use of bone regeneration and prosthodontic treatment for PRGs.CASE SUMMARY This case reported the management of a 40-year-old male patient with the chief complaint of slight mobility and abscess in the upper right anterior tooth for 15 d and was diagnosed with type II PRG of tooth 12 with combined endodonticperiodontal lesions.The accumulation of plaque and calculus caused primary periodontitis and a secondary endodontic infection.A multidisciplinary management approach was designed that included root canal therapy,groove sealing,a periodontal regenerative procedure,and prosthodontic treatment.During a 2-year follow-up period,a good prognosis was observed.CONCLUSION This report indicates that bone regeneration and prosthodontic treatment may contribute to the long-term favorable prognosis of teeth with PRGs.

Morphometric Analysis of Maxillary Central Incisor to Determine its Crown Form: A Model‑based Cross‑sectional Study

The size and shape of tooth crowns are morphogenetically predetermined during embryogenesis.The maxillary central incisors have contributed to sexual dimorphism,and several classifications of the form of maxillary central incisors are available in the literature.We,in the present study,aimed to analyze the mesiodistal(MD)measurements at two levels of maxillary central incisor,to determine its crown form.The study was conducted on 100 dental plaster models(50 males and 50 females).The MD dimensions at the contact area level MD_incisal(MD_I)and at the gingival papilla level(MD_G)and the gingivo‑incisal height of the crown were measured in the dental models using digital Vernier caliper.The data were analyzed using SPSS version 16 statistical software.The mean values of all the three parameters measured were slightly greater for males and also for the left central incisors.There were no significant differences in all the three variables when the right and left incisors were compared.Significant differences were noted when the parameters are compared between genders.The height/width ratio of crown showed a significant difference between male and female.The value of the ratio between the two MD dimensions(MD_I and MD_G)was used to determine the crown form.The ratio between the MD dimensions at incisal and gingival area showed a significant difference between genders and no such significance was found between right and left central incisors.There is a significant difference in the form of maxillary central incisors between male and female samples and not between right and left.The MD dimensions at incisal and gingival thirds decide the form of crown.

Correlation between Maxillary Central Incisor Crown Form and Maxillary Dental Arch Form:A Model‑Based Morphometric,Cross‑Sectional Study

The crown form of maxillary central incisor tooth is one of the vital phenomenon for a person’s esthetics.Its crown form has been compared with other anatomical parameters such as arch form and facial form.Three different classes of tooth forms which relate to square,tapered,and ovoid forms are identified.The aim of this study was to morphometrically evaluate the correlation between maxillary dental arch form and the maxillary central incisor crown form.Dentate cast models of fifty male and fifty female normal occlusion controls in the age group of 18-23 years were analyzed.The mesiodistal(MD)dimensions of the maxillary central incisors were measured at incisal(MD_I)and at gingival(MD_G)levels.The transverse widths of maxillary casts were measured at the first molar and at the first premolar levels.The measured data were statistically analyzed using the SPSS software.The MD dimensions of maxillary central incisor were significantly greater in males than females.The ratio between the two MD dimensions also varied significantly among genders.The intermolar width(IMW)and interfirst premolar width(IPmW)between males and females were highly significant(P<0.05),whereas the ratio between these two parameters in males and females was not significant(P=0.43).Eighty‑eight percentage of the participants were found to have an ovoid type of maxillary arch,while only 45%of them had the ovoid form of maxillary central incisors.The MD_I and the IMW were found to be in the ratio of 1:5.5 in both genders.The MD_G and the IPmW were in the ratio of 1:4.7 in males and 1:4.5 in females.There was a weak positive correlation between MD_I and IMW(r^(2)=0.146)and between MD_G and IPmW(r^(2)=0.05).No significant concordance between the maxillary central incisor crown form and the maxillary arch form was found in this study.

Prediction of Facial Profile Based on Morphometric Measurements and Profile Characteristics of Permanent Maxillary Central Incisor Teeth

The computation of facial profile from dental morphometrics has been a subject of great interest in forensic odontology.The use of teeth to draw a profile and facial features is valuable in times of mass disasters when body remains are unavailable due to extreme destruction.This study aims to identify and evaluate applicable parameters in the permanent maxillary central incisors and the face of an individual.A correlation of these parameters establishes a mathematical equation that further charts a tooth‑facial profile table.Thirty soft and hard tissue landmarks on the face in the frontal and the lateral profiles(using standardized photographs)and seven landmarks on the facial/labial surface of the clinical crown of the permanent maxillary central incisor(using casts of the maxilla)were identified for the study.Based on these,a set of eight horizontal and seven vertical parameters on the face and four parameters on the tooth were created for the assessment.Internal and external correlations between the two were carried out and statistically analyzed.A logistic regression was made to predict the probability of the parameters most likely to be reproduced in the creation of the facial profile,based on tooth morphometrics.The results indicated a definite correlation between the facial and the tooth parameters.Among the multiple parameters,a definite correlation in the horizontal dimension could be established between the mouth width and the mesiodistal width(MDW)of the tooth.In the vertical dimension,a definite relationship existed between the crown height of the tooth and the width of the midface(zygoma‑mandible).There exist divergences in the correlation of tooth and facial parameters.