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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.

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.

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.

BACKGROUND Clinicians needed to be aware of the thinness of the palatal bone plate when identifying severe protrusion of maxillary incisors, as this could result in perforation of the palatal bone plate during surgical procedures associated with immediate maxillary implant placement. PURPOSE This study evaluated the thickness of the palatal bone plate, the buccolingual angulation of maxillary incisors, and the correlation between these two parameters in relation to immediate implant placement. MATERIALS AND METHODS Cone-beam computed tomography images of 37 Asian patients (20-60 years old) with no evidence of dental treatment in the maxillary incisor area were collected and classified into groups based on sex and incisor locations. Sagittal slices were used to measure the palatal bone plate thickness at the cervical, middle, and apical levels, and the buccolingual angulation of each tooth was also measured. The intraclass correlation, Shapiro-Wilk test, descriptive analysis, Student's t-test, and Pearson correlation were used for statistical and correlation analyses, with P

OBJECTIVE The treatment of congenitally missing maxillary lateral incisors is often complex and requires a multidisciplinary approach, which demands continuous collaboration among the different specialists involved in the rehabilitation. In young patients, implant therapy or the preparation of intact teeth for fixed prostheses is not indicated. CLINICAL CONSIDERATIONS Two complex cases of double maxillary canine inclusion were treated with combined surgical, orthodontic, and conservative prosthetic treatments. Orthodontic therapy allowed the creation of the necessary interocclusal space to fabricate the all-ceramic resin-bonded fixed partial dentures without the preparation of the abutment teeth. CONCLUSIONS Carefully planned and meticulously executed orthodontic and prosthetic therapies allowed for a noninvasive rehabilitation of patients with maxillary lateral incisor agenesis. CLINICAL SIGNIFICANCE This article provides clinicians with a noninvasive solution for agenesis of lateral incisors associated with canine inclusions. Indications for the choice of material of all-ceramic resin-bonded fixed partial dentures are discussed and presented.

Objective Clinicians are faced with three common treatment options for the high frequency of missing or lost maxillary lateral incisors; canine substitution, a resin-bonded fixed dental prosthesis (RBFDP), or a dental implant. A review of current data and guidelines for treatment provide new insight into making the most appropriate selection. Overview The incidence of maxillary incisor agenesis and loss is prevalent. Both canine substitution and RBFDPs exhibit esthetic and functional advantages and disadvantages. Conclusions Most missing lateral incisors are detected at an early age as a result of congenital absence; therefore, proper treatment of these young patients is essential. Both canine substitution and RBFDPs can provide long-term success and esthetics when carefully executed. The decision should be based on the patient's expectations, their clinical presentation, cost, and the team's ability to provide the best long-term esthetic and functional prognosis for a specific patient. Clinical significance Patients regularly present for treatment of missing and lost maxillary lateral incisors. The functional and esthetic aspects of canine substitution and a RBFDP should be clearly understood relative to the clinical parameters of each patient prior to treatment.

Introduction This case report presents the successful multidisciplinary treatment of a maxillary lateral incisor with a deep and narrow recession involving the root apex associated with pulpal necrosis. The tooth initially considered with a hopeless prognosis, was treated with a combined periodontal plastic, regenerative, and endodontic surgical procedure. Case presentation A recently reported technique, the laterally stretched (LAST) flap with a connective tissue graft (CTG) technique for root coverage, was combined with enamel matrix derivative (EMD) for periodontal regeneration of the periapical lesion, that complemented an apicoectomy with retrograde sealing. The 6-year follow-up evidenced root coverage (RC) of 91.6% and increased keratinized tissue. Clinical and radiographic evaluation showed resolution of the periapical process. Conclusions A severe gingival recession with endodontic involvement can be repaired if adequate control of the endodontic infection is obtained. The LAST flap, originally described for lower anterior teeth, was used successfully in a maxillary tooth, under extreme circumstances.

Purpose To evaluate the fit of single crowns fabricated using conventional, digital, or cast digitization methods. Materials and methods One subject with a peg-shaped maxillary lateral incisor was selected in this study. Tooth preparation for an all-ceramic crown was performed and 10 conventional poly(vinyl siloxane) impressions, and 10 digital impressions using an intraoral scanner were made. Each working cast was scanned using a laboratory scanner and an intraoral scanner. Four groups were tested Group 1: conventional impressions. Group 2: cast laboratory scans. Group 3: cast scans using intraoral scanner. Group 4: direct intraoral scans. For group 1, heat-pressed glass ceramic crowns (IPS e.max Press) were fabricated using casts produced from the conventional impressions. For groups 2-4, crowns were milled using ceramic blocks (IPS e.max CAD). Ten crowns were fabricated for each group. Marginal and internal gaps were measured using a replica technique. Replicas were sectioned mesiodistally and buccolingually and were observed under a stereomicroscope. Three measurements were selected for each cut: occlusal, axial, and marginal. Statistical analysis was performed using two-way ANOVA and Tukey HSD tests. Results For each replica, 6 measurements were made for the mesiodistal and the same for the buccolingual cuts, producing 12 measurement points per crown (4 measurements for marginal, 4 for axial, 4 for occlusal), 120 measurements for each group (40 measurements for marginal, 40 for axial, 40 for occlusal), and 480 measurements in total. Two-way ANOVA revealed location to be a significant factor (p = 0.001). No significant differences among groups (p = 0.456), and no interactions between groups and locations (p = 0.221) were found. Means for the occlusal site were significantly larger than other sites in most group combinations, while the difference between the marginal and axial sites was not significant. No significant differences among groups were found for each measurement. The marginal gaps ranged from 125.46 ± 25.39 μm for group 3 to 135.59 ± 24.07 μm for group 4. The smallest axial mean was in group 1 (98.10 ± 18.77 μm), and the largest was 127.25 ± 19.79 μm in group 4. The smallest occlusal mean was in group 2 (166.53 ± 36.51 μm), and the largest occlusal mean was in group 3 (203.32 ± 80.24 μm). Conclusions Ceramic crowns, which were made using all-digital approach or cast digitization by a laboratory or intraoral scanner had comparable fit to those produced by conventional approach.

AIM: To describe a minimally invasive method to create a 3D-printed guide to gain access to obliterated root canals on the basis of CBCT data. SUMMARY: A 85-year-old female ASA III was referred for root canal treatment of tooth 22. Clinically, there were no complaints, no percussion pain or sinus tract. Radiologically, the tooth had an obliterated canal with an apical radiolucency. The tooth was diagnosed with asymptomatic apical periodontitis. Microguided Endodontic treatment was performed with the help of a 3D-printed guide. The root canal was localized initially with the aid of the 3D-printed guide using a round carbide bur with a head diameter of 0.8 mm. Then, the canal was shaped and cleaned using mechanical rotary files under copious irrigation with 5% NaOCl, 17% EDTA and passive ultrasonic activation. A completely healed apical area of tooth 22 was visible after 6 months on periapical radiographs and small field of view CBCT. KEY LEARNING POINTS: Using the Microguided Endodontics concept, a minimally invasive access was achieved up to the middle of the root, in a maxillary lateral incisor with pulp canal obliteration (PCO) and apical periodontitis. This technique is a valuable tool for the negotiation of PCO, reducing chair time and risk of iatrogenic damage to the root. ispartof: INTERNATIONAL ENDODONTIC JOURNAL vol:52 issue:4 pages:540-549 ispartof: location:NETHERLANDS, ACTA, Amsterdam status: published

To evaluate (i) a possible correlation between the mesio-distal gap width and the alveolar ridge (AR) dimensions in patients missing the maxillary lateral incisor (I2) either due to agenesis or loss and (ii) the possibility of straightforward implant placement based on simulation.The bucco-palatal width, area, and height of the AR at the position of I2, and the mesio-distal gap width between the central incisor and the canine, were assessed in maxillary CT scans of three groups: Patients with (i) agenesis of I2 (TBucco-palatal width and area of the AR at I2 and the adjacent teeth was significantly reduced in TIn patients congenitally missing I2, an increased mesio-distal gap width correlates significantly with reduced edentulous AR dimensions. A mesio-distal gap of6 mm was associated with thin bucco-palatal alveolar ridges, precluding straightforward implant placement in 60-80% of the cases.

Objective To investigate how the distance between narrow implants and adjacent teeth influences the marginal bone levels (MBL) up to 3 years after placement. Material and Methods A prospective, single-arm, multicenter clinical study was designed to include patients missing 12, 22, 32, 31, 41 or 42 teeth. Implants of 3.0 mm diameter and different lengths were used in the study. One-stage surgery was performed and healing abutments placed during the 6–10 weeks healing period. Clinical and radiographic evaluation was performed at implant installation, loading, and at the 6, 12, 24 and 36-months follow-up visits. Results Eighty-three implants were placed in 59 patients. A total of 48 implants were placed in narrow implant-to-tooth spaces (percentile 25, 0.83(0.25) mm), 80 in regular spaces (percentile 25

The study aims to report a technique for the extraction of an anterior maxillary root with simultaneous immediate implant placement and immediate loading with provisional non-functional restoration. Due to a root fracture of a maxillary lateral incisor (#22), a semilunar flap was utilised to create a bony window in the apical area of the tooth and gently extract the remaining portion of the root through the alveolar socket. This technique is recommended in cases of immediate implant placement in fresh extraction sites where coronal bony bridge is intact. Then an implant was placed and the apical bony defect was repaired with guided bone regeneration. The loading of the implant with a temporary implant restoration within 24 h was applied without functional occlusal contacts. The placement of the permanent restoration was scheduled for 6 months later. After 1 year, a clinical and radiographic examination showed a normal peri-implant bone level and a successful aesthetic effect. Furthermore, after four years the patient was examined and the implant is still showing good functional and aesthetic outcome. The preservation of the coronal bony anatomy, periosteum and soft tissues during the immediate implant placement is a major contributing factor to a desired aesthetic effect, which is enhanced with the option of immediate non-functional loading. The described surgical approach preserves the advantages of immediate implant placement in fresh extraction sites in the maxillary aesthetic zone without intrasulcular incision and mucoperiosteal flap elevation while minimising the bony injuries during the extraction of the tooth.

This case report, involving an indigenous Australian, presents the diagnosis and non-surgical endodontic management of a 22 with developmental abnormalities. They include a dens evaginatus and a dens invaginatus that extends to an apical burst in a second truncated root. Cone-beam computed tomography and endodontic microscopy were not available to the clinician. This case report focuses on ambiguities appearing in the literature relating to classification and terminology associated with the abovementioned developmental anomalies. It also demonstrates the need to methodically collect and cautiously interpret available information before initiating endodontic intervention. Axial inclination, distance perception, internal demarcation and spatial awareness, together with an understanding of dental anatomy, embryology and histology and associated physiology and pathology, allowed the clinician to accurately predict the point, the angle and the depth of coronal access. Sensibility of the dentino-pulpal complex was maintained. Critical thinking, experience, innovation, problem-solving and established principles can compensate for inaccessible technologies.

Aim Autotransplantation is a viable treatment option for a missing tooth when there is a suitable donor, especially in adolescents with remaining facial growth. This report presents the aesthetic restoration of a missing maxillary lateral incisor through orthodontic treatment and autotransplantation of a mesiodens using a CBCT-fabricated rapid-prototyping model. Summary A 14-year-old male patient with a congenitally missing maxillary lateral incisor was referred from the Department of Orthodontics. The teeth were moved orthodontically to regain space for the missing lateral incisor and to close the space of the mesiodens after transplantation. A replica of the donor tooth was fabricated from a cone-beam computed tomography scan through a rapid-prototyping machine before autotransplantation surgery. The model was used to create a socket for the graft tooth, thereby shortening the extra-oral time and minimizing the damage to the root surface. After transplantation and orthodontic tooth movement, the mesiodens was finally restored with an aesthetic laminate restoration. Over 3 years, the aesthetics remained excellent, and the transplant functioned normally without any signs or symptoms of root resorption. Key learning point Missing anterior teeth may be replaced through a combination of orthodontics, autotransplantation with a rapid-prototyping model and prosthodontic restoration, in growing patients.

The congenitally missing maxillary lateral incisor is the most common agenesis in the anterior region. There are several treatment options for this anomaly, which causes severe deficiencies: orthodontic space closure, tooth-supported restoration, or single-tooth implant. Each of these solutions has a high degree of success if used in the correct situation. An implant-supported restoration with an interdisciplinary approach provides a predictable outcome. This article describes the treatment of a patient with agenesis of the maxillary left lateral incisor. After orthodontic space management, it was decided to restore the tooth with an all-ceramic crown cemented on a zirconia custom abutment, which fractured after only 6 weeks of service. Fractographic analysis revealed that the failure was due to over-reduction of the buccal wall to correct the labial emergence of the implant. Zirconia abutments should be designed with even wall thicknesses of at least 0.8 mm to avoid areas that may compromise functional success.

Purpose Fiber-reinforced composite dowels have been widely used for their superior biomechanical properties; however, their preformed shape cannot fit irregularly shaped root canals. This study aimed to describe a novel computer-aided method to create a custom-made one-piece dowel-and-core based on the digitization of impressions and clinical standard crown preparations. Materials and Methods A standard maxillary die stone model containing three prepared teeth each (maxillary lateral incisor, canine, premolar) requiring dowel restorations was made. It was then mounted on an average value articulator with the mandibular stone model to simulate natural occlusion. Impressions for each tooth were obtained using vinylpolysiloxane with a sectional dual-arch tray and digitized with an optical scanner. The dowel-and-core virtual model was created by slicing 3D dowel data from impression digitization with core data selected from a standard crown preparation database of 107 records collected from clinics and digitized. The position of the chosen digital core was manually regulated to coordinate with the adjacent teeth to fulfill the crown restorative requirements. Based on virtual models, one-piece custom dowel-and-cores for three experimental teeth were milled from a glass fiber block with computer-aided manufacturing techniques. Furthermore, two patients were treated to evaluate the practicality of this new method. Results The one-piece glass fiber dowel-and-core made for experimental teeth fulfilled the clinical requirements for dowel restorations. Moreover, two patients were treated to validate the technique. Conclusion This novel computer-aided method to create a custom one-piece glass fiber dowel-and-core proved to be practical and efficient.

Aim The aim of the present study was to determine the association of both buccally- and palatally-impacted canines with other dental anomalies. Methods This retrospective study was conducted on a population of 533 southern Chinese children and adolescents who had impacted maxillary canines that had been treated in the Paediatric Dentistry and Orthodontics Clinic, Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong. Descriptions of the impacted canine and other associated anomalies were obtained from the case notes and radiographs. Clinical photographs and study casts were used, where available. Results A total of 253 (47.5%) patients with impacted maxillary canines were diagnosed with other dental anomalies. Microdontia was the most frequently-occurring anomaly reported in these patients, with the maxillary lateral incisor the most commonly affected tooth. Other odontogenic anomalies that were associated with both buccally- and palatally-impacted canines included hypodontia, supernumerary teeth, transposition of other teeth, enamel hypoplasia, other impacted teeth, and dens invaginatus. Conclusion Both buccally- and palatally-impacted canines were found to be associated with other odontogenic anomalies.

The objective of this clinical report is to present decoronation of young permanent ankylosed incisors as an option to preserve the alveolar process in young people where implant rehabilitation is not yet indicated. A 13-year-old patient presented with intrusive luxation of the permanent maxillary lateral incisor and lateral luxation of both permanent maxillary central incisors. During 6 months, clinical and radiographic evaluation showed progressive root replacement resorption, and surgical decoronation was recommended for all three incisors and left for a period of 6 years until the implant and grafting procedures be performed. Decoronation in young teeth is a reliable technique in terms of preservation of the width and height of the alveolar process, and improves the aesthetic conditions after installation of the provisional prosthetics. Decoronation may be considered an alternative strategy for complex posttraumatic clinical scenarios, such as young ankylosed incisors.

UNLABELLED This article reviews some commonly used esthetic proportions and paradigms in dentistry. Establishing optimal anterior esthetics frequently entails restorative, orthodontic, and periodontal treatment. Several guidelines have been purported to facilitate an esthetic outcome during the rehabilitation of the maxillary anterior teeth. The golden proportion, recurring esthetic dental proportion, tooth width : height ratios, vertical positioning of the maxillary lateral incisor, and the apparent contact dimension are examples of some such guidelines. Evaluation of these esthetic paradigms including their validity, esthetic significance, perception by laypeople, and the range of tolerance to alterations are very important considerations. CLINICAL SIGNIFICANCE This review presents a comprehensive analysis of some selected esthetic dental paradigms and recommendations for their application in the interdisciplinary management of anterior dental esthetics.

Aim To report the treatment of an unusual combination of one dens evaginatus and two dens invaginatus in a single tooth and its healing outcome after 10 years. Summary The long-term outcome of a maxillary lateral incisor with dens evaginatus combined with two Oehlers type II dens invaginatus and a large periradicular lesion in an 11-year-old female treated endodontically and restoratively is described. The endodontic treatment included intracanal medication with calcium hydroxide and canal filling using a thermoplastic root canal filling technique. The crown was restored with conventional composite resin. During periodic clinical and radiographic follow-up, the patient remained symptom free, and the periradicular region was completely healed, meeting both aesthetic and functional expectations after 10 years. Key learning points The co-occurrence of dens evaginatus and two dens invaginatus in the same tooth is an unusual finding that compromises aesthetics and predisposes the patient to dental pulp infection. The complex morphology observed in this case represented both endodontic and restorative challenges.

Dens invaginatus is an anomaly characterized by an infolding of enamel and dentin that can lead to caries and pulpal death while the tooth is still immature, and present difficulties with diagnosis and treatment. Generally such open apices are managed by long term apexifaction procedures. This article demonstrated rapid management of a maxillary lateral incisor having a type 2 dens invaginatus, necrotic pulp, open apex and very large periradicular lesion using calcium hydroxide for one week prior to placement of a mineral trioxide aggregate (MTA) plug. After setting of the MTA, the remaining canal space was obturated using a warm vertical gutta percha technique. At 6 months follow-up the patient was asymptomatic, the lesion had almost entirely resolved, and, the root was already completely surrounded by bone.

Objective: The purpose of this study was to assess the presence of the golden proportion (GP) in the facial view tooth-to-tooth width proportion of the six maxillary anterior teeth and to evaluate the width/height (W/H) ratios of the incisors of patients with maxillary lateral incisor (LI) agenesis treated either with implants or orthodontically (by moving canines into the position of the laterals, recontouring them, and placing composite restorations over the repositioned teeth). Materials and Methods: Forty-eight patients with LI agenesis were divided into four experimental groups: unilateral recontouring group (N = 10), bilateral recontouring group (BRG, N = 18), unilateral implant group (UIG, N = 10), bilateral implant group (N = 10), and a control group (CG, N = 25) of patients without agenesis. GP ratios were determined on patients' dental casts placed over Levin's grids, whereas W/H ratios were measured directly on the casts and a millimeter ruler to determine these distances. Statistical analysis was performed with Shapiro–Wilk, Kruskal–Wallis, Mann–Whitney, Friedman, and Wilcoxon tests (p

Restoring a misaligned tooth with an inadequate contact point is a challenge to the practitioner. In some instances, teeth that could be repositioned and adequately restored are extracted. Thus, the aim of this article was to describe a treatment using orthodontic and prosthetic techniques to restore esthetics and function in a patient with a distally drifted maxillary lateral incisor. The patient's functional and esthetic expectations were successfully met with the outlined treatment.

This report describes non-surgical endodontic treatment of Oehlers' type III dens invaginatus in a maxillary lateral incisor with the aid of postobturation cone-beam computed tomography (CBCT). The endodontic treatment was initiated with the aid of a surgical operating microscope, and two canals, one of which represented the invagination, were instrumented, irrigated under passive ultrasonic activation and obturated with the lateral condensation technique. As postobturation periapical radiographs suggested the presence of untereated and/or unfilled areas in the root canal and invagination, CBCT was taken to assess the possibility of further treatment. The CBCT scans demonstrated inaccessible and unfilled canal and invagination areas because of complex internal morphology characterized by (i) C- or ring-shaped cross-sectional canal configuration with constrictions at different points in different root levels and (ii) a prominent intraradicular cavity that was communicated with the enamel-lined invagination and opened into the apical periodontium. Thus, it was judged that further endodontic treatment was not feasible. A 14-month follow-up revealed a satisfactory clinical and radiographic outcome, suggesting that the chemomechanical debridement may have sufficed to induce periapical healing. CBCT greatly helped the decision of avoiding further intervention that could have been difficult to negotiate.

Impaction of permanent teeth represents a clinical challenge with regard to diagnosis, treatment plan, and prognosis. There is a close relationship between deciduous teeth and permanent teeth germ, and any injury in the deciduous dentition may influence the permanent teeth eruption. The extent of the damage caused to the permanent teeth germ depends on the patient age at the time of injury, type of trauma, severity, and direction of the impact. Conventional radiographic images are frequently used for diagnosis; however, recent developments in three-dimensional (3D) imaging systems have enabled dentistry to visualize structural changes effectively, with better contrast and more details, close to the reality. The cone-beam computed tomography (CBCT) has been used in the diagnosis and treatment plan of these impacted teeth. The purpose of the present case report is to describe a successful conservative management of a retained permanent maxillary lateral incisor with delayed root development after a trauma through the deciduous predecessor in a 9 year-old patient. After clinical and radiographic examination, a CBCT examination of the maxilla was requested to complement the diagnosis, providing an accurate 3D position of the retained tooth and its relationship to adjacent structures. The proposed treatment plan was the surgical exposure and orthodontic traction of the retained tooth. The lateral incisor spontaneously erupted after 6 months. Therefore, this case report suggests that permanent teeth with incomplete root formation have a great potential for spontaneous eruption because no tooth malposition or mechanical obstacles are observed.

– Re-restoring endodontically treated teeth with complicated crown or crown root fractures is a major challenge for dental practitioners, because they can present difficulties for successful treatment. This report describes the management of supragingivally complicated crown fracture of an endodontically treated maxillary lateral incisor. The involved tooth was restored with the reattachment procedure using light transmitting fiber post. After 11 months, the reattached tooth had a satisfying function, favorable physiological and esthetic outcomes and healthy surrounding periodontal structures.

Bhuva B, Barnes JJ, Patel S. The use of limited cone beam computed tomography in the diagnosis and management of a case of perforating internal root resorption. International Endodontic Journal, 44, 777–786, 2011. Abstract Aim To describe the use of cone beam computed tomography (CBCT) in the diagnosis and management of a maxillary lateral incisor with perforating internal root resorption (IRR). Summary Root resorption is the loss of dentine or cementum as a result of osteoclastic cell action. IRR occurs exclusively as a result of pulpal inflammation. Until very recently, the diagnosis of internal and external resorptive defects has been limited to the information obtained from conventional radiographic techniques. This case report describes the use of CBCT in the diagnosis and treatment planning of a case of perforating IRR. Emphasis is given to the modifications made to the treatment procedures in view of the additional information obtained from the CBCT data. Key learning points • Internal root resorptive defects may perforate the external root surface, and this may not be detectable using conventional radiographic techniques; consideration of this should be made during diagnosis and treatment planning. • CBCT provides additional relevant information on the location and nature of root resorptive defects when compared with that provided by conventional radiographs. • CBCT findings may modify treatment planning, as well as the techniques that may be employed during both non-surgical and surgical endodontic treatment.

Gandhi A, Kathuria A, Gandhi T. Endodontic-periodontal management of two rooted maxillary lateral incisor associated with complex radicular lingual groove by using spiral computed tomography as a diagnostic aid: a case report. International Endodontic Journal, 44, 574–582, 2011. Abstract Aim To present the successful endodontic and periodontal management of a two rooted maxillary lateral incisor tooth with a complex radicular lingual groove and severe periodontal destruction using spiral computed tomography as a diagnostic aid. Summary A 30-year-old male patient presented with a chief complaint of mobility and discharge of pus in an upper front tooth. Clinical examination revealed a sinus tract on the labial gingival surface and a 10-mm-deep periodontal pocket associated with maxillary left lateral incisor tooth. On the lingual side, a groove emerging from cingulum, continuing mesioapically down the lingual aspect of tooth was found. Intraoral periapical radiographs demonstrated a lateral periodontal defect around the mesial aspect and a diffuse radiolucency at the apex of maxillary left lateral incisor tooth. The sinus tract was traced with gutta-percha to the maxillary left lateral incisor that showed an accessory root surrounded by a large radiolucent area. A spiral computed tomographic scan for better understanding of the complicated root canal morphology of the tooth was performed. Based on the clinical, radiographic and spiral computed tomographic findings, a diagnosis of an endo-perio lesion in tooth 22 was made. Management consisted of conventional root canal treatment, radiculoplasty, root resection of accessory root and surgical curettage of the periodontal defect. Follow-up with radiographic examination at 3 months and 1 year was performed. At 1-year recall, the patient was asymptomatic, there was no evidence of the sinus tract and a 3-mm nonbleeding pocket was present in relation to tooth 22. Progression of hard tissue healing was observed in the periapical radiograph taken 1 year postoperatively. Key learning points • The key to achieving favourable results in this particular type of developmental anomaly is accurate diagnosis and treatment planning. • The health of the periapical osseous tissues appears to be the provital factor for tooth retention. • A favourable outcome can only be achieved with a comprehensive treatment approach that effectively manages all local factors that are contributing to the disease process.

Durack C, Patel S. The use of cone beam computed tomography in the management of dens invaginatus affecting a strategic tooth in a patient affected by hypodontia: a case report. International Endodontic Journal, 44, 474–483, 2011. Abstract Aim To report on the use of cone beam computed tomography (CBCT) in the diagnosis and management of dens invaginatus. Summary Chronic apical periodontitis of an invaginated maxillary lateral incisor was diagnosed in a patient suffering from hypodontia and awaiting active orthodontic therapy. Loss of the tooth would have complicated orthodontic treatment. Conventional periapical radiographs provided insufficient information about the nature of the invagination and its relation to the root canal to formulate an appropriate plan for treating the tooth. A small volume CBCT scan of the tooth revealed that the invagination and the root canal were completely separate, non-communicating spaces and that the wall of the invagination acted as an obstruction to the effective chemomechanical debridement of the infected root canal. An innovative method of accessing the infected root canal, based on information from the CBCT images, was adapted to permit its instrumentation, disinfection and filling. Key learning points • Teeth with dens invaginatus requiring endodontic treatment present diagnostic and technical challenges. • CBCT can provide essential information in the management of dens invaginatus.

Inflammatory root resorption is a serious complication of dental trauma, which leads to progressive loss of the root structure. This report describes the treatment a previously traumatized young maxillary lateral incisor, severely affected by inflammatory root resorption. An 11-year-old boy presented with pain and mobility in his maxillary incisors which experienced fall trauma 2 years earlier. Radiographic examination revealed incomplete root development of the right central incisor, associated with advanced inflammatory root resorption and a periapical lesion. Following removal of a prior long-term calcium hydroxide dressing, the root canal was submitted to a 2-week irrigation regimen involving 1.25% sodium hypochlorite and 2% chlorhexidine gluconate. Thereafter, the entire root was filled with mineral trioxide aggregate. The radiographic follow up at 6 months showed arrest of root resorption and initiation of periapical healing in the absence of clinical symptoms and mobility. This was followed by advanced osseous regeneration and re-establishment of the periodontal space at 12 and 24 months. From the present case, it can be concluded that mineral trioxide aggregate obturation can be a viable option that can improve the healing outcomes in cases of severe inflammatory root resorption in young permanent teeth.

Clinicians agree that, regardless of gender or race, tooth agenesis has become more prominent in recent societies. The congenital absence of one or more maxillary lateral incisors poses a challenge to effective treatment planning for the restorative dentist. However, the one-sided orthodontic approach of just moving canines mesially to eliminate restorative procedures leads to compromise. Adult patients presenting with malocclusions, missing lateral incisors, or anterior crowding but who fail to get proper orthodontic treatment, requesting instead esthetic solutions that do not establish a stable occlusion, proper alignment, and proper axial inclination of the teeth will have compromised esthetic and periodontal results. An evaluation of anterior smile esthetics must include both static and dynamic evaluations of frontal and profile views to optimize both dental and facial appearance. This article presents how orthodontics is combined with other specialties in treating a congenitally missing lateral incisor. One case is used to illustrate how orthodontic treatment is progressed in collaboration with other specialists.

Keles A, Cakici F. Endodontic treatment of a maxillary lateral incisor with vital pulp, periradicular lesion and type III dens invaginatus: a case report. International Endodontic Journal 43, 608–614, 2010. Abstract Aim To report the healing of a periradicular lesion and maintaining vitality of the pulp following endodontic treatment of the invaginated canal of a dental invagination. Summary Dens invaginatus is a developmental malformation resulting from invagination of the tooth crown or root before calcification has occurred. A case of type III dens invaginatus, an invagination that extends from the crown to the apex, in the maxillary right lateral incisor with a healthy pulp and large peri-invagination periodontitis is reported. Non-surgical root canal treatment of the invagination was performed. There appeared to be no communication between the main root canal and the invaginated canal. The invaginated canal was filled by lateral condensation of gutta-percha and a calcium hydroxide sealer. The final restoration of the tooth was completed using composite, and the tooth was reviewed after 1 and 2 years. Non-surgical root canal treatment of the invagination retained the pulp in a health condition and resulted in resolution of a substantial peri-invagination lesion. Key learning points • Even though there are no symptoms, radiography should be performed in teeth that exhibit anatomical differences from the contralateral tooth. • Even if there is extensive apical pathology in a tooth with type III dens invaginatus, pulp sensibility tests should be performed. • Correct diagnosis and treatment planning are fundamental when treating dens invaginatus.

The aim of this study was to compare the bone loss pattern and soft tissue healing of immediately versus one-stage loaded 3.0-mm-diameter implants in cases involving a single missing lateral maxillary incisor.Sixty patients with a missing lateral incisor in the maxilla were randomized to one of the treatments: 30 patients in the immediate-restoration group and 30 patients in the one-stage group. All implants were placed in healed sites and had to be inserted with a torque25 Ncm. The implants in the immediate-restoration group were fitted with a non-occluding temporary crown on the day of surgery. Both groups received a full occluding final crown 6 months after surgery. Mean marginal bone loss, probing depth, and bleeding on probing were assessed at 6-, 12-, 24-, and 36-month follow-up examinations by a masked examiner.Sixty 3.0-mm-diameter implants were placed between July 2003 and February 2006; 27 (45.0%) were in men, and 33 (55.0%) were in women. All implants osseointegrated and were clinically stable at the 6-month follow-up. No statistically significant differences were observed for bleeding or plaque index. No implant fractures occurred. At the 36-month follow-up, the accumulated mean marginal bone loss and probing depth were 0.85 +/- 0.71 mm and 1.91 +/- 0.59 mm, respectively, for the immediate-loading group (n = 30) and 0.75 +/- 0.63 mm and 2.27 +/- 0.81 mm, respectively, for the one-stage group (n = 30). There was no statistically significant difference (P0.05) for the tested outcome measures between the two procedures.In the rehabilitation of a single missing lateral maxillary incisor, no statistically significant difference was assessed between immediately and one-stage restored small-diameter implants with regard to implant survival, mean marginal bone loss, and probing depth. Three-millimeter-diameter implants proved to be a predictable treatment option in our test and control groups if a strict clinical protocol was followed.

OBJECTIVE: To clarify the prevalence of supernumerary primary teeth in Japanese children, we evaluated this prevalence in a sample of 8122 children aged 3–6 yearS. Furthermore, we undertook a statistical comparison of the findings of the present study with those of previous investigations on the prevalence of supernumerary primary teeth in Japanese, Chinese and Caucasian children. SUBJECTS: The subjects used in the study consisted of 8122 children aged 3–6 years (4102 boys and 4020 girls). The children were examined in kindergartens. METHODS: The prevalence of supernumerary primary teeth was recorded by visual inspection. Statistical analysis was carried out using the χ2 test. RESULTS: Four cases of supernumerary primary teeth were found among the children examined, and thus the prevalence was 0.05%.All of the supernumerary primary teeth were located in the maxillary lateral incisor area. CONCLUSIONS: The prevalence in a sample of 8122 Japanese children was 0.05% and that in a combined sample of 65 068 Japanese children was 0.06%.

Aim To describe conventional and surgical endodontic treatment of a maxillary right lateral incisor with an unusual root dilaceration and to discuss the treatment outcome. Summary Root dilacerations refer to severe curvature or angulations that may occur anywhere along the length of a root. This anatomical deviation may present an unfavourable outcome if clinicians fail to recognize the difficulties. The following case report describes conventional and surgical endodontic treatment of a maxillary right lateral incisor with an unusual root dilaceration. Key learning points • Root morphology may present a challenge for clinicians during root canal treatment. • Clinicians should be aware of the importance of surgical endodontics and be familiar with microsurgery principals and techniques.

Summary. Aim. To determine the prevalence of concomitant developmental dental anomalies in a group of Chinese children with dens evaginatus. Methods. The dental records and orthopantomograms of 10–15 year old children and adolescents who had been diagnosed with dens evaginatus in a school dental clinic were reviewed retrospectively. Results. Four hundred and forty-eight of 7102 (6·3%) children were found to have dens evaginatus. Concomitant developmental dental anomalies were found in 77 children (17·2%). The most commonly seen dental anomalies in the study population were hypodontia, hyperdontia, microdontic maxillary lateral incisor, and dental impaction. The prevalence of these anomalies did not differ significantly to that found in the general Chinese population. When analysed separately, however, the prevalence of supernumerary premolars was found to be higher in children with dens evaginatus than in the general population, and the difference was statistically significant (P

Summary Supernumerary teeth are more common in the permanent than the primary dentition [1]. In the latter, the majority occur in the maxillary lateral incisor region or as a mesiodens. Indeed, in one study conducted in the USA, all 26 cases of primary supernumerary teeth examined were found to be lateral incisors [2]. This report describes a case presenting with three erupted supernumerary (supplemental) teeth in the primary dentition, including, somewhat unusually, bilateral duplication of maxillary canines.

UNLABELLED Dentists often encounter patients with missing or malformed teeth. The maxillary lateral incisor is the second most common congenitally absent tooth. There are three treatment options that exist for replacing missing lateral incisors. They include canine substitution, a tooth-supported restoration, or a single-tooth implant. Selecting the appropriate option depends on the malocclusion, specific space requirements, tooth-size relationship, and size and shape of the canine. The ideal treatment is the most conservative option that satisfies individual esthetic and functional requirements. Often the ideal option is canine substitution. Although the orthodontist positions the canine in the most esthetic and functional location, the restorative dentist often needs to place a porcelain veneer or crown to re-create normal lateral incisor shape and color. This article closely examines patient selection and illustrates the importance of interdisciplinary treatment planning to achieve optimal esthetics. It is the first in a three-part series discussing the three treatment alternatives for replacing missing lateral incisors. CLINICAL SIGNIFICANCE Patients with congenitally missing lateral incisors often raise difficult treatment planning issues. Therefore, to produce the most predictable esthetic results, it is important to choose the treatment that will best address the initial diagnosis. This article is the first in a three-part series that describes the different treatments available for patients with congenitally missing lateral incisors. This first article focuses on canine substitution as a method of tooth replacement for these missing teeth. The general dentist will learn to evaluate specific patient selection criteria and determine whether canine substitution is an appropriate treatment alternative for replacing missing lateral incisors. The orthodontist will understand how to position the canines to satisfy functional requirements and achieve proper esthetics. Finally, the importance of interdisciplinary team treatment planning is emphasized as a requirement for achieving optimal final esthetics.

Aim To report the healing of a periradicular lesion following nonsurgical root canal treatment of a dental invagination. Summary A case of dens invaginatus type 3 with a periradicular lesion and a healthy pulp is reported. Nonsurgical root canal treatment of the invagination was performed successfully and resolved an associated periradicular lesion. Despite the complex anatomy and a diagnosis of apical periodontitis, pulp health was retained after endodontic treatment of the invaginated canal. Clinical considerations and treatment are discussed and reported. Key learning points • Dens invaginatus can present in a variety of forms, knowledge of which can usefully inform endodontic diagnosis and treatment. • In certain cases, success can be achieved by treating the invagination alone. • Pulp health may be preserved during and after treatment of an infected invagination.

Background: In cases of a missing maxillary lateral incisor, an implant-supported crown is often the treatment of choice in order to avoid affecting intact adjacent teeth; however, proper implant p ...

AIM To describe combined endodontic and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. SUMMARY A rare case is presented in which combined endodontic and orthodontic treatment was performed on a cross-bite fused tooth. Clinical and radiographic examination showed the maxillary lateral incisor fused with a supernumerary and an impacted canine. The fused tooth required nonsurgical and surgical endodontic treatment for functional and aesthetic reasons. The root canals were dressed with calcium hydroxide for 2 months before they were obturated with thermoplasticized injectable gutta-percha. Then, the distal part of the fused tooth was removed and the mesial part of the tooth was replanted and fixed. Three months after the completion of orthodontic therapy, the impacted canine erupted between the remaining tooth and the first premolar. Recall examination, 3 years after completion of root canal treatment, showed clinical and radiographic evidence of healing. KEY LEARNING POINTS Fusion has been described as a development anomaly characterized by the union of two adjacent teeth. Proper combined endodontic and orthodontic treatment resulted in maintaining one tooth half and solving the aesthetic and functional problem of a fused tooth.

Aim To observe the thermographic appearance of teeth and to develop a suitable protocol for imaging teeth in human subjects using modern thermographic imaging (TI) equipment in a thermologically controlled environment. Methodology The emissivity of enamel was investigated using an extracted incisor tooth. A total of 12 unrestored maxillary lateral incisors in six healthy patients were then imaged under rubber dam after a 20-min equilibration period and the thermographic data analysed using a dedicated software package. Recordings were made from standardized gingival and incisal sites on each tooth and the temperature gradient established for each tooth. Subsequently, a sequence of images of both maxillary central incisors in one patient was stored every 30 s during a 20-min equilibration period with and without an air-conditioning unit in operation. Results For the lateral incisors there was a consistent temperature gradient (mean 1.28 °C) from gingival area to incisal area and there were no statistically significant differences between right and left sides for the gingival site (t = 0.34, NS) or the incisal site (t = 0.62, NS). The air-conditioning unit had a rapid and profound cooling effect. With the air-conditioning disabled there was a mean tooth surface temperature increase of 1.1 °C from 0 to 5 min of the equilibration period and 0.3 °C from 15 to 20 min. Conclusions There was no significant difference in gingival or incisal temperatures between pairs of contralateral maxillary lateral incisors and a consistent temperature gradient existed from gingival to incisal areas of healthy maxillary lateral incisor teeth. The protocol described is suitable for TI of vital teeth. However, TI measured tooth surface temperature only which was extremely sensitive to air currents. A 15-min acclimatization period under rubber dam was adequate to allow stable tooth surface temperature measurement.

Palato-radicular groove (PRG) is a common developmental anomaly of maxillary incisors, whereas PRG associated with a birooted maxillary incisor is relatively infrequent. The clinical significance of PRG is related to the incidence of localized periodontitis with or without pulpal pathosis, depending on the depth, extent, and complexity of the groove. Successful treatments of PRG in single-rooted incisors have been reported in the literature. However, treatment of PRG in birooted incisors has often been ineffective. This case report describes a pulpal-periodontal combined lesion occurring on a birooted maxillary left lateral incisor with concomitant PRG in a 13-year-old boy which was successfully treated by conventional endodontic therapy in combination with periodontal treatment including accessory root resection, radiculoplasty and bone grafting. Seven-year follow-up is included in this report. The basis of a successful result is accurate diagnosis and elimination of inflammatory irritants and contributory factors. Awareness of the existence of this abnormality by the clinician is important.

Developmental grooves are not rare and often appear on maxillary lateral incisors. This may represent a challenge and sometimes tooth extraction is inevitable. This case report describes a combined technique of regenerative and antimicrobial/root conditioning used to treat a maxillary lateral incisor in a 32-year-old woman. Tooth #10 presented a periodontal probing depth of 8 mm below the cingulum, associated with a developmental groove. The tooth was vital. After initial preparation, a palatal mini-flap was raised, granulation tissue was eliminated by means of ultrasonic bactericidal curettage and radicoloplasty performed. The surface was then treated for 3 minutes with tetracycline-HCl solution (100mg/ml), and the defect filled with sterile, medical grade, calcium sulfate. Clinical measurements were retaken at 6, 12, and 18 months. The results indicated a reduction of probing depth to 2 mm, reestablishment of the lamina dura, and radiographical evidence of bone growth. This combined treatment allowed the tooth to be saved, the palatal surgical approach did not alter the esthetics of the area, and its simplicity is recommended.

Three unusual cases of maxillary premolar root resorption are reported. Three teenage patients were referred to the orthodontic department for management of ectopic maxillary canines. Radiographic examination revealed unilateral premolar root resorption in all three patients. This represents an unusual finding. Whereas the prevalence of maxillary lateral incisor root resorption secondary to palatally ectopic canines has been reported, the prevalence of premolar root resorption is unknown. This report discusses the findings in the context of the available literature. The postulated aetiology and the need for early diagnosis are highlighted.

A case of dens evaginatus (DE) and dens invaginatus (DI) concurrently affecting the maxillary right permanent lateral incisor in a 25-year-old Hispanic male is reported. DE, referred to as Talon's cusp in the anterior teeth and Leong's premolar in the premolar teeth, is a relatively rare condition by itself. An association of DI with this rare anomaly within the same tooth has never been reported before although it has been known to occur within the same patient. Since it is known that DE may be composed of normal enamel and dentine, as well as varying amounts of pulpal tissue, care should be exercised while performing any aesthetic procedures to remove or recontour it.

In this article, I describe a previously unreported maxillary lateral incisor defect (MLID) of the enamel in great apes and evaluate potential general causes (genetic, systemic stress, or localized disturbance), as well as examine differences in prevalence among the represented taxa. This defect occurred only on the labial surface of the maxillary lateral incisor and extended from the cervical-mesial quarter of the crown to the mesial edge of the cementoenamel junction (CEJ). The study sample consisted of 136 great ape specimens, including 41 gorillas, 25 chimpanzees, and 70 orangutans from the Smithsonian's National Museum of Natural History great ape collection. I used logistic regression to assess the prevalence of this defect in the sample and a binomial probability test for bilaterality. This defect of the maxillary lateral incisor is the second most common defect I observed in the study sample (30.1% of individuals affected), and was more likely to occur in individuals with linear enamel hypoplasia (LEH) and pit defects than those without these defects. Among specimens with both maxillary lateral incisors present, the defect was mostly bilateral. Pan and Pongo were significantly more likely to exhibit the defect than Gorilla. Between Pongo species, Pongo pygmaeus was significantly more likely to exhibit the defect than Pongo abelii. Between subspecies of Gorilla, although Gorilla gorilla gorilla exhibited the defect and Gorilla gorilla beringei did not, the difference was not significant. No sex differences were evident in this sample. The prevalence of this defect indicates it is not hereditary. The bilateral trend indicates a systemic cause, although the high inter-tooth specificity suggests a local disturbance and a combination of both is possible.

An unusual presentation of a chronic suppurative granuloma on the alar base area originating from a maxillary lateral incisor is reported. Treatment involved adequate endodontic therapy with simultaneous apical surgery and excision of the granuloma and sinus tract. Awareness of the possible dental origin of facial sinuses, despite their unusual location, is emphasized.