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In this case report, we present the endodontic treatment and microsurgical intervention of dens invaginatus affecting a lateral incisor using cone-beam-computed tomography (CBCT). A 26-year-old woman visited us with a diagnosis of acute apical periodontitis in the upper right lateral incisor (tooth 12). Endodontic treatment of the tooth was carried out. Intraoral radiography provided limited information on the unusual anatomy of the pulp chamber and root canal system; therefore, preoperative CBCT was performed. At the 3-month recall, a radiograph revealed a 5-mm-diameter lateral transparency, and CBCT was, therefore, repeated to facilitate microsurgery treatment planning. A medical image-processing program was used to demonstrate the changes between the CBCT images obtained before and after root canal preparation. In conclusion, endodontic treatment of dens invaginatus is challenging even for endodontic specialists, because the therapy sometimes requires surgical intervention. The currently available novel three-dimensional imaging modalities may have importance in planning and following up the root canal treatment in such cases, especially when unforeseen complications arise.

Objectives:To compare tooth size between subjects with mild, moderate and severe hypodontia and a control group.Material and Methods:The study comprised 120 patients with hypodontia divided into three groups of 40 mild (≤2 teeth congenitally missing), 40 moderate (3-5 teeth congenitally missing) and 40 severe (≥6 teeth congenitally missing) hypodontia; and 40 age and sex matched controls. Tooth size was recorded by measuring the mesiodistal and buccolingual dimensions of all fully erupted teeth on study models using digital callipers and compared between all hypodontia and control groups using Two-way ANOVA and Post Hoc Tests of subgroup comparison.Results:Two-way ANOVA revealed patients with hypodontia had significantly smaller mesiodistal and buccolingual tooth dimensions compared with controls (ppConclusion:Patients with hypodontia have smaller tooth dimensions than control. Tooth size appears to be affected by the degree of hypodontia, with severe hypodontia having a greater effect on tooth size reduction. The findings of this study may contribute to understanding the aetiology of hypodontia and aid the multidisciplinary management of this complex condition.

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.

Dens invaginatus is a developmental malformation of teeth, showing a wide spectrum of anatomical variations, resulting from the invagination of a portion of a crown that might be confined to the crown or it may pass the cement-enamel junction and may result in a second apical foramen formation during the stage of odonto-genesis. It is clinically significant due to early development of caries and subsequent necrosis of the pulp. Chronic peri-apical lesions are often associated with these anomalies without clinical symptoms. Clinicians should be mindful of the possibility of dens invaginatus when a patient comes with a tooth having signs of pulpitis without history of trauma, caries and should examine the suspicious tooth as well as the peri-odontium radiographically. Most affected permanent teeth are the maxillary lateral incisors followed by central incisors, canines, premolars and molars. This article describes both surgical and nonsurgical endodontic management of dens invaginatus type III with large apical radiolucency in upper left lateral incisorBirdem Med J 2015; 5(2): 111-115

This study was aimed to investigate the prevalence of maxillary lateral incisor agenesis and associated skeletal characteristics in an orthodontic patient population.The records of the 1066 patients seeking orthodontic treatment were screened for maxillary lateral incisor agenesis (MLIA). The following data were recorded for each subject: age; gender; unilateral or bilateral agenesis of MLI and side. The lateral cephalogram of each subject with MLIA was digitally traced. The data were compared to age-matched control orthodontic patients with skeletal Class I.The prevalence of maxillary lateral incisor agenesis was 4.9% (52 patients) in which 63.5% were females. There was a significant difference between MLIA patients and controls in sagittal relationships (ANB, Wits, AB plane, angle of convexity and Co-A/Co-Gn differential analyses) p 0.05.Patients with maxillary lateral incisor agenesis showed a significant tendency for skeletal Class III compared with the Class I control. This could be attributed to maxillary hypoplasia/retrognathia.

Teeth with calcified canals, dilacerated roots, and associated large periradicular lesions involving both cortical plates pose a challenge to dentists. In addition to the nonsurgical endodontic treatment, such teeth may require surgical intervention with concomitant use of bone grafting materials and barrier techniques. These techniques, when combined with the use of a host modulating agent such as platelet-rich fibrin (PRF), may improve the chances of success. A 26-year-old woman was referred for dental treatment with a recurrence of an intraoral sinus tract 2 months after periradicular surgery in the upper anterior region. Clinical and radiographic examinations revealed a calcified and perforated maxillary left lateral incisor with a severely dilacerated root as well as an associated large radiolucent lesion surrounding the roots of the maxillary left central and lateral incisors. A cone-beam computed tomographic scan of the anterior maxilla showed erosion of the labial and palatal cortical plates in the same region. A calcified canal in the lateral incisor was negotiated up to the straight line portion of the canal. Periradicular surgery with root-end resection was performed, and root-end filling was performed with mineral trioxide aggregate. The perforation present on the middle third of the labial surface of the root was repaired with mineral trioxide aggregate, and the canal was cleaned, shaped, and obturated. A PRF scaffold was prepared and used with a collagen membrane and a freeze-dried bone allograft. Follow-up visits after 3 months, 6 months, and 1 year revealed satisfactory clinical and radiographic healing. The combined use of nonsurgical and surgical modes of treatment cannot be overemphasized in this case. The use of PRF along with a bone graft and a barrier membrane may have enhanced the speed of healing and the resolution of periradicular radiolucency by enhancing bone regeneration.

Dilaceration of the permanent tooth usually is a consequence of traumatic injuries to the primary teeth. Although it may appear anywhere in the long axis of the tooth, i.e., crown, cementoenamel junction, or root, most often the root is involved. However, crown dilaceration is a rare condition representing 3% of the total injuries. Maxillary incisors are more susceptible to such injury and affected tooth may either erupt buccally or lingually or remain impacted. Hitherto, the treatment options also differ as per the clinical scenario. This article proposes a novel technique of restoring esthetic function of the affected permanent maxillary lateral incisor with crown-root dilaceration while preserving the vitality of tooth. How to cite this article: Achary RC, Ravi GR. A Novel approach of Esthetic Management and preserving Vitality of Dilacerated Permanent Maxillary Lateral Incisor. Int J Clin Pediatr Dent 2016;9(2):152-155.

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

Dens invaginatus is a developmental variation of a tooth resulting from an alteration in the normal growth pattern of the dental papilla. It is clinically characterized by a palatine furrow that can be limited to the coronal pulp or may extend to the radicular apex. The commonly affected tooth is maxillary lateral incisor. The occurrence of multiple dens invaginatus is extremely rare. Although a clinical examination may reveal a deep pit or fissure on the lingual surfaces of maxillary anterior teeth, the radiographic examination is the choice for diagnosis of dens invaginatus. Familiarity with the radiographic appearance of this anomaly is essential for the dental practitioner. The purpose of this paper is to present a clinical case of multiple dens invaginatus involving maxillary anterior teeth which was diagnosed during routine radiographic evaluation. Keywords: Anomaly, Dens invaginatus, Dens in dente

Antiresorptive drugs have been widely used to treat patients with hypercalcemia caused by malignancy, bone metastasis, multiple myeloma, and osteoporosis. However, it is well known that antiresorptive drugs can cause osteonecrosis of the jaw (ONJ). Herein, we report a rare case of nasal septal abscess caused by medication related osteonecrosis of the jaw (MRONJ) in a breast cancer patient. A 69-year-old woman was referred to our clinic for evaluation of nasal obstruction. Physical examination revealed a cherry-like swelling of the nasal mucosa emanating from the septum that obstructed both nasal cavities and a fistulous tract showing pus discharge after extraction of the bilateral maxillary central incisors (MCI) and the right maxillary lateral incisor (MLI). Computed tomography and panoramic radiography revealed extensive osteonecrosis of the maxilla and swelling of the nasal mucosa. The clinical diagnosis was nasal septal abscess caused by osteonecrosis of the maxilla. Surgical procedure was undertaken for this case. An indwelling drain was placed in the oral cavity, and sequestrectomy was performed with incision and drainage of the anterior portion of left nasal septum. The patient was doing well at the 7-month follow-up. The patient had a medical history of breast cancer with bone, lung, liver metastases, and had received intravenous bisphosphonate, which is one of the antiresorptive medicines, over the past 4 years. We suspect that this history played an important role in MRONJ induced nasal septal abscess.

Purpose: For patients with narrow, single-tooth edentulous ridges as a result of permanent tooth agenesis (hypodontia) in the maxillary lateral and mandibular incisor regions, dental implant treatment may present a reliable and predictable restorative treatment solution. The aim of the present study was to evaluate the clinical reliability and outcome of small-diameter dental implants placed in a one-stage procedure with early loading replacing maxillary lateral or mandibular incisor teeth. Materials and Methods: Patients with hypodontia in the maxillary lateral incisor or mandibular incisor region analyzed in this report were selected from a larger prospective multicenter study. Small-diameter dental implants (AstraTech OsseoSpeed TX 3.0 S, Dentsply) of different lengths were placed using a one-stage surgical protocol with a 6- to 10-week healing period before loading. Probing pocket depth, bleeding on probing, and gingival zenith score were assessed after 6, 12, 24, and 36 months. Radiographic examination was assessed at 6, 12, and 36 months. Results: In total, 38 patients were included in this analysis and 62 small-diameter implants were placed. The mean distance between adjacent teeth was 6.30 mm (SD: 1.36). All patients received a titanium transmucosal abutment and cement-retained ceramic crown after 6 to 10 weeks of healing. Two implants were lost during the healing period before loading, providing a total implant survival rate of 96.8%. No implant fractures were reported. Mean marginal bone level change from surgery to follow-up visits at 6, 12, and 36 months were 0.39 mm, 0.22 mm, and 0.23 mm, respectively. The condition of soft tissue was stable at all follow-up visits with clinically insignificant changes in probing depth, bleeding on probing, and gingival zenith score. Conclusion: This study evaluated the behavior over 36 months of AstraTech Osseospeed TX 3.0 S dental implants placed into narrow one-tooth defect edentulous ridges as a result of hypodontia. The data collected highlighted the stability of the marginal bone level and soft tissues around the dental implants in conjunction with durable mechanical function. Small-diameter implants can be considered a valid solution in the restorative treatment of hypodontia in the maxillary lateral and mandibular incisor regions.

The maxillary permanent canine is the tooth most frequently involved, which is often transposed with the first premolar followed by transposition between the maxillary permanent canine and maxillary lateral incisor. This study describes the correction of complete transposition of the maxillary left first premolar with impacted permanent maxillary left canine and congenital missing maxillary lateral incisor. The current case report describes a multidisciplinary approach for the alignment of impacted and transposed teeth with surgical exposure of impacted maxillary canine and restorative treatment of transposed maxillary left first premolar. The satisfactory results were achieved with maximum three-dimensional control of tooth movement and without any iatrogenic damage.

Background: Alveolar ridge resorption still continues to be a problem in oral surgery. Cause of bone resorption is including tooth extraction, periodontal disease and inflammatory periapical pathologies. Various methods and materials have been suggested to minimize this resorption. Aim: Goal of this case report is to present alveolar ridge preservation (ARP) following horizontally fractured maxillary lateral incisor with allograft in the aesthetic zone. Case presentation: 30-year-old female patient with fractured tooth was treated by grafting and insertion dental implant. Fractured tooth extraction was performed and extraction socket augmentation was performed by allograft and covered with collagen membrane. Augmented area was treated with bone-level implant. Definitive prosthesis single-tooth porcelain-fused-to-zirconia restorations were fabricated. Conclusions: Before implant insertion, extraction and grafting socket procedure is appropriate treatment for of fractured teeth with granulation tissue.

Fusion is a developmental anomaly in tooth morphology, which may be due to either union of two separate tooth buds or partial splitting of a single tooth bud. A thorough understanding of root canal anatomy is an essential prerequisite for a successful endodontic treatment. This case report describes successful endodontic management of a maxillary left lateral incisor fused with a supernumerary tooth using spiral computed tomography (SCT) as a diagnostic aid. A patient reported with a painless swelling in the maxillary anterior region associated with a fused maxillary lateral incisor. Spiral CT was performed to better understand the complex root canal anatomy. Endodontic treatment was done using methyl trioxide aggregate (MTA) as apical plug and obturation by thermoplasticized gutta-percha. The tooth was completely asymptomatic at 1-year follow-up showing signs of healing. The present case report emphasizes on the importance of three-dimensional (3D) imaging techniques, such as SCT in cases of developmental anomalies having complicated root canal morphology for successful endodontic therapy. How to cite this article Dua D, Dua A, Patil AC. Endodontic Management of a Maxillary Lateral Incisor fused with Supernumerary Tooth using Spiral Computed Tomography as Diagnostic Aid. World J Dent 2016;7(4):199-202.

Introduction. The radicular groove is a developmental groove which is usually found on the palatal or lateral aspects of the maxillary incisor teeth. The present case is a maxillary lateral incisor with a small second root and a deep radicular groove. The developmental groove caused a combined periodontal-endodontic lesion. Methods. Case was managed using a combined treatment procedure involving nonsurgical root canal therapy and surgical periodontal treatment. After completion of root canal treatment, guided tissue regeneration (GTR) was carried out using decalcified freeze dried bone allograft (DFDBA) and a bioabsorbable collagenous membrane. Tooth also was splinted for two months. Results. After 12 months the tooth was asymptomatic. The periapical radiolucency disappeared and probing depth did not exceed 3 mm. Conclusion. Combined treatment procedure involving nonsurgical root canal therapy and surgical periodontal regenerative treatment can be a predictable technique in treating combined endodontic-periodontal lesions caused by radicular groove.

Objective: The aims of this study were to determine the prevalence of hypodontia in the permanent dentition in a sample of Qatari patients attending a dental center and to compare the results with the reported findings of other populations. Materials and Methods: Orthodontic files including orthopantomographs of 1000 patients (655 females and 345 males, 11-36-year-old) were examined and inspected for evidence of hypodontia. Results: The prevalence of hypodontia in the present Qatari sample was 7.8%; 6.9% was in males and 8.2% in females. Hypodontia was found more frequently in the maxilla than in the mandible. The distribution of missing teeth was noticed in the left side more than the right side. The most frequently missing teeth were the maxillary lateral incisors followed by the mandibular second premolars, maxillary second premolars, and mandibular left lateral incisor. The majority of patients with hypodontia had one or two teeth missing, but rarely more than four teeth were missing in the same patient. Bilateral missing teeth in the current study was commonly seen in the maxillary lateral incisor (14.1%) followed by mandibular second premolar (12.8%) and maxillary second premolar (6.4%). Conclusions: The prevalence of hypodontia in a sample of Qatari individuals was within the range reported in the literature for other populations. The incidence of hypodontia in the anterior segment requires multidisciplinary team approach (orthodontic and prosthodontic) to restore the esthetic and function and improve patient self-esteem.

In appearance related society that we live in , the younger adolescent patient caneasily become self conscious if their teeth are different to others. A common from of microdontia which affect the maxillary lateral incisor is known as “peg lateral”. Treatment approach has to be case specific and depends on the condition of primary predecessor, number of missing teeth, status of occlusion and patient preference.This clinical report describes the treatment of both sided peg-shaped lateral incisors that were restored with resin composite laminate veneers. The aim of the treatment is to close the diastema and restore the contours of the tooth. These simple procedures may be a cost –effective treatment alternative to restore the esthetics of these teeth and may prove particularly growing patients before more definitive restorations can be considered.Update Dent. Coll. j: 2016; 6 (2): 31-33

The aim of the study was to assess the risk of incidence of additional congenital dental anomalies in children with nonsyndromic cleft lip, alveolar and/without palate (CL/P). Hypodontia, hyperdontia and canines impaction was recognized. From patients with CL/P treated at the Clinic of Congenital Facial Deformities in Chair and Department of Jaw Orthopedics Medical University of Lublin, 56 subjects were randomly selected. On the panoramic radiographs taken at the age of 8&ndash, 12 years, the angle of upper unerupted canines was measured using Westerlund&rsquo, s recommendations. The supernumerary teeth and hypodontia were checked. The procedures: maxillary expansion, secondary alveolar bone graft (SABG) and extraction of primary canines were noted. The frequency of canines impaction was 5.36%. Hypodontia was found in 37.5% of patients, hyperdontia was present in 23.21% of patients. No influence of procedures (expansion of the maxilla, SABG, deciduous canines extraction) on permanent maxillary canine eruption was proved. Patients with CL/P are exposed to the unfavorable position of unerupted maxillary canines most frequently in the cleft area of complete cleft. Maxillary lateral incisor on the cleft side is most frequently affected with congenital anomaly. Hypodontia and hyperdontia do not influence maxillary canine impaction. Good clinical result was achieved with an applied approach, which should be widely introduced.

Introduction: Dens invaginatus type 3, a severe form extending beyond the cementoenamel junction and exhibiting a second foramen into the lateral periodontal ligament or periradicular tissue. This anomaly may involve the periradicular tissue and cause pulpal necrosis and periradicular lesions. Case Report: An 11-year-old female patient was presented with slight swelling and periodic pus drainage from buccal gingiva of the maxillary left lateral incisor as her main complaint. Tooth had no pain on percussion or palpation, no color change, no caries and no mobility. Radiographic examination revealed that there was a radiolucent area on the mesial side of the coronal root. It was observed that this radiolucency was associated with apex of dens invaginatus. Because of continuous drainage through the canal, calcium hydroxide was replaced after 1 week with irrigated NaOCl. The drainage was under control after 3 weeks. Root canal treatment was applied to the malformed area by filling only the invaginated canal completely with MTA. Cavity was restored with light-cured resin composite. Results: Main pulp was kept vital and 2 years follow up showed periapical repair and absence of clinical symptoms. The patient was remained asymptomatic and pulp vitality was continued. Conclusion: Dens invaginatus is a dental malformation, which has a complicated treatment because of the complex root canal anatomy. It is very important to be able to identify and treat this dental malformation correctly. Keywords: dens invaginatus, maxillary lateral incisor, periradicular lesion, MTA INVAJINE KANALA MTA ILE ENDODONTIK TEDAVI VE VITAL PULPALI TIP 3 DENS INVAJINATUS : 2 YIL TAKIPLI OLGU RAPORU Ozet Giris: Dens invajinatus tip 3, sementoenamel bileskenin otesine uzanan ve lateral periodontal ligament veya periradikuler dokuya ikinci bir foramen ile acilan siddetli bir malformasyondur. Bu anomali, pulpal nekroz ve periradikuler lezyonlara neden olabilir. Olgu Raporu: On bir yasinda kiz cocuk hasta maksiller sol lateral kesici disinin bukkal diseti bolgesindeki sislik ve puy drenaji sikayetiyle basvurdu. Yapilan ilk muayenede diste perkusyona ya da palpasyona hassasiyet, renk degisikligi, curuk ve mobilite gozlenmedi. Radyografik incelemede koronal kokun mezial tarafinda radyolusent bir alan oldugu goruldu. Bu radyolusensinin dens invajinatusun apeksiyle iliskili oldugu gozlendi. Invajine kanaldan devam eden puy drenaji nedeniyle NaOCl ile irigasyon yapildi ve kanalda 1 hafta kalsiyum hidroksit bekletildi. Drenaj 3 haftanin sonunda kontrol altina alindi. Tip 3 dens invaginatus tanisiyla tedaviye baslanan hastanin yalnizca invajine kanali, MTA ile tumuyle doldurularak malforme bolgeye kok kanal tedavisi uygulandi. Ust yapi, isikla sertlesen kompozit rezinle restore edildi. Bulgular: Ana pulpanin vital kalmasi ve 2 yillik takipte periapikal onarim saglandi ve klinik semptomlarin yoklugu gosterildi. Hasta asemptomatikken, pulpanin canliliginin devami saglandi. Sonuclar: Dens invajinatus, karmasik kok kanal anatomisi nedeniyle karmasik bir tedavisi olan dental bir deformasyondur. Bu dental deformasyonu dogru tanimlayabilmek ve dogru tedavi edebilmek onem tasimaktadir. Anahtar Kelimeler: dens invajinatus; maksiller lateral keser; periradikuler lezyon; MTA

Objectives: The aim of this study was to assess the frequency of internal resorption (IR) defects in select adult North Indian population with a history of concussion injury to their anterior teeth. Material and Methods: The study population consisted of patients reporting with a history of concussion injury to their anterior teeth. At least two intraoral periapical radiographs, one at central and other at a 20° horizontal angulation, were taken for each of the affected teeth to check for any IR defect. The radiographs were inspected after placing them over a viewing box using magnifying glasses. Percentage of IR defects and their occurrence on the basis of tooth type, duration of trauma, gender, and side was assessed. Results: A total of 1507 patients reported with a history of a traumatic dental injury (TDI) to their anterior teeth. About 37.1% (560/1507) patients and 602 teeth with TDI had a history concussion injury. The percentage of patients with concussion injuries resulting in IR defect was 3.3% (19/560), and the percentage of teeth with IR defect was 3.16% (19/602). About 68.42% (13/19) were in males, and 31.58% (6/19) were in females; however, the difference was not statistically significant (χ2 = 1.05, P = 0.590). Most of the patients reported with a history of TDI within 0–5 years back, and the median age at the time of presentation was 20 years. Maxillary left central incisor was most affected, 4.84% (9/186) followed by maxillary right central incisor 3.5% (7/200) mandibular left lateral incisor 3.85% (1/26), mandibular left central incisor 3.57% (1/28), and maxillary lateral incisor 1.52% (1/66). Out of the 19 IR defects, 15 (78.9%) were located in the root, four were located coronally (21.05%), out of which 2 had a pink-colored crown. Conclusion: Silent injuries such as concussion and subsequent IR can potentially weaken the tooth; therefore, follow-up of patients with a history of TDIs is vital to rule out any developing but obscure resorptive defects.

This report describes the management of an uncommon case of dens invaginatus of a microdontic upper lateral incisor, with an extended apical lesion. Dens invaginatus is a developmental abnormality of a tooth where enamel and dentin fold into the pulpal space. This abnormal anatomy, and the separation of two distinct root canal spaces, complicates conventional treatment, making the apical portion inaccessible to instrumentation and impeding disinfection of the canal space. The coexistence of dens invaginatus affecting a microdontic tooth is a rare anomaly found in the literature. This case report describes a young female patient with dens invaginatus affecting a microdontic maxillary lateral incisor, combined with necrotic pulp and apical periodontitis. The conventional treatment was completed first to disinfect the coronal portion of the accessible pulpal space. At a subsequent appointment, it was completed by a surgical approach to cleanse and seal the apical part of the root canal space. The tooth was then restored, and the orthodontic treatment was initiated. One-year follow-up demonstrated a complete healing of the apical lesion.

Horizontally impacted permanent maxillary incisors are rarely treated by surgical extraction due to their unfavorable position and traumatic extraction. Fixed prostheses such as fixed partial dentures and implants are contraindicated in children because of their growing age, as they adversely affect bone growth. In this case report, we have presented 18-month follow-up study of a 13-year-old child with a horizontally impacted permanent maxillary lateral incisor which was autotransplanted into its original position. To avoid interference in periodontal healing, intentional endodontic treatment was carried out followed by placement of a jacket crown.

Objective This second of a two-part series reviews the single dental implant as the most current treatment alternative for replacement of a missing or lost maxillary lateral incisor. Assessments of dental maturity for implant placement, implant space requirements, surgical and restorative influence on soft tissue profiles, and implant success are reviewed. Overview Recent data indicates that implant success rates are high, and esthetics and soft tissue profiles appear to be stable for maxillary lateral incisor implants. Implant placement should be assessed by dental maturity of the specific patient as opposed to chronological age, and implant spacing should be developed and assessed by all team members. Conclusions Implant replacement of a missing lateral incisor is a predictable treatment mode if implant placement is deferred until dental maturity and then accurately placed in a well-developed site. Treatment involves more complicated planning and execution from team members than other alternatives, but innovations in techniques and materials render it a favorable alternative for lateral incisor replacement. Clinical significance Implant restoration of a missing or lost maxillary lateral incisor is surgically and restoratively more complex than space closure or a resin-bonded fixed dental prosthesis but demonstrates high success rates and high esthetic potential when team members follow strict treatment protocols.

Previous studies have reported incidence rates of dehiscence (DEH) and fenestration (FEN) as high as 36.51 and 51.09%, respectively. Only a few studies comparing DEH and FEN before and after orthodontic treatment (OT) are available in the literature. The aim of this study was to evaluate the occurrence of DEH and FEN in anterior teeth, before and after OT, using cone-beam computed tomography (CBCT). In addition, findings may provide a clinical basis for avoiding DEH and FEN during therapeutic tooth alignment. CBCT images of 21 patients near the end of their peak growth and development were included. DEH and FEN in the anterior teeth and thicknesses of the alveolar bone at the palatal (TP) and labiolingual (LL) sides of each anterior tooth were measured before and after OT. After OT, the incidence rates of mandibular anterior labial DEH, maxillary anterior TP-bone defect, and mandibular anterior lingual bone defect were increased by 20, 19, and 30%, respectively. Assessment of CT images prior to treatment showed that the teeth developing bone defects were significantly different regarding the apical alveolar bone thicknesses compared to the teeth that did not develop bone defects after OT, i.e., the incidence of DEH and FEN after OT was lower if the thickness of the apex to labiolingual alveolar bone before OT was as follows: the apex to labial alveolar bone thickness of the maxillary central incisor and maxillary lateral incisor was >4 mm, the apex to palatal alveolar bone thickness of the maxillary lateral incisor was >3 mm; the apex to labiolingual alveolar bone thickness of the lower incisor was >5 mm. The incidence of post-OT DEH at the maxillary anterior and mandibular anterior lingual surfaces were increased significantly compared to before treatment. In general, the smaller the apex to labiolingual alveolar bone thickness, the greater the likelihood of bone defects occurring after OT. Evaluation of the apical position of anterior teeth in alveolar bone can help minimize the occurrence of bone defects after OT.

Isolated cleft palate without cleft lip is a rare deformity. Cleft lip and cleft palate can sometimes develop in combination with a syndrome due to genetic causes. Affected patients have morbidity through life from birth and experience comprehensive treatment for such clefts including surgery. It is extremely rare that the untreated clefts are found during routine cadaveric dissection, since many patients have treatment for clefts in developed countries. Herein, we present a case of an untreated incomplete isolated cleft palate on the right side of the maxilla. An oronasal fistula was found in the same location as the missing right maxillary lateral incisor, and the soft palate was considerably intruding into the hard palate but without penetration into the nasal cavity. The right incisivus labii superioris muscle forming the oral vestibule was incompletely torn with two fistulae. An incomplete bony defect was found on the right maxilla without oronasal or oroantral fistula. This paper may contribute to evaluating the disturbed site of the incomplete isolated cleft palate with no treatment.

Introduction Needle-free anesthetic delivery is a promising alternative to traditional anesthetic routes of administration. The purpose of this study was to determine the patient preference for and pulpal anesthetic efficacy of a 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray in maxillary lateral incisors and first premolars. Methods Fifty adult subjects randomly received a 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray and mock infiltration or a mock nasal spray and 2% lidocaine with 1:100,000 epinephrine infiltration at the maxillary lateral incisor or first premolar in 2 appointments spaced at least 1 week apart in a single-blind cross-over design. Pulpal anesthesia was evaluated with an electric pulp tester. Side effects and subject preferences were also recorded. Results Anesthetic success was significantly lower for the Kovanaze nasal spray and mock infiltration (22%–37%) than for the mock nasal spray and lidocaine infiltration (89%–91%). Subjects reported more unwanted effects (nasal drainage and congestion, burning, pressure, and sinus congestion) after the Kovanaze nasal spray and mock infiltration than the mock spray and maxillary infiltration. Before participating in the study, more subjects (56%) preferred the nasal spray route versus a standard infiltration (44%). After experiencing both routes of administration, 100% of subjects preferred the standard infiltration. Conclusions The 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray provided significantly less successful pulpal anesthesia than the lidocaine infiltration, was less preferable, and caused more unwanted effects.

Background: Developmental anomalies in the number of teeth can result from disturbances in the developing dental lamina of the tooth. The dental lamina may become hyperactive leading to the formation of a supernumerary tooth or may fail to proliferate leading to the congenital absence of a primary or permanent tooth. Aims: The aim of the study was to assess the prevalence and distribution of hypodontia and hyperdontia in permanent dentition, excluding the third molars in children in Vadodara, Gujarat. Setting and Design: A descriptive, analytical, and cross-sectional study was conducted to determine the above-mentioned aims. Materials and Methods: In the study, panoramic radiographs of 1816 children (967 girls and 849 boys), aged 8 to 14 years were recorded and inspected for anomalies in the number of teeth. Statistical Analysis Used: The data was analyzed using SPSS version 10.00 (Statistical Package for the Social Sciences, Chicago, USA). Descriptive statistics and Chi-square-test were used to compare the results. The level of significance was set at 0.05. Results: The prevalence of hypodontia was 11.01%, and the most frequently absent tooth was the maxillary lateral incisor. There was an increased prevalence of hypodontia in females and in the mandibular arch of the permanent dentition. The prevalence of hyperdontia was 2.97% and the most common supernumerary tooth was mesiodens. There was an increased prevalence of hyperdontia in males and in the maxillary arch of the permanent dentition. Conclusions: There was a high prevalence of hypodontia and a low incidence of hyperdontia in the studied population. Prompt diagnosis of these anomalies can help plan treatment modalities at an early age to establish a functional and esthetic dentition.

Variations in alignment of teeth among adults are present and widely cited in the literature complete tooth rotation on its own axis degrees however not a commonly observed condition is In this article a unique case of a healthy patient with a degree rotated maxillary lateral incisor will be presented and addressed from an esthetic point of view

Preservation of the maxillary lateral incisor space after orthodontic treatment in an adolescent patient traditionally requires the use of a retainer with a lateral pontic, commonly referred to as a "flipper," which is minimally effective in the long term. This article illustrates a technique for chairside fabrication of a Maryland bridge retainer for semi-permanent retention. A stainless steel braided palatal wire is bonded to the anterior teeth. A pontic is then built intraorally with flowable composite, using the palatal wire as scaffolding. The retainer is maintained until the patient is of age for a more permanent restoration.

Spacing between the maxillary anterior teeth is a common concern for young patients and their parents. Patients often consider a diastema to be an annoying but minor problem; they might consult their general dentists for help, or try to address the issue themselves by applying elastic "gap bands." Moreover, parents, without any informed consent, sometimes accept this erroneous method as an easy and inexpensive treatment approach. A 9-year-old boy had severe acute periodontitis involving the maxillary central incisors caused by the placement of an elastic band and its apical migration. Despite periodontal and surgical interventions, the maxillary central incisors were finally extracted, and the patient started orthodontic treatment. The orthodontic treatment plan included maxillary lateral incisor substitution to replace the lost central incisors and mesialization of the maxillary posterior dentition. An interdisciplinary approach with excellent cooperation among the orthodontist, general dentist, and other dental specialists obtained an esthetically pleasing and optimized functional result. Treating the diastema between the anterior teeth with elastic gap bands and without fixed orthodontic appliances should be avoided. Patients should seek proper orthodontic advice for even small-scale orthodontic problems to prevent catastrophic outcomes, as exhibited in this case report.

Background. The purpose of this study was to report the outcome of the management of both horizontal and vertical defects of alveolar crest using the bone slat technique approach in conjunction with third molar removal prior to implant placement in the aesthetic area.Methods. We present a 20-year-old female patient who lost a maxillary lateral incisor. The objective of treatment was to replace the lateral incisor with an implant-supported crown restoration without interfering with the integrity and topography of the adjacent gingival tissues. Because the future implant site showed horizontal and vertical bone defect the Authors decided to perform bone regeneration. The need for such bone augmentation in the younger patient often coincides with the timing for third molar removal. By combining third molar extraction with bone harvest and alveolar grafting, the patient undergoes only one surgical approach. The bone height (9.5 mm) and width (5.7 mm) were measured at the point of interest (tooth 12) both before and after implant placement in the reconstructed panoramic and parasagittal views by Cone Beam Computed Tomography (CBCT) scan.Results. The final results demonstrated an increase in length of 5 mm after bone slat technique (from 9.5 mm to 13.5 mm) and an increase in width of 1 mm (from 5.7 mm to 6.7 mm). ISQ measurements were recorded at the time of implant placement (the mean was: 68.5) and immediately after individualized screw-retained provisional crown (the mean was: 77).Conclusions. This technique is reliable and aesthetic and functional results appear to be stable and respect this requisite: simple and fast graft harvesting and low risk of morbidity especially in conjunction with third molar removal. Background. The purpose of this study was to report the outcome of the management of both horizontal and vertical defects of alveolar crest using the bone slat technique approach in conjunction with third molar removal prior to implant placement in the aesthetic area.Methods. We present a 20-year-old female patient who lost a maxillary lateral incisor. The objective of treatment was to replace the lateral incisor with an implant-supported crown restoration without interfering with the integrity and topography of the adjacent gingival tissues. Because the future implant site showed horizontal and vertical bone defect the Authors decided to perform bone regeneration. The need for such bone augmentation in the younger patient often coincides with the timing for third molar removal. By combining third molar extraction with bone harvest and alveolar grafting, the patient undergoes only one surgical approach. The bone height (9.5 mm) and width (5.7 mm) were measured at the point of interest (tooth 12) both before and after implant placement in the reconstructed panoramic and parasagittal views by Cone Beam Computed Tomography (CBCT) scan.Results. The final results demonstrated an increase in length of 5 mm after bone slat technique (from 9.5 mm to 13.5 mm) and an increase in width of 1 mm (from 5.7 mm to 6.7 mm). ISQ measurements were recorded at the time of implant placement (the mean was: 68.5) and immediately after individualized screw-retained provisional crown (the mean was: 77).Conclusions. This technique is reliable and aesthetic and functional results appear to be stable and respect this requisite: simple and fast graft harvesting and low risk of morbidity especially in conjunction with third molar removal.

Objective To assess whether subject gender influences aesthetic opinion when altering the width of maxillary lateral incisors. Method Photographs of a male and a female smile, displaying only the lips and teeth, were digitally altered to produce images where the maxillary lateral incisor was proportioned 52%, 57%, 62%, 67%, 72% and 77% in relation to the width of the maxillary central incisor. The image was then made symmetrical. One hundred participants (50 male and 50 female) were asked to rank each set of photographs from 'most' to 'least attractive'. Result The 57% lateral incisor was considered the 'most attractive' with the 77% lateral incisor the 'least attractive' however no statistically significant difference existed with relation to subject or rater gender. Conclusion Neither the 'golden proportion' nor the 'Recurrent Aesthetic Dental' ('RED') proportion was deemed the most attractive. As subject gender did not have a significant effect, dentists should work to create aesthetic results on an individual basis, operating within a so-called 'golden range'.

OBJECTIVE Loss of teeth frequently results in compound horizontal and vertical alveolar bone defects. An appropriate bone structure is the key for implant placement and bony support of soft tissues. Advanced bone augmentation techniques are required for the reconstruction of these defects. This report will present a new bone block grafting technique with 12-month follow-up. METHOD The seedling technique was used to augment the alveolar bone 3-dimensionally with autologous bone block and an osseointegrated implant in a 2-stage procedure. Horizontal and vertical bone loss is revealed after cone beam radiographic examination in the right maxillary lateral incisor area. Initially, the implant was placed at the right maxillary tuber area, where the bone was abundant. After 2-months healing phase, the osseointegrated implant was harvested with the surrounding bone and transplanted to the anterior region of maxilla to augment the horizontal and the vertical components of the recipient site. Transplanted implant inserted into autogenous bone block was fixed with mini plate to the adjacent native bone. Prosthetic restoration was applied 4 months after the transplantation. RESULTS Seven months after the first surgery, treatment of anterior bone deficiency was accomplished. The patient was fully satisfied with the function and the esthetics of the restoration. The radiological and clinical examinations at 1-year follow-up evaluation showed successful outcome of transplanted autogenous bone block without any resorption. CONCLUSION This clinical report demonstrated that anterior maxillary single-tooth replacement, according to seedling concept of autogenous bone block with osseointegrated implant, is a successful and predictable treatment modality.

Dens invaginatus (DI) represents an endodontic challenge because of its complex root canal morphology. This case report presents the clinical management of a 22-year-old woman with type II DI in right maxillary lateral incisor with a painful swelling. Pulp testing revealed no response with the tooth. Type II DI with open apex and large periradicular lesion was seen on radiograph. The treatment was planned by using cone-beam computed tomography (CBCT) imaging. Canal treatment was completed in two appointments with the aid of a dental operating microscope. In the first appointment, the internal anatomy was modified using an ultrasonic tip, and chemo-mechanical preparation was performed using the XP-endo Finisher instrument and NaOCl; calcium hydroxide intracanal dressing was used for one month. In the second appointment, an apical plug of mineral trioxide aggregate (MTA) Repair HP was performed and the remaining pulp space was then filled with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. At the fourteen-month reevaluation, the patient was asymptomatic, the tooth had remained functional, and radiographic and CBCT assessment showed significant osseous healing of the lesion. Successful non-surgical management of the present type II DI was achieved in the present case. The association of CBCT, dental operating microscope, XP-endo Finisher, NaOCl and MTA Repair HP were important for ensuring a predictable outcome. Key words:Cone beam computed tomography, dens invaginatus, MTA apexification, XP-endo Finisher.

Objective This study analyzed the maintenance of lateral incisors in the dental rehabilitation of individuals with cleft lip and palate. Material and Methods The study was conducted on a tertiary craniofacial center and comprised retrospective analysis of panoramic and periapical radiographs of Caucasoid individuals with non-syndromic complete unilateral cleft lip and palate, analyzing all radiographs available on the records of each individual, from the first to the last up to 12 years of age. Overall, 2,826 records were reviewed to achieve a sample of 1,000 individuals. Among these, 487 individuals presented the permanent lateral incisors on both cleft and non-cleft sides, which were included in this study. Results The results were evaluated in percentages and by descriptive statistics. The association between maintenance of the lateral incisor and timing of alveolar bone graft were analyzed by the t test. Among the 487 individuals, 265 had not completed treatment, 62 presented insufficient information, and 44 concluded the treatment elsewhere. Among the remaining 116 individuals, the lateral incisor was extracted from 88 (75.86%) of them on the cleft side (CS) and from 23 (19.83%) people on the non-cleft side (NCS). The age at accomplishment of alveolar bone graft was significantly associated with maintenance of the lateral incisor on the cleft side (p

A palatogingival groove is a developmental anomaly that predisposes the involved tooth to develop a severe periodontal lesion. These grooves often present a clinical challenge because diagnosis and treatment planning require an interdisciplinary approach. This case report describes the successful management of a right maxillary lateral incisor with a deep palatogingival groove in combination with an extensive periodontal pocket and pulp necrosis of the involved tooth. Collaborative management used a combination of endodontic treatment, periodontal therapy, odontoplasty, and a periodontal regenerative procedure using protein complex derived from enamel matrix (Emdogain; Straumann, Basel, Switzerland). Despite a predicted poor prognosis, the tooth lesion healed. This report also discusses the rationale behind the treatment modalities.

Introduction:Cleft lip and palate are craniofacial anomalies highly prevalent in the overall population. In oral clefts involving the alveolar ridge, variations of number, shape, size and position are observed in maxillary lateral incisors. The objective of this manuscript is to elucidate the embryonic origin of maxillary lateral incisors in order to understand the etiology of these variations.Contextualization: The hypothesis that orofacial clefts would split maxillary lateral incisor buds has been previously reported. However, recent studies showed that maxillary lateral incisors have dual embryonic origin, being partially formed by both the medial nasal process and the maxillary process. In other words, the mesial half of the lateral incisor seems to come from the medial nasal process while the distal half of the lateral incisor originates from the maxillary process. In cleft patients, these processes do not fuse, which results in different numerical and positional patterns for lateral incisors relating to the alveolar cleft. In addition to these considerations, this study proposes a nomenclature for maxillary lateral incisors in patients with cleft lip and palate, based on embryology and lateral incisors position in relation to the alveolar cleft.Conclusion:Embryological knowledge on the dual origin of maxillary lateral incisors and the use of a proper nomenclature for their numerical and positional variations renders appropriate communication among professionals and treatment planning easier, in addition to standardizing research analysis. Introdução:as fissuras de lábio e palato são malformações de alta prevalência na população. Nas fissuras que envolvem o rebordo alveolar, o incisivo lateral superior mostra variações de número, forma, tamanho e posição, o que o torna objeto de estudo, na tentativa de elucidar sua origem embrionária para compreender a etiologia dessas alterações.Contextualização:existia a hipótese de que a fissura orofacial seria capaz de segmentar o botão embrionário do incisivo lateral. No entanto, estudos recentes evidenciaram que o incisivo lateral superior possui dupla origem embrionária, sendo formado parcialmente pelo processo nasal medial e pelo processo maxilar. Em outras palavras, a metade mesial do incisivo lateral provém do processo nasal medial, enquanto a metade distal do incisivo lateral origina-se do processo maxilar. No paciente com fissura, não há fusão desses processos, o que resulta nos diferentes padrões numéricos e posicionais do incisivo lateral em relação à fissura. Além dessas considerações, propõe-se também uma nomenclatura para o incisivo lateral em pacientes com fissura labiopalatina, com embasamento na Embriologia, considerando-se sua posição em relação à fissura alveolar.Conclusão:o conhecimento embriológico da dupla origem do incisivo lateral superior e o emprego de uma nomenclatura adequada para as suas variações numéricas e posicionais facilita a comunicação entre profissionais, o planejamento dos casos e possibilita a realização de estudos clínicos comparativos.

The existence of pulpal and periodontal disease can complicate the diagnosis and treatment planning and affect the sequence of care to be performed. A palatogingival groove is a developmental anomaly that often leads to the establishment of combined periodontal–endodontic lesions and can be an unidentified cause of endodontic failure. This case report describes a case of palatogingival groove in an upper right lateral incisor with endodontic failure. The diagnosis was confirmed with the help of spiral computed tomography and management included a combination of re-endodontic therapy and periodontal therapy.

Tooth related factors such as palatoradicular groove can be one of the causes for localized periodontal destruction. Such pathological process may result in apicomarginal defect along with inflammation of pulp. This creates challenging situation which clinician must be capable of performing advanced periodontal regenerative procedures for the successful management. This case report discusses clinical management of apicomarginal defect associated with extensive periradicular destruction in a maxillary lateral incisor, along with histopathologic aspect of the lesion.

The purpose of this report is to present a rare case of a maxillary lateral incisor exhibiting two separate root canals confirmed by cone-beam computed tomography (CBCT). A 65-year-old female patient with an esthetic complaint regarding her maxillary left lateral incisor was referred to our clinic. During a radiographical examination, an endodontically treated root canal and an extra root canal with an apical lesion were observed. The retreatment was performed. CBCT findings confirmed the root canal mophology of the maxillary left lateral with two distinct canals. We conclude that the CBCT imaging is an adjunctive tool for better assessment of complex root canal systems.

In this study, a patient with a large periapical lesion related to the maxillary left central incisor and two canalled lateral incisors was presented. A single visit non-surgical root canal treatment was performed for both teeth. A three-year follow-up radiograph revealed complete healing of the periapical lesion. This report confirms that the large size of a periapical lesion neither mandates surgical removal nor the placement of intra-canal dressing and that such a lesion can heal following a conservative single visit endodontic treatment. Furthermore, familiarity with the variations of root canal morphology is essential for successful endodontic treatment. Maxillary lateral incisors usually have a single canal; however, this case report describes endodontic treatment of maxillary lateral incisor with two buccopalatal root canals. Key words: Healing of large periapical lesion, single visit root canal treatment, two canalled maxillary lateral incisor.

Background and Overview Dens invaginatus (DI) is defined as a rare dental malformation. The inherent structural variants of this anatomic disorder make it difficult to perform conventional endodontic treatment procedures by means of a conservative access cavity. In this clinical case report, the authors describe the treatment of a type II DI by means of guided splints for cavity access. Case Description This is a clinical report of a case of type II DI in a maxillary lateral incisor. The authors established the diagnosis by means of cone-beam computed tomography (CBCT). The authors manufactured 3 splint guides from a Digital Imaging and Communications in Medicine file and a stereolithography file obtained from a plaster model of the patient by using software for guided implant placement, for access opening, and for locating the root canals. Conclusions CBCT is an effective method for obtaining information about the root canal system in teeth with DI. In addition, guided implant surgery software is effective for manufacturing splint guides for endodontic treatment with conservative pulp chamber access. Practical Implications Information obtained from CBCT allows the clinician to fabricate splint guides for minimally invasive access opening in this type of case, thus reducing the loss of dental tissue.

Introduction Studies have found women try to avoid pain more than men, accept it less, and fear it more. The role of operator gender on subject gender pain in a clinical setting needs further study. The purpose of this randomized, double-blind investigation was to evaluate operator gender and its influence on reported subject gender pain in maxillary anterior infiltrations. Methods Two hundred subjects (100 male and 100 female) participated. At the initial appointment, each subject randomly received an infiltration over the maxillary lateral incisor of a cartridge of 2% lidocaine with 1:100,000 epinephrine by 1 of 20 calibrated male or female operators. At the second appointment (separated by at least 2 weeks), each subject received an infiltration of the same anesthetic at the same location by an operator of the opposite gender. Immediately after each infiltration, subjects rated the pain of injection (needle insertion, needle placement, and solution deposition) on 170-mm visual analogue scale. Dental anxiety was determined for each subject by using the Corah Dental Anxiety Scale. Results No significant differences were detected between male and female participants on the Corah Dental Anxiety Scale. For all 4 operator-gender combinations, no significant difference was found in reported pain for needle insertion or placement. A significant difference ( P = .0357) was found during the solution deposition phase among female subjects receiving injections from male operators. Conclusions Gender had a statistically significant effect for solution deposition pain when a male operator administered the injection to female subjects.