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Statement of problem Patients diagnosed with a cleft palate often have a congenitally missing maxillary lateral incisor. The congenital cleft presents the practitioner with challenges including the quantity and quality of bone, a surgically managed cleft correction, and limited clinical space. Purpose The purpose of the present prospective investigation was to report preliminary results at the 1-year follow-up for this planned 5-year investigation of narrow diameter implants used to restore a missing lateral incisor in patients with a cleft palate. Material and methods Fourteen study participants with a cleft palate and a missing maxillary lateral incisor were enrolled based on established criteria. Narrow diameter implants (AstraTech OsseoSpeed TX 3.0S and 3.5 mm) were placed by using a 2-stage protocol and restored. All study participants received an Atlantis abutment and a cement-retained crown. Four probing depth measurements and bleeding on probing were measured at baseline and at 1 year. Probing depth measurements were evaluated using a 2-way repeated measures ANOVA with Tukey-Kramer multiple comparisons tests. Radiographic marginal bone loss was measured at 1-year by using a digital subtraction technique and evaluated by using a repeated measures ANOVA. Pretreatment cone beam computed tomography (CBCT) images were used to measure a mean gray level that was proportional to bone mineral density (BMD) in the implant site. One-way mixed ANOVA was used to compare the mean gray level and average implant stability quotient (ISQ) loading. A Pearson correlation was also tested between those parameters (α=.05) for each statistical analysis. Results The mean marginal bone loss at 1 year was 0.601 ±0.48 mm. Regarding probing depth measurements, a 2-way repeated measures ANOVA found both the location (P=.012) and time (P=.009) were significant. The Tukey-Kramer multiple comparisons test showed a significant difference between the buccal and distal site (P=.006) from baseline to 1-year follow-up. Conclusions Narrow diameter implants are a reliable treatment for replacing a missing lateral incisor in patients with a cleft palate at 1 year, with an implant survival rate of 100% and implant success rate of 94% using the established criteria. A negative association was found between the bone mineral density and the implant stability in the alveolar cleft site of a patient with a cleft palate. The peri-implant soft tissue probe depths exhibited significant change during the first year.

(1) Background: Hypodontia has a multifactorial aetiology, in which genetic factors are a major component. Associated with this congenital absence, the formed teeth may show differences in size and shape, which may vary with the specific genetic variants and with the location of the missing teeth. The aims of the present study were to investigate a specific variant of MSX1, derive morphometric tooth measurements in a sample of patients with isolated maxillary lateral incisor agenesis and matched controls, and model the findings. (2) Methods: Genotyping of the MSX1 rs8670 genetic variant and morphometric measurements with a 2D image analysis method were performed for 26 hypodontia patients and 26 matched controls. (3) Results: The risk of upper lateral incisor agenesis was 6.9 times higher when the T allele was present. The morphometric parameters showed significant differences between hypodontia patients and controls and between the unilateral and bilateral agenesis cases. The most affected crown dimension in the hypodontia patients was the bucco-lingual dimension. In crown shape there was significant variation the Carabelli trait in upper first molars. (4) Conclusions: The MSX1 rs8670 variant was associated with variations in morphological outcomes. The new findings for compensatory interactions between the maxillary incisors indicate that epigenetic and environmental factors interact with this genetic variant. A single-level directional complex interactive network model incorporates the variations seen in this study.

Congenitally missing anterior teeth alters the patient's physiognomy and diction in a big way. Maxillary incisor agenesis, prominently the lateral incisor is the most common congenitally missing permanent tooth, in the anterior maxillary region, which is the esthetic zone, representing approximately 20% of all dental anomalies. Treatment planning is inclusive of; smile design, preparation, perception of the patients, and their expectations in relation to esthetics, interdisciplinary alliance that meets the functional, health, and esthetic needs. A critical factor for the overall success is that of choosing a suitable restorative recourse. The case report describes the esthetic rehabilitation for congenitally missing maxillary lateral incisor and early traumatic loss of central incisor using an all ceramic-fixed prosthesis.

Apexification procedures are frequently performed on immature permanent teeth with incomplete root formation, open apices and necrotic pulp status with or without periapical lesions in order to induce a calcific barrier prior to root canal therapy. The elimination and control of infection in the root canal space is critical to the success of these procedures. A healthy 21-year old male presented with pulpal necrosis, a large periapical lesion, incomplete root formation and an open apex on a maxillary right lateral incisor. Triple antibiotic paste was used to achieve antimicrobial control after traditional calcium hydroxide paste medicament failed to resolve the symptoms. Obturation was achieved using MTA and the conventional apexification technique. Excellent healing of the large periapical lesion was achieved without surgical intervention and the 4-year follow-up CBCT demonstrated complete bone fill of the lesion. Clinicians should be aware that alternative antimicrobial medicaments, such as triple antibiotic paste, may be beneficial in situations where conventional medicaments prove unsuccessful. The use of triple antibiotic paste may result in sufficient healing of the periapical lesion to justify placement of an MTA apical barrier without the need for surgical intervention

Dens invaginatus is a developmental malformation of teeth with the enfolding of enamel and dentin into the pulp chamber and sometimes into the root that most commonly affects the maxillary lateral incisors. This anomaly may increase the risk of pulpal disease and can potentially complicate treatment due to its aberrant anatomy, thus posing a diagnostic challenge. Similarly, the incomplete elimination of the invagination and debridement may create dead space within the canal leading to the failures. This case reports the endodontic management of the Oehler’s type II Dens invaginatus.

Maxillary central incisor is the most commonly affected tooth during trauma followed by maxillary lateral incisor and mandibular incisors. Trauma to the anterior tooth requires urgent care because of the essentiality of preserving the natural tooth. When a complicated crown a fracture takes place, it necessitates endodontic treatment and restoration of a fractured crown segment with post in the canal. This case report describes a patient with a broken central incisor and treated with a Richmond crown. Keywords: Cast Post & Core, Fracture Crown, Elastomeric Impression Material, Richmond Crown

Dens invaginatus (DI), which often occurs in the maxillary lateral incisor, is an important issue in endodontics because the treatment complexity increases depending on the degree of invagination and the vitality or nonvitality of the pulp. An 11-year-old female patient with a sinus tract in the gingiva of the maxillary lateral incisors showed peri-invagination periodontitis and double DI on radiography. Cone-beam computed tomographic imaging was used to examine the structure in the root canal in detail, and Oehlers type IIIA and IIIB DI was found. It was also shown that the patient’s bone defect was caused by type IIIA. Because a healthy reaction was observed in the pulp test, the final diagnosis was peri-invagination periodontitis associated with type IIIA of the double DI with vital pulp. We expected the lesion to heal by treating only the type IIIA invaginated pseudo–root canal while preserving the healthy pulp. The invaginated root canal was cleaned under a microscope using ultrasonic instruments and nickel-titanium files to minimize irritation to the pulp. Because the lesion shrinkage was confirmed by cone-beam computed tomographic imaging taken 3 months after the start of treatment, vertical compaction of the warm gutta-percha technique was performed. At the 6-month postoperative recall, the pulp was normal, and the lesions were further improved. Treatment of the main root canal of double DI is complicated. However, proper diagnosis and careful cleaning of the invaginated root canal are essential for healing while preserving the pulp.

Missing maxillary lateral incisor is the most prevalent developmental dental anomaly. The management of missing lateral incisor, either need to be closed and use canine as substitution or create space orthodontically for the prosthetic replacement of the missing lateral incisors. A careful diagnosis and treatment plan are deemed essential to address the patient’s needs as the spacing is present in the esthetic region of the jaw which is very challenging so it should be managed by multidisciplinary approach including specialists in orthodontics, prosthodontics, operative dentistry and periodontist. Space closure with canine lateralization option seems less invasive, treatment can be completed relatively in short period of time and it’s adaptation with the facial changes throughout life without having artificial prosthesis provided other factors favoring for this option. This review article describes the various treatment options and their ideal indications, contraindications, advantages and disadvantages as well as emphasize on some modifications in the treatment mechanics which is crucial to achieve the optimal esthetic and to improve the occlusion.

This report describes a case of talon cusp treated by an intentional partial pulpotomy, which made it possible to recontour the tooth crown into the desired shape. The patient was an 11-year-old boy with a large talon cusp on the lingual surface of the right maxillary lateral incisor. He was referred to our clinic for treatment of abnormality cusp because it was expected to impede orthodontic treatment. The talon cusp was amputated using an intentional partial pulpotomy. The procedure resulted in successful recontouring of the tooth crown into the desired morphology and the dental pulp exhibited a vital reaction at three years after the operation.

Background Radicular cysts may enlarge considerably, cause extensive bone destruction, and jeopardize the integrity of the associated vital teeth. The different treatment approaches are aimed mainly at eliminating the cystic epithelial membrane while reducing the risk of injury to vital structures. Contrary to other treatment modalities, preapical surgery offers an unequivocal single occasion resolution for the patient. However, it has been associated with higher risk of collateral damages. Case presentation A patient presented with a large radicular cyst originating from a maxillary lateral incisor. The adjacent central and canine teeth initially failed to exhibit responses to sensibility tests but showed signs of vitality. Microsurgical management was aimed at enucleating the cystic membrane while maintaining adjacent teeth vitality. Upon careful and controlled cyst enucleation under the dental operating microscope, the neurovascular bundle of one of the involved teeth was visualized and its integrity was maintained throughout the procedure. Results The procedure was successful and follow up recalls revealed recovery of normal sensibility of tooth 11 and 13 with complete bone regeneration around their apices. Conclusion Within the limitation of the present case report, we demonstrated that complete excision of large periapical cyst can be performed without sacrificing the vitality of the adjacent teeth, by preserving the integrity of their neurovascular supply through controlled microsurgical enucleation, and by a potential apical vascular repair ensuing unintended injury. Diagnosing the pulp vitality of non-offending teeth whose apices protrude into the cystic lumen is a complex process and can be misleading. Pressure from the growing cyst can inhibit vital teeth responses to neural-based sensibility tests leading to false negative results. Thus, in such cases, the use of blood perfusion-based vitality testing is recommended for correct initial diagnosis.

Introduction: Rehabilitation of the anterior maxilla using dental implants is frequently problematic because of the deficiency of alveolar ridge width. Under certain conditions ridge augmentation with simultaneous implant placement is recommended. Objectives: To evaluate horizontal augmentation of narrow anterior maxillary alveolar ridge with simultaneous implant placement using Cerabone® with and without platelet rich plasma (PRP). Materials and Methods: In this study, 14 implants were placed in patients with insufficient alveolar ridge width in the maxillary lateral incisor region. Patients were divided into two groups; In Group “1” Cerabone® only was used as an augmentation material while in Group “2” a mixture of Cerabone® and PRP was used. A collagen membrane was used to cover the grafting material. Postoperative pain was assessed using visual analogue scale. Healing and postoperative edema were evaluated. Cone Beam Computed Tomography (CBCT) was obtained before surgery, immediately postoperatively and after 6 months so that the labial bone width and bone density were evaluated. Osstell was used to evaluate implant stability quotient (ISQ) during surgery and after 6 months. Results: All implants in both groups were successfully osseointegrated and functionally stable. No significant difference in postoperative pain, edema or wound healing was detected between the two groups. The mean percentage of change in ISQ was superior in Group “2” when compared to Group “1”, but statistically there was no significant difference (P=0.898). The labial bone width in Group “2” was significantly higher than that of Group “1” (P=0.002). The mean percentage of change in labial bone density was 57.95% in Group “1” and 112.52% in Group “2” (P=0.848). Conclusion: Cerabone® can be used effectively for guided bone regeneration around dental implant in narrow maxillary anterior alveolar ridges. Moreover, the addition of PRP has a positive effect on bone regeneration around implants.

Developmental anomalies are one of the challenging clinical conditions to achieve successful treatment outcomes. Among these, Palatogingival groove [PGG] is a rare developmental anomaly usually found on the palatal aspect of maxillary anterior teeth. As self-cleansing is difficult in such patients, it can lead to serious localized periodontal lesion or can occur in combination with endodontic lesion. It is our sole responsibility being a specialist in the field of dentistry, to early diagnose and provide treatment for such conditions. On the basis of PGG extension to the pulp, it can be classified as simple or complex; accordingly, plethora of treatment options are available. Clinically taking interdisciplinary treatment modalities into consideration, curettage of the involved gingival tissues, elimination of the groove by grinding (saucerization), or by sealing with a Biocompatible material which might enhance the healing potential. Incase if the groove extends beyond the middle-third of the root, surgical flap debridement along with combined use of barrier membrane and alloplastic bone graft are recommended. This article represents a rare clinical case reports in management of PGG defect with an innovative conservative approach for simple, minimal groove extensive case and groove extension beyond 1/3rd of the root region, treated with surgical multi-interdisciplinary approach. Keywords: Biodentine, Collagen Membranes, Endodontic­periodontal lesion, Maxillary lateral incisor, Palato­ gingival developmental groove, Platelet­rich fibrin, Saucerization.

Dens invaginatus is a developmental deformation with varying anatomical features, caused by the envelopment of the enamel organ and/or the Hertwig’s epithelial root sheath within the tooth before calcification completes, increasing the vulnerability of pulpal and periodontal inflammation, posing challenges to treatment, and adequate healing. Cell rest of Malassez, remnants of enamel organ or root sheet may cause cystic lesion formations, also hinder the normal healing process and form a fibrous scar. Intraosseous fibrous scar is a result of incomplete wound healing after periradicular surgery which mimics an asymptomatic residual cyst clinically and radiographically. We herein report a case of a surgically managed an immature maxillary lateral incisor affected with Type II dens invaginatus associated with incomplete periradicular healing presented as intraosseous fibrous scar with a persistent well-defined radiolucency between the healthy trabecular bone. The regular clinical and radiographic follow-up records the asymptomatic endodontically treated dens invaginatus with an intact lamina dura and regular healing trabecular bone pattern. Its 4 years of post-operative evaluation has been presented. Features of this case, causes of such incomplete healing, diagnosis, treatment line, prognosis, and the dilemma of the clinician are discussed together with its probable implications.

The aim of this study was to analyze the morphologic features of alveolus in relatively healthy maxillary and mandibular incisors using cone-beam-computed tomography (CBCT). CBCT images of 318 patients were retrospectively acquired. Alveolar bone in incisive area was divided into: type 1 (thick), type 2 (relatively thick with mono-plate concavity), type 3 (thin with double-plate concavities), and type 4 (vulnerably thin). Alveolus prevalence and widths were analyzed statistically relative to age, gender, and molar relationship. Prevalence of type 1 alveolus was 78.9% in maxillary central incisors, 15.1% in maxillary lateral incisors, 24.1% in mandibular central incisors, and 5.0% in mandibular lateral incisors. Type 2 alveolus was commonly observed in the maxillary lateral incisors (82.2%), mandibular central incisors (66.2%), and mandibular lateral incisors (87.9%). Prevalence of type 3 and 4 alveoli ranged from 0.0 to 9.4%. As for maxillary central incisors, type 1 was the widest both at the alveolar crest (7.77 ± 0.58 mm) and apical area (9.05 ± 1.86 mm), while type 3 had the lowest width at the apical region (4.08 ± 0.51 mm). Among maxillary central incisors, prevalence of type 1 tended to decrease with age. At all maxillary and mandibular incisor sites, alveolus widths were significantly thicker in males than in females. At maxillary lateral incisor and mandibular incisor sites, prevalence of alveolus type was significantly different among three molar relationships. A 4-type classification system was suggested for alveolus morphology in incisive region. Identification of alveolus type might aid in the corresponding treatment.

Purpose To evaluate the effect of three two-retainer designs of a resin-bonded fixed dental prosthesis (RBFDP) on fracture resistance. Materials and methods A total of 21 three-unit, all-ceramic RBFPDs were fabricated to replace a missing maxillary lateral incisor. The prostheses were divided into three groups of 7 each: Group L (labial RBFPD); Group ML (modified labial RBFPD, fabricated the same as in Group L with additional preparation that included a shallow proximal groove at the pontic side); and Group P, an all-ceramic palatal RBFPD that acted as control. Preparations were done on the maxillary left central incisor and canine of a typodont model, and 21 epoxy resin models were duplicated for the three groups. The RBFPDs were designed using CAD software and constructed using the heat-pressed technique, after which the prostheses were bonded to their corresponding epoxy resin model according to the manufacturer's instructions. A fracture resistance test was performed on all specimens following aging. Data were analyzed using one-way ANOVA. Results The highest fracture load values were recorded in Group P (547.5 N), followed by Group ML (462.6 N) and then Group L (418.3 N). The difference among the three designs was not statistically significant (F = 2.5, P = 0.1). Conclusion Both labial and modified labial RBFDPs could be a viable alternative treatment option for replacement of missing maxillary lateral incisors.

Background: The congenital absence of one or more deciduous or permanent teeth is called hypodontia. It is the most prevalentcongenital dental abnormality. Hypodontia could be caused by a number of genetic and environmental factors.Objectives: The aim of the current study was to find out the impact of hypodontia on oral health and quality of life of children.Material and Methods: A cross sectional comparative study was carried out on 40 patients suffering from hypodontia and 40healthy controls in the outpatient department of Nishtar institute of dentistry, Multan. Patients and healthy controls were selected bynon-probability convenient sampling technique without any gender discrimination. Age of the selected patients and controls was11-14 years. Oral health was checked by using dental examination instruments. Urdu Proformas were used for betterunderstanding of children.Results: Mean age of the study subjects was 11.9 (± 0.94) years with range of 11 to 14 years. There was 36 (45%) male and 44(55%) female. In our study, maxillary lateral incisor was the most commonly missing tooth. Out of 40 patients suffering fromhypodontia, about 37 (92.5%) patients presented with poor oral health, 38 (95%) patients were affected by their condition and31(77.5%) patients were dissatisfied from their appearance.Conclusion: Hypodontia had great impact on the quality of life of the children. Patients presented with poor oral health and werehighly dissatisfied from their condition.Keywords: Hypodontia, oral health, quality of life

Summary Background/Objectives This retrospective study evaluated the prevalence of dental anomalies of number in different subphenotypes of isolated cleft palate. Materials/Methods The sample comprised 26 individuals with submucous cleft palate (group S) and 68 individuals with complete cleft palate (group C) aged between 9 and 12 years from a single centre. Panoramic radiographs were evaluated regarding the presence of dental anomalies of number in permanent teeth. Intergroup comparison was performed using chi-square tests (P < 0.05). Results Tooth agenesis was found in 34.61 and 36.76 per cent of group S and group C, respectively. The most commonly missing teeth were the maxillary second premolar, maxillary lateral incisor, and mandibular second premolar. Supernumerary teeth were found in none and 1.47 per cent of the individuals with submucous and complete cleft palate, respectively. No statistically significant difference was found between groups for the frequency of tooth agenesis and supernumerary teeth. Limitations Only dental anomalies of number were evaluated. Conclusions/Implications Individuals with submucous and complete cleft palate showed similar prevalence for tooth agenesis and supernumerary teeth. Dental anomalies frequency seems not to be a discriminator for subphenotypes of cleft palate.

This study describes a conservative approach to surgical management of root canal perforation in maxillary lateral incisors. A patient was referred for retreatment of a maxillary lateral incisor. Her chief complaint was discomfort in the buccal mucosa. Periapical radiography showed radiopaque material consistent with sealing material inside the root canal. A CBCT scan was acquired and revealed a gutta-percha cone outside the root canal, from the middle third to beyond the root apex. The imaging examination showed that the pulp cavity had not been affected. Thus, we took the clinical alternative of surgically managing the perforation by sealing with MTA, thereby avoiding endodontic treatment, and followed up with only clinical and radiographic control. At the two-year follow-up, after the surgical procedure to remove the extruded filling material, we observed bone tissue formation and positive response to pulp tests, without any clinical signs or symptoms. Root perforation is considered an unpleasant error in an operative procedure. Once a perforation is properly diagnosed, located, and sealed with biomaterial, a favorable prognosis is often achieved. MTA offered good sealing of the perforation, with promising results. Decision-making using the CBCT scan enabled us to adopt a conservative approach and favored more reliable treatment predictability.

This clinical report presents the use of a modified polyetheretherketone (PEEK) post and core in order to support a lithium disilicate ceramic crown for a maxillary lateral incisor. When considering post-and-core restorations, material flexibility is essential to prevent root fractures. The low elastic modulus of PEEK (4 GPa) could result in lower root fracture rates, preserving tooth structure and favoring tooth re-restoration if the post fractures. PEEK is biocompatible, presents adequate bond strength with dentin when bonded with a resin cement, and can be used under ceramic restorations because of its white, esthetic color. PEEK posts and cores could also cost less when fabricated using common laboratory procedures. Polyetheretherketone (PEEK) posts and cores could be a viable alternative to rigid cast or zirconia posts, or even to fiber-reinforced composite posts, especially when combined with lithium disilicate crowns.

The present case report discusses the endodontic management of maxillary lateral incisor with very thin and double-curved root, also known as bayonet-shaped root. A young healthy male patient presented with acute pain in the left maxillary incisor. Clinical examination and radiographic analysis confirmed the diagnosis of previously treated pulp and symptomatic apical periodontitis. Endodontic treatment was carried out with hand and rotary instruments, and the canal was filled using lateral compaction technique. Six-month radiographic follow-up showed good signs of periapical healing. Technique to prepare and obturate such thin and double-curved root requires preoperative measurement of canal curvature angles with creation of glide path to the apex to maintain the taper of the canal and to avoid mishaps.

Objective The following is a clinical report addressing when to save or remove implants with esthetic deficiencies in the smile zone as well as the sequence and timing of interdisciplinary treatment. Clinical considerations Key factors in the decision-making process in treating implants in malposition are whether the implants are (1) in a reasonable restorative position, (2) free of disease, and (3) placed with adequate depth. This clinical report encompassed periodontal corrective surgery, non-surgical soft tissue sculpting through subgingival crown contour, material selection for definitive restorations, and cementation techniques for cement-retained restorations. Clinical significance Knowledge and understanding of interdisciplinary treatment planning, sequencing, and respective techniques that can be implemented when confronting implants in malposition in the smile zone will allow the interdisciplinary team to achieve the desired esthetic restorative result.

Dental implants have evolved as a standard treatment option for the replacement of missing teeth. Though this treatment modality provides a high level of patient satisfaction and success, it cannot be performed in all cases. Implant use is also restricted when the quality and quantity of bone at the edentulous site is limited, in addition to medically impaired patients. Among the conditions are remaining ridges with reduced interdental spacing, atrophic edentulous maxillary and mandibular ridges, and narrow ridges such as the mandibular incisor and maxillary lateral incisor area. A proper augmentation method for the placement of a regular diameter implant (3.75 to 7 mm) can improve the height and width of bone at such sites. However, bone augmentation and bone grafting procedures are rarely undertaken due to financial constraints, the risk of subjecting the patient to additional surgical procedures, the added time factor, or the guarded prognosis of the grafted site. In such cases, mini-implants are the choice of treatment. Mini-implants have the potential to be a viable alternative to standard-diameter implants in some circumstances. Benefits of mini-implants can be gained by replacing a single missing tooth, or preferably they must be used in multiples to retain fixed dental prostheses and might serve as an inexpensive, and efficient solution for retaining overdentures in selected cases.

Summary Background The maxillary lateral incisor is one of the teeth most likely to suffer agenesis, resulting in spacing between the central incisor and the canine. Objective To compare maxillary lateral incisor agenesis with space closure treatment versus non-treatment based on measurements of the self-perceived oral-health-related quality of life (OHRQoL) and self-esteem of the participants. Subjects and methods A total of 44 people, aged 17–49 years, with missing lateral incisors were randomly assigned to two groups (n = 22 in each)—a treated group in which the space was orthodontically closed (TG) and a control group that remained untreated (CG). Randomization was performed by a researcher who was not involved in the clinical part of the study. The outcomes were assessed using the Oral Health Impact Profile and Rosenberg’s Self-Esteem Scale, which were applied before (phase 1) and after (phase 2) the orthodontic treatment in the TG, and at baseline (phase 1) and 12 months after (phase 2) in the CG. All the data were blindly evaluated, supporting the single-blinded design of the study. Results All participants finished the randomized controlled trial, and the demographic characteristics were similar between the groups. In phase 1, the levels of self-esteem and OHRQoL at baseline were similar (P = 0.079, P = 0.693, respectively). In phase 2, the self-esteem scores of the CG decreased and the OHRQoL increased (P = 0.005, P < 0.001, respectively), while self-esteem increased in the TG and the OHRQoL decreased (P < 0.001). The CG had lower scores than the TG for self-esteem, but the opposite was observed for OHRQoL (P < 0.001). Limitations Information bias may have occurred. Since the questionnaires could not have been applied at the same time in both groups, the time difference between the two assessments may have led to random and systematic error. Conclusions The spacing resulting from missing maxillary lateral incisors had a negative impact on the OHRQoL and self-esteem of the participants, while orthodontically closing those spaces had a positive impact on those aspects. Clinical trial registration This study was not registered. Protocol The protocol was not published before trial commencement.

Background: Previous studies on root resorption were reviewed by panoramic radiographs. Cone-beam computed tomography (CBCT) showed that 41.5% of teeth experienced resorption when panoramically examinated, while 68% of teeth experienced resorption when the examination method used was CBCT. Root resorption occurs in the maxillary central incisor (as much as 74%) and in the maxillary lateral incisor (as much as 82%). The maxillary canines have the most resorption, followed by the lateral maxillary incisors. Purpose: The aim of this study was to determine the differences of apical resorption in anterior maxillary teeth before and after orthodontic treatment in skeletal Class I/II cases of extraction. Methods: Samples from this study were the results of panoramic photographs of 50 patients treated by fixed orthodontic appliances at the Dental and Oral Hospital Airlangga University. These were selected according to the sample criteria. The evaluation method consists of measuring root and crown lengths with a digital application (RadiAnt DICOM Viewer). Subsequently, the measurements were evaluated using CBCT images. Results: The data were statistically analysed using normality tests with Shapiro–Wilk and Kolmogorov–Smirnov tests. Based on the results of paired sample tests, it was found that every treatment group had significant differences in the average length of the crowns and roots, with a result of p=0.000 (p

Root resorption is one of the serious consequences of dental trauma. If left untreated, it may lead to loss of significant portion of the root, rendering the tooth unsalvageable. This report documents the nonsurgical management of a previously traumatized maxillary lateral incisor (#22) with a large periapical lesion, severely affected by inflammatory communicating internal- external root resorption. A cone beam computed tomography was advised, to aid in diagnosis and treatment planning. Endodontic treatment comprised of copious irrigation with 1.5% sodium hypochlorite and 2% chlorhexidine gluconate, intracanal calcium hydroxide dressings and mineral trioxide aggregate (MTA) placement in apical 5mm.Follow up at 6 months showed arrest of resorptive process and initiation of periapical healing. At 12 months, complete radiographic healing in the absence of clinical signs and symtoms was evident. Keywords: Calcium hydroxide, Cone beam computed tomography, Mineral trioxide aggregate, Root resorption.

Introduction. A radicular cyst is an odontogenic cyst originated from residual epithelial cells (remnants of Malassez cells) of periodontal ligaments with the previous history of chronic inflammation. The radicular cyst usually results from traumatized pulp or necrotic pulp that is left untreated. This study aimed to treat the maxillary lateral incisor with necrotic pulp and radicular cyst by apicoectomy, retrograde closure using mineral trioxide aggregate, followed by enucleation and bone graft application. Case Report. A 28-year-old female patient who suffered from recurrence pain and swelling in the right maxillary incisor area came to Gadjah Mada University Dental. The patient had a history of trauma on her maxillary right incisor 12 years ago. Vitality test, percussion test and palpation test showed negative results. Cone beam computed tomography radiograph showed circular radiolucent lesions with a firm radiopaque border surrounding the apical of tooth resulted in a cortical bone loss on the labial aspect. The lateral maxillary incisor was diagnosed as necrotic pulp with the radicular cyst. Conventional endodontic treatment was performed in two visits using calcium hydroxide as intracanal medicament followed by class I composite resin restoration. Apicoectomy procedure was performed on the third visit using mineral trioxide aggregate as retrograde filling material followed by enucleation of radicular cysts and application of bone graft as bone regeneration material. Three months of control after treatment showed good bone tissue regeneration. Post-operative control in the third month showed functional bone tissue regeneration. Conclusion. Apicoectomy and retrograde closure using aggregate mineral trioxide followed by enucleation and bone graft application is a treatment of choice for pulp necrosis with the radicular cyst.

A case report of discussed an inventive management of apically extending palatogingival groove causing periodontal destruction along with rationale behind this technique. In this case the endodontic – periodontal lesion successfully manages without using any subgingival restorative material despite having poor prognosis.

This study aimed to evaluate the effect of ultrasonic activation on coronal marginal adaptation and microporosity of tricalcium silicate-based materials. Sixty freshly extracted human maxillary lateral incisor teeth were instrumented with ProTaper Next X2 files followed by Peeso-Reamer burs, sizes 1 to 5. The specimens were randomly divided into six groups (n = 10): Group 1, Biodentine + hand condensation; Group 2, Biodentine + ultrasonic activation; Group 3, NeoMTA Plus + hand condensation; Group 4, NeoMTA Plus + ultrasonic activation; Group 5, ProRoot WMTA + hand condensation; and Group 6, ProRoot WMTA + ultrasonic activation. All tested materials were mixed mechanically and placed 2 mm underneath the cement-enamel junction by hand condensation or indirect ultrasonic activation. Volumetric analysis of the voids between the dentine wall and coronal barrier material and the porosity within the material was evaluated with micro-CT. There was no significant difference in marginal adaptation among the six groups (P > 0.05). Ultrasonic activation favoured a reduced microporosity in Biodentine Group (P < 0.001). Bezmiâlem Vakıf Üniversitesi

Complete arch fixed implant supported prosthesis made of monolithic zirconia is a popular treatment option with minimal complications, as documented in the literature over a 5-year period. One of the limitations of this material is its inability to be used when the span between adjacent implants is excessively long. A potential solution to mitigate this problem is to support the zirconia prosthesis with a metal substructure, which intrinsically has higher tensile strength. This clinical report describes the successful use of this prosthetic design in a male patient with bruxism and history of multiple implant failures in the maxilla. This resulted in a large anterior-posterior span between the anterior implants in the maxillary lateral incisor region and the distal implants in the pterygoid region. This article also describes the use of a split file digital workflow to scan the prototype prosthesis and then digitally design and mill the screw-retained cobalt chromium bar, as well as the overlaying of zirconia prosthesis which was retained by separate screws. This novel approach offers promise for management of the atrophic maxilla where implants with remote anchorage are used resulting in broader distribution of implants.

Immediate implant placement has some advantages, such as time-saving, optimal soft tissue architecture preservation, and patient acceptance. In this case, prior to implant placement, minimally guided bone regeneration was performed to augment the concavity on the apico-labial aspect of a fractured maxillary right lateral incisor. After eight months, the tooth was extracted, and an implant was immediately inserted, and a provisional composite-based crown was delivered in the same appointment. After four months, well molded mid-facial gingiva and interproximal papilla were obtained, and a final metal-ceramic crown was fabricated.

To review currently available evidence regarding the use of mini-screw implant (MSI)-supported pontics for the transitional management of missing permanent maxillary lateral incisors in children and adolescents. Indexed databases were searched until October 2019. The following inclusion criteria were imposed: (a) children and adolescents with missing permanent maxillary lateral incisor/s; (b) temporary replacement of missing permanent maxillary lateral incisors with MSI-supported pontics; (c) clinical and radiographic assessment of the outcome [MSI stability and/or alveolar bone (ALB) development]; and (d) follow-up after pontic placement. Commentaries, letters to the Editor, reviews, and studies in adult patients and/or patients with systemic/genetic diseases, with no follow-up, and without clinical and radiographic assessment of the outcome were excluded. Six out of 225 initially-identified studies were included. All studies were case-reports/series. A variability was observed among studies-assessed regarding the treatment protocol such as in the MSI dimensions, loading time and pontic retention protocol. Results from the included studies indicate that the MSI-supported pontics remained stable, with no infraocclusion and angular bony defect formation, ALB levels and bone density were maintained, and there was vertical ALB development during the follow-up period which ranged up to 99 months. Reported complications included MSI loss due to mobility, crown repair/replacement due to discoloration, and gingival impingement. The limited evidence shows that MSI-supported pontics are useful transitional restorations for missing permanent maxillary lateral incisors in children and adolescents; however, further well-designed clinical trials are needed in this regard.

Loss of alveolar bone may be attributed to various factors, such periodontal diseases, endodontic pathology, facial trauma, and traumatic tooth extraction. Different techniques such as ridge preservation procedures have been proposed to maintain the ridge dimension to a certain amount. However, applying these methods to extraction sockets could not completely preserve the coronal part of facial bone walls which were comprised almost entirely of bundle bone. The socket shield technique (SST) with immediate implant in esthetic zone provides a promising treatment to better manage these risks and preserve the post-extraction hard and soft tissues. This case report demonstrates the 3-year follow up of the treatment of non-restorable maxillary lateral incisor with the socket shield technique in conjunction with immediate implant placement. Keywords: Socket-shield technique, Dental implant, Ridge preservation, Immediate implant, Alveolar ridge resorption, Buccal bone, Esthetic zone.

BACKGROUND Invaginated teeth pose greater challenges in clinical management because of their complex configuration. With advancements in equipment and materials, such as the dental operation microscope, cone-beam computed tomography and mineral trioxide aggregate, the preservation rate of type III dens invaginatus could be greatly increased. CASE SUMMARY This case report presented a 31-year-old woman with complaints of spontaneous swelling and pain in the right maxillary lateral tooth. With the aid of cone-beam computed tomography, type III dens invaginatus with apical periodontitis was diagnosed and confirmed. Three-visit endodontic treatment was performed. In the first visit, the invagination was carefully removed under the dental operation microscope, and chemomechanical preparation was done. In the second visit, mineral trioxide aggregate apical barrier surgery was performed in this tooth. In the third visit, the canal was finally obturated with thermoplastic gutta-percha to recover the crown morphology. A 26-mo follow-up revealed a satisfied outcome both in the radiographic and oral examinations. CONCLUSION In this case, removal of the entire abnormal structure provided great convenience for the follow-up treatment. When confronted with the same clinical case in the future, we can take a similar approach to address it.

A unilateral congenitally missing maxillary lateral incisor is often associated with a small or peg-shaped contralateral tooth. This form of hypodontia is also frequently combined with a generally undersized maxillary dentition, which could therefore be considered a paradigm for esthetic situations where problems of tooth position, size and form need to be connected and resolved. The space opening versus the space closure option should derive from a hierarchy of decisions. When we treat young patients, the restorative solutions should be obtained by a minimally invasive approach, which facilitates both the reversibility and ease of reintervention in the long term.

Summary Objectives To determine the prevalence and distribution of clinically missing permanent incisors, and the age at which they are detected, in school-aged children. Methods A total of 2573 children aged 4–13 underwent oral health screening on at least one occasion between 2001 and 2017. In order to define a threshold age, after which permanent incisor agenesis could be suspected clinically with reasonable certainty, children who had been seen for at least three consecutive years, with any clinically missing permanent incisor were selected (n = 19). The maximum age of detection among these children was chosen as the threshold age. Based on this, a total of 766 children at or above the threshold age were screened for a cross-sectional epidemiological survey. Chi-squared tests were used to compare the prevalence of clinically missing permanent incisors among boys and girls, comparing unilateral versus bilateral, and right- versus left-sided missing teeth. Results Roughly 2% of the sample presented with at least one clinically missing maxillary lateral incisor. This was bilateral in half of cases. Clinically missing mandibular incisors were found in 0.5% of children. Finally, the threshold age for clinical suspicion of maxillary lateral incisor agenesis was set at 11.5 years. Agenesis was confirmed in all of the children attending a follow-up radiographic visit. Conclusions Approximately 1 in 50 children present with a clinically missing maxillary lateral incisor. The age at suspicion of maxillary lateral incisor agenesis can sometimes be several years after its expected eruption, perhaps due to significant variation in eruption times.

Aim To evaluate the effect of the differences in the dimensions of maxillary lateral incisor on the esthetic perception of smile among dental professionals and the general population. Materials and methods Two sets of photographs where the maxillary incisor dimensions were modified using computer software (Adobe Photoshop) were created. In the first set, six images were included where the maxillary lateral incisor width was modified. The second set included five images where only the maxillary lateral incisor length was modified keeping the gingival margins same. Three groups of participants formed the sample. Hypodontia patients formed the first group, non-hypodontia patients formed the control group, while the dentists constituted to the third group. A total of 156 participants were recruited, 36 patients with radiographically confirmed hypodontia out of which 22 were female and 14 were male, 54 non-hypodontia "control" patients out of which 29 were female and 24 were male, and 66 dentists out of which 39 were female and 27 were male. Every participant had 15 seconds to view each photograph along with 30 seconds at the end for confirmation. Results The "most attractive smile" was the ones with 77% lateral incisor to central incisor width proportion according to 25.0% of the hypodontia group and 40.8% of the dentist's group, while only 4.2% of the control group agreed that it was the most attractive. However, the "least popular" was the 52% lateral incisor to central incisor width proportion according to 40.0% of patients who are hypodontic, 20.8% of participants from control group, and 49.0% of dentists. Conclusion The golden proportion was not considered as the most attractive among all groups. The esthetic perceptions of the patients might not be same as that of the dentists. In general, reductions in the maxillary lateral incisor width were not all acceptable. Clinical significance This study will help us understand the different perceptions of the patients and the dentists on esthetics, which would further help us in planning the treatment accordingly.

Teeth are biological markers of maturity, and their eruption into the oral cavity is an essential milestone in an individual's life. Multiple factors have been considered to play a role in the pattern of tooth eruption, including dental caries, fluorides and congenital conditions such as Down's syndrome. The aim of the paper was to determine the time of eruption of permanent teeth amongst children aged between five and ten years, visiting the Dental College in Mangalore. A survey was conducted among children aged between 5 to 10 years visiting A.B. Shetty Memorial Institute of Dental Sciences Deralakatte, Mangalore. Each child included in the study was screened by clinical examination for the erupted and erupting permanent teeth. A parent/guardian accompanying a child was interviewed and their data were recorded. The study revealed that the first tooth to erupt was the left mandibular first molar, with a mean age of eruption at 6.4 years. A slight early eruption of teeth was noticed in the left side of the jaw compared to the right side in the present study. The first permanent tooth to erupt in the oral cavity is the left mandibular first molar and there is a slight delay in the eruption of the maxillary lateral incisor in the study population.

Introduction: Developmental disturbances of teeth at the stage of morpho-differentiation have been related to abnormalities associated with changes in the tooth shape and size. Dens evaginatus and dens invaginatus are the developmental variations of the human dentition. Dens evaginatus, a rare anomaly characterized by the presence of a tubercle on the occlusal surface of teeth is seen to occur due to abnormal proliferation and folding of the inner enamel epithelium and part of the dental papilla into the stellate reticulum of the enamel organ; whereas, dens invaginatus is seen to occur due to infolding of the enamel and dentine into the pulp cavity and sometimes extending to the root apex. Case report: We report cases with bilateral dens evaginatus in mandibular second premolars and dens invaginatus in maxillary lateral incisor. Conclusion: Such developmental anomalies of teeth deserve clinical importance, as high chances of early pulpal pathosis.

Although endodontic treatment has shown high success rates, the factors involved in the failure cases are still being studied. In this sense, the complexity of interradicular anatomy may lead to inadequate instrumentation and the persistence of etiological factors related to apical periodontitis and endodontic failure. The present case report illustrates the occurrence, diagnosis and nonsurgical endodontic treatment of a maxillary lateral incisor with two canals. A 24-year-old Peruvian woman was referred complaining of darkening of the upper front tooth. After clinical examination, the patient was diagnosed with necrotic pulp and asymptomatic apical periodontitis. Still, radiographic examination revealed a disruption in the canal continuity, leading to a suspicion of unusual root canal morphology in the maxillary lateral incisor. By taking radiographs from different angles, according to the technique described by Clark, the presence of two independent canals was verified. Since most cases of endodontic failure are due to untreated canals, a predictable endodontic therapy must achieve the removal and neutralisation of etiologic factors related to periapical infiltration. The occurrence of additional root canals requires a correct interpretation of radiographic images to detect these variants and take the necessary considerations for proper endodontic treatment.

The aim of this study was to investigate root canal curvature and direction of maxillary lateral incisors in Shandong, China. Cone beam computed tomography (CBCT) images of 176 maxillary lateral incisors of 88 patients were collected in Shandong Province, China. Software included with CBCT was used to measure the angle of root canal curvature of maxillary lateral incisors on the maximum bending plane. In addition, the direction of each root canal was recorded. The data were statistically analyzed by SPSS 17.0 software package. The results showed that all the samples had a single canal (Vertucci's type I). The incidence of straight root canals, curved root canals, and S-type root canals was 39.2%, 58%, and 2.8%, respectively. The difference in the mean angle of root canal curvature failed to identify any differences between the left and right side (P > .05). The most curved root canal of maxillary lateral incisors oriented in the palato-distal direction. The maxillary lateral incisors were mainly curved root canals of which the proportion of moderate curvature was the largest. Software included with CBCT would provide some valuable information for root canal instrumentation of maxillary lateral incisors.

Dental trauma (DT) can compromise teeth, periodontium, and soft tissues. Fairly common among children and teenagers, DT is a public health problem worldwide, for its high prevalence on upper central incisors can trigger functional, aesthetic, and psychosocial issues in patients. Several approaches are possible for properly treating DT, such as the direct restoration using resin-based composite (RC). This study aimed to report and discuss two restorative techniques using RC in an 8-years old male child with upper anterior teeth fractured due to DT, including coronal fracture involving enamel and dentin in the right maxillary central incisor, and only enamel in the right maxillary lateral incisor. The restoration was performed using adhesive system (AS) and RC under relative isolation of the operatory field. Due to the large fractured area in the right maxillary central incisor, a silicon guide was previously prepared based on a waxing model to facilitate the reestablishment of the lingual surface form and anatomy. Having had a smaller fractured area, the right maxillary lateral incisor was restored using the direct free-hand technique. In this clinical case, enamel and detin were restored by incremental filling technique with different resin opacities. In the follow-up clinical evaluation, the patient, relatives, and dental clinicians reported satisfactory functional and aesthetic outcomes. O traumatismo dentário (TD) pode comprometer os dentes, o periodonto de suporte e/ou os tecidos moles adjacentes. Frequente em crianças e adolescentes, o TD é um problema de saúde pública mundial, pois, com alta prevalência sobre os incisivos centrais superiores, pode gerar problemas funcionais, estéticos e psicossociais ao paciente. Diferentes terapêuticas estão disponíveis para o tratamento de TD, entre as quais destacamos a técnica restauradora direta com resina composta (RC). Este estudo tem como objetivo relatar e discutir duas técnicas restauradoras com RC em pacientes odontopediátricos, com dentes anterossuperiores fraturados devido ao TD, tendo, por base, o caso clínico de um paciente com 8 anos, do sexo masculino, diagnosticado com fratura coronária do esmalte e da dentina no incisivo central superior direito e do esmalte, no incisivo lateral superior direito. A restauração dos dentes fraturados foi realizada com sistema adesivo (SA) e RC, sob isolamento relativo do campo operatório. No incisivo central superior direito, devido à extensão da área, foi utilizada a técnica da matriz de silicone para a restauração anatomofuncional da face palatina, confeccionada previamente, a partir do enceramento do modelo estudo. Com menor extensão, a restauração do incisivo lateral superior direito foi realizada pela técnica da mão livre. Nesse caso clínico, dentina e esmalte vestibular foram restaurados por meio da estratificação de incrementos de RC com diferentes opacidades. Em fase de proservação clínica, os resultados estético e funcional obtidos foram considerados altamente satisfatórios para os pacientes, familiares e operadores.

Low-density lipoprotein receptor-related protein 6 (LRP6) is a pathogenic gene of selective tooth agenesis-7 (OMIM#616724). Although the malformation of the digits and fore- and hindlimbs has been reported in Lrp6-deficient mice, it has been rarely discovered in humans with LRP6 mutations. Here, we demonstrate an unreported autosomal dominant LRP6 heterozygous mutation (c.2840 T > C;p.Met947Thr) in a tooth agenesis family with hand polydactyly, and another unreported autosomal dominant LRP6 heterozygous mutation (c.1154 G > C;p.Arg385Pro) in a non-syndromic tooth agenesis family. Bioinformatic prediction demonstrated the deleterious effects of the mutations, and LRP6 structure changes suggested the corresponding functional impairments. Analysis on the pattern of LRP6-related tooth agenesis demonstrated the maxillary lateral incisor was the most affected. Our study report that LRP6 mutation might be associated with hand preaxial polydactyly in humans, which broaden the phenotypic spectrum of LRP6-related disorders, and provide valuable information on the characteristics of LRP6-related tooth agenesis.

The reported clinical scenarios presented two patients, one managed with a prefabricated abutment and the other with a customized abutment, and both patients were pleased with the outcome. However, from a professional viewpoint, the esthetic outcome using the custom zirconia abutment was superior to that using the prefabricated titanium abutment.

Maxillary lateral incisor is the most frequent congenitally missing anterior tooth of the permanent dentition. The absence of the anterior tooth can adversely affect the production/transmission of speech sounds, mental health, and facial aesthetics of an individual. Considering this, prosthetic rehabilitation of missing front tooth is important. The treatment alternatives include implant supported single crown, conventional fixed partial dentures (FPDs), and resin bonded FPDs that are unilaterally or bilaterally supported by metallic wings. However, with the development in adhesive dentistry fiber reinforced composite (FRC) supported FPDs have provided a workable substitute for traditional techniques because of their improved esthetics, minimal invasiveness, less cost, enhanced bond strength, and revocable nature. The current case, reports the two years follow up of twenty-four years old female patient, for whom the congenitally absent maxillary right lateral incisor was restored with FRC supported FPD. doi: https://doi.org/10.12669/pjms.37.3.3873 How to cite this:Javed MQ. Fiber reinforced composite supported restoration of congenitally missing tooth by minimally invasive approach: Two years follow-up. Pak J Med Sci. 2021;37(3):919-921. doi: https://doi.org/10.12669/pjms.37.3.3873 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A supernumerary tooth is an entity in addition to the normal series of teeth that, although rare, can be fused to a tooth, whether deciduous or permanent. Diagnosis and management in cases involving supernumerary teeth in the anterior region of the maxilla are often challenging. The clinical examination associated with the radiographic examination is decisive for the diagnosis and planning of cases. This article describes a case of unilateral fusion of a supernumerary tooth to a permanent upper lateral incisor, in which clinical and radiographic diagnosis was essential for a conservative approach. Descriptors: Diagnosis; Fused Teeth; Tooth, Supernumerary. References Rajab LD and Hamdan MA. Supernumerary teeth: review of the literature and a survey of 152 cases. Int J Paediatr Dent. 2002;12:244–54. Yang G. Supernumerary teeth and gemination. Br J Oral Maxillofac Surg. 2012;50:15–8. Zhu M, Liu C, Ren S, Lin Z, Miao L, Sun W. Fusion of a supernumerary tooth to right mandibular second molar: a case report and literature review. Int J Clin Exp Med. 2015;8(8):11890-95. Rudagi K, Rudagi BM, Metgud S, Wagle R. Endodontic management of mandibular second molar fused to a supernumerary tooth, using spiral computed tomography as a diagnostic aid: a case report. Case Rep Dent. 2012;2012:614129. Nandini DB, Deepak BS, Selvamani M, Puneeth HK. Diagnostic dilemma of a double tooth: a rare case report and review. Journal of Clinical and Diagnostic Research. 2014;8(1):271-72. Duncan WK, Helpin ML. Bilateral fusion and gemination: a literature analysis and case report. Oral Surg Oral Med Oral Pathol.1987;64(1):82-7. Gupta S, Singla S, Marwah N, Dutta S, Goel M. Synodontia between permanent maxillary lateral incisor and a supernumerary tooth: treatment J Oral Health Comm Dent. 2007;1:52-5. Mader CL (1979) Fusion of teeth. J Am Dent Assoc 98:62-4. Kumar V, Pandey V, Rohini G, Jyoti B. Fusion Between Maxillary Premolar and A Supernumerary Tooth: A Rare Case Presentation. J Clin Diagn Res. 2015;9(11): ZJ03-4. Maréchaux SC. The treatment of fusion of a maxillary central incisor and a supernumerary: report of a case. ASDC J Dent Child. 1984;51:196-99. De Siqueira VC, Braga TL, Martins MA, Raitz R, Martins MD. Dental fusion and dens evaginatus in the permanent dentition: literature review and clinical case report with conservative treatment. J Dent Child (Chic) 2004;71:69-72. Karacay S, Guven G, Koymen R. Management of a fused central incisor in association with a macrodont lateral incisor: a case report. Pediatr Dent. 2006;28:336-40. Cetinbas T, Halil S, Akcam MO, Sari S, Cetiner S. Hemisection of a fused tooth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:e120-24. Nunes E, deMoraes IG, de Novaes PM, de Sousa SM. Bilateral fusion of mandibular second molars with supernumerary teeth: case report. Brazilian Dent J. 2002;13:137-41.

Anatomical variations in the root are quite possible, if such teeth are infected, it is challenging to treat them. A patient with two rooted maxillary lateral incisor having open apex with periapical lesion reported to the department. Non-surgical endodontic treatment was initiated under magnification, open apex was sealed with MTA plug and root canal treatment completed. The case was followed up for one year and there was radiographic healing of periapical lesion. Keywords: MTA plug, Openapex, Periapical lesion, Two rooted lateral incisor.

Palatoradicular grooves are the developmental anomalies that owing to complexity in morphology and extent along the root length, can be an aetiology for periodontal destruction, endodontic involvement or both. We report a case of a 34 years male patient who presented with a chief complaint of pain and swelling in his upper left front region of jaw since one month. Clinical and radiographic examination confirmed presence of periodontal-endodontic lesion with respect to 22. Endodontic treatment followed by periodontal debridement, regenerative procedures, odontoplasty and sealing of the groove was done. Combined endodontic-periodontal approach was successful in resolving the pathology with satisfactory and stable healing seen clinically and radiographically for upto six months postoperative.

Maxillary lateral incisors are generally considered as a tooth with a single root and single canal. This is not true in all cases as case reports have advocated maxillary lateral incisors showing two roots with two or three root canals, Thorough knowledge of the internal and external dental anatomy and its variations is essential for a successful endodontic treatment. This case report deals with the periapical surgery in a two rooted maxillary lateral incisor along with the central incisor.