Management options and long-term follow-ups for permanent double incisors: six to eleven-year case reports.

BACKGROUND: Double teeth are dental anomalies that can lead to aesthetic and orthodontic problems. CASE PRESENTATION: This report discusses two cases involving the multidisciplinary management of permanent maxillary left lateral incisors fused with a supernumerary tooth in two girls aged 9 and 10. Following intraoral and radiographic examinations, one was diagnosed with fusion, and the other was diagnosed with concrescence. The crown of the fused incisor was separated using a burs and extracted intraorally. The concrescent incisor was separated along its length using a laser and intentionally replanted extraorally. After a 6-year follow-up, no pathological signs were observed in the fused incisor. However, after an 11-year follow-up, external resorption was observed in the concrescent incisor. CONCLUSIONS: Both incisors remained asymptomatic throughout the observation period. This case report highlights two different and effective methods employed to preserve the natural function, form, and aesthetics of double incisors.

Three-dimensional evaluation of dental characteristics in patients with Cleidocranial dysplasia.

BACKGROUND: Cleidocranial dysplasia (CCD) is an autosomal dominant hereditary disorder. Besides skeletal abnormalities, CCD is often associated with dental complications, such as multiple supernumerary teeth and permanent teeth impaction or delayed eruption. METHODS: Supernumerary teeth of axial, sagittal and coronal CBCT view was characterized in detail and 3D image reconstruction was performed. Number and location of teeth, morphology of supernumerary teeth, positional relationship between supernumerary and adjacent permanent teeth, direction of supernumerary teeth in CCD patients were analyzed. RESULTS: The mean age of the 3 CCD patients in this study was 16.7 years. Among 36 supernumerary teeth, the majority of them were identified as apical side located and lingual side located. Normal orientation was the most common type in this study, followed by sagittal orientation, and horizontal orientation. Horizontal orientation teeth were all distributed in the mandible. Supernumerary teeth exhibited significantly shorter crown and dental-root lengths, as well as smaller crown mesiodistal and buccolingual diameters (P < 0.01). There was no difference in the number of supernumerary teeth between the maxilla and mandible, and the premolars region had the largest number of supernumerary teeth and the incisor region had the smallest number. CONCLUSIONS: This study compares number and location of teeth, morphology of supernumerary teeth, positional relationship between supernumerary and adjacent permanent teeth and direction of supernumerary teeth, this study also provides a reference for the comprehensive evaluation of CCD patients before surgery.

Multidisciplinary management of a tooth with severe root dilaceration and enamel hypoplasia: a case report.

Dental trauma in primary teeth can cause irreversible changes in the development of permanent tooth germs, including enamel hypoplasia, crown dilaceration, and root dilaceration. This article discusses multidisciplinary treatment of enamel hypoplasia and root dilaceration in the maxillary left central incisor of an 11-year-old girl. A 10-year follow-up is reported to demonstrate the long-term clinical outcomes. At the initial presentation, the patient's mother reported that the child had an accident at the age of 2 years, resulting in intrusive luxation of the primary maxillary left central incisor. After the accident, the patient was monitored for eruption of the permanent successor tooth, and different approaches were proposed during each period of the patient's development on the basis of the clinical diagnosis of root dilaceration and enamel hypoplasia. The crown was restored with composite resin, and the root defect was restored with resin-modified glass ionomer cement. After 10 years, the clinical outcomes highlight that the multidisciplinary approach was successful in preserving the natural tooth with good periodontal health conditions.

Characteristic dental pattern with hypodontia and short roots in Fraser syndrome.

Fraser syndrome (FS) is a rare autosomal recessive multiple congenital malformation syndrome characterized by cryptophthalmos, cutaneous syndactyly, renal agenesis, ambiguous genitalia, and laryngotracheal anomalies. It is caused by biallelic mutations of FRAS1, FREM2, and GRIP1 genes, encoding components of a protein complex that mediates embryonic epithelial-mesenchymal interactions. Anecdotal reports have described abnormal orodental findings in FS, but no study has as yet addressed the orodental findings of FS systematically. We reviewed dental radiographs of 10 unrelated patients with FS of different genetic etiologies. Dental anomalies were present in all patients with FS and included hypodontia, dental crowding, medial diastema, and retained teeth. A very consistent pattern of shortened dental roots of most permanent teeth as well as altered length/width ratio with shortened dental crowns of upper incisors was also identified. These findings suggest that the FRAS1-FREM complex mediates critical mesenchymal-epithelial interactions during dental crown and root development. The orodental findings of FS reported herein represent a previously underestimated manifestation of the disorder with significant impact on orodental health for affected individuals. Integration of dentists and orthodontists into the multidisciplinary team for management of FS is therefore recommended.

Treatment of peri-invagination lesion and vitality preservation in an immature type III dens invaginatus: a case report.

BACKGROUND: To report a case of type III dens invaginatus associated with peri-invagination periodontitis in an immature permanent mandibular central incisor with open apex, in which only the invagination area was treated and vitality was preserved. CASE PRESENTATION: A 9-year-old boy was referred complaining of pain in the mandibular left central incisor. After radiographic examination, an invagination into the pulp chamber of the tooth associated with periapical radiolucency was detected. Endodontic access was performed and the orifice was identified under a dental operating microscope. The invagination area was chemo-mechanically cleaned. After 1 week, the invagination was obturated with mineral trioxide aggregate. During the 2-year follow up period, the tooth was asymptomatic. Radiographic examination revealed significant progression of periapical healing and root development in the main root canal of the tooth. CONCLUSION: Non-surgical root canal treatment of the invagination may preserve pulp vitality, and continuous root development of the tooth.

Association between developmental dental anomalies, early childhood caries and oral hygiene status of 3-5-year-old children in Ile-Ife, Nigeria.

BACKGROUND: To determine the association between developmental dental anomalies (DDA), early childhood caries (ECC) and oral hygiene status of 3-5-year-old children resident in Ile-Ife, Nigeria. METHODS: This was a cross-sectional study. We analyzed data for 3-5-year-olds extracted from the dataset of a household survey collected to determine the association between ECC and maternal psychosocial wellbeing in children 0-5-year-old. The outcome variables for the study were ECC and poor oral hygiene. The explanatory variable was the presence of developmental dental anomalies (supernumerary, supplemental, mesiodens, hypodontia, macrodontia, microdontia, peg-shaped lateral, dens evaginatus, dens invaginatus, talons cusp, fusion/germination, hypoplasia, hypomineralized second molar, fluorosis, amelogenesis imperfecta). The prevalence of each anomaly was determined. Poisson regression analysis was conducted to determine the association between presence of developmental dental anomalies, ECC and oral hygiene status. The model was adjusted for sex, age and socioeconomic status. RESULTS: Of the 918 children examined, 75 (8.2%) had developmental dental anomalies, 43 (4.7%) had ECC, and 38 (4.1%) had poor oral hygiene. The most prevalent developmental dental anomalies was enamel hypoplasia (3.9%). Of the 43 children with ECC, 6 (14.0%) had enamel hypoplasia and 3 (7.6%) had hypomineralized second primary molar. There was a significant association between ECC and enamel hypoplasia (p < 0.001) and a borderline association between ECC and hypomineralized second primary molars (p = 0.05). The proportion of children with poor oral hygiene (PR: 2.03; 95% CI: 0.91-4.56; p = 0.09) and ECC (PR: 2.02; 95% CI: 0.92-4.46; p = 0.08) who had developmental dental anomalies was twice that of children with good oral hygiene and without ECC respectively, although the differences did not reach statistical significance. CONCLUSIONS: Enamel hypoplasia and hypomineralized second primary molars are developmental dental anomalies associated with ECC. developmental dental anomalies also increases the probability of having poor oral hygiene in the population studied.

Frequency of crown and root dilaceration of permanent incisors after dental trauma to their predecessor teeth.

BACKGROUND/AIMS: Dental trauma to the predecessor teeth can cause crown and root dilacerations to the successor teeth, which can interfere with the normal development of permanent teeth. The aims of this study were to verify the types of trauma more frequent to the predecessor teeth that cause dilaceration to their successor teeth, to determine the frequency of crown and root dilacerations in permanent incisors, taking into account the child's age at the time of trauma, and to describe the types of treatment performed. MATERIALS AND METHODS: Details of 815 anterior primary teeth with dental injury were obtained from 483 dental records of children aged 0-9 years at the time of trauma. RESULTS: Of 815 traumatized primary teeth, 161 successor teeth were clinically and radiographically reviewed until complete eruption and had some type of sequel. Avulsion and intrusive luxation were the most frequent types of trauma to the predecessor teeth that caused dilaceration to their successor teeth. Enamel discoloration (30.4%), hypoplasia (23.6%), root (14.3%) and crown (9.9%) dilacerations were the most common sequelae observed in the successor teeth. Root and crown dilacerations were more frequent in children aged more than and up to 3 years, respectively. Tooth extraction and orthodontic treatment were the most common treatments. CONCLUSIONS: Dentists must be aware of the relationship between the child's age at the time of trauma to the predecessor tooth and the type of sequel to the successor tooth in order to diagnose, monitor, and treat the sequel properly.

Cone-Beam Computed Tomography Study Of Crown Dilaceration With a Talon Cusp in an Unerupted Permanent Maxillary Tooth.

This article describes a rare case of crown dilaceration with a talon cusp in an unerupted permanent maxillary central incisor. Our patient was a 7-year-old boy with a history of trauma to his primary maxillary teeth (#51 and 52), at 3 years of age complaining of failure of eruption of tooth #11. Periapical radiography showed incomplete formation of tooth root #11 and more superior position of tooth bud #11 relative to tooth bud #12. A cone-beam computed tomography was ordered, which revealed crown dilaceration with a talon cusp in tooth bud #11. The patient was scheduled for follow-up at 6 months.

CAD/CAM Endocrown Fabrication from a Polymer-Infiltrated Ceramic Network Block for Primary Molar: A Case Report.

OBJECTIVE: The aim of this case report is to describe the treatment of a primary molar with a deep carious lesion by pulpotomy and placement of a ceramic endocrown. CLINICAL CASE: A 7-year-old male patient with profound caries in tooth number 85 was referred to our clinic and underwent a pulpotomy. As the final treatment in tooth restoration, placement of an endocrown was planned, because little more than half of the tooth structure remained. After an additional request from the patient's parents for an advanced and prompt restoration, a computer-aided design/computer-aided manufacturing (CAD/CAM) polymer-infiltrated ceramic network (PICN) block was chosen. A three-dimensional model of the arch was obtained after scanning the dental cast, and the endocrown was designed digitally according to the model. When the design was complete, the endocrown was fabricated with a milling machine. Finally, the endocrown was cemented with self-adhesive resin cement. RESULTS: Over the 9-month follow-up period, no pulpal or periradicular pathology was observed on radiographs. Regarding the crown, the marginal fit was excellent, the anatomical form was protected, and no discoloration occurred. CONCLUSION: During follow-up, the CAD/CAM PICN block endocrown proved to be a good material for the short- to long-term treatment of a primary tooth. However, more clinical cases and follow-up are required to investigate the long-term effects of antagonistic tooth wear.

Phenotypes of Enamel Hypomineralization and Molar Incisor Hypomineralization in Permanent Dentition: Identification, Quantification and Proposal for Classification.

OBJECTIVES: To report the extent, pattern, clinical presentation and phenotypes of enamel hypomineralization in permanent dentition Study Design: This cross sectional observational study recruited a random sample of 1726, 12-16 year olds. Enamel hypomineralization was scored on all teeth by a calibrated examiner using the EAPD 2003 criteria. Proportions of affected subjects (prevalence) with a minimum of one hypomineralization and Molar Incisor Hypomineralization (MIH) were calculated. Proportions of following phenotypes were quantified i.e. MH (only FPM hypomineralization), M+IH (concomitantly affected FPMs and permanent incisors without affecting any other tooth in the arch), MIHO (hypomineralization affecting at least one of the canines, premolars or 2(nd) molars and simultaneously including at least one FPM), IH (only permanent incisor's hypomineralization) and NoFPM (hypomineralization affecting at least one of the canines, premolars and 2(nd) molars but not FPM; incisors can be affected concomitantly). A comparative evaluation of extent and severity of enamel hypomineralization was performed amongst various phenotypes. Statistical measures employed t-test, chi square tests and ANOVA. RESULTS: Overall prevalence of affected subjects was 13.21% (228/1726) and 9.79% (169/1726) for enamel hypomineralization and MIH respectively. A total of 4.36±3.45 teeth/subject and 6.01±5.20 surfaces/subject were found to be affected with enamel hypomineralization. Most prevalent phenotype was M+IH while the least prevalent was IH. Maximum severity i.e. number of affected surfaces and surfaces with PEB were reported for MIHO (p<0.001). CONCLUSION: Enamel hypomineralization can manifest in any tooth in five phenotypic variations in permanent dentition with varying extent and severity.

Globodontia in the Otodental Syndrome: A Rare Defect of Tooth Morphology Occurring with Hearing Loss in an Eight-Year-Old.

Otodental syndrome is a hereditary disorder comprising globodontia and sensorineural hearing loss. Globodontia is characterized by distinctively bulbous, enlarged crowns of molar and primary canine teeth. Anomalies including taurodontism and hypodontia also occur. We report on the dental treatment and multidisciplinary management of an eight-year-old girl with this rare condition. Referral to Clinical Genetics and Oral Pathology was instrumental in establishing a diagnosis of otodental syndrome for this young patient and her mother, who had similar dental defects. CPD/Clinical Relevance: To increase awareness among practitioners of this rare dental disorder and highlight the need for multidisciplinary management of such cases.

The prevalence, pattern and clinical presentation of developmental dental hard-tissue anomalies in children with primary and mix dentition from Ile-Ife, Nigeria.

BACKGROUND: The study of dental anomalies is important because it generates information that is important for both the anthropological and clinical management of patients. The objective of this study is to determine the prevalence and pattern of presentation of dental hard-tissue developmental anomalies in the mix dentition of children residing in Ile-Ife, a suburban region of Nigeria. METHODS: Information on age, sex and socioeconomic status was collected from 1,036 children aged four months to 12 years through a household survey. Clinical examination was conducted to assess the presence of dental anomalies. Associations between age, sex, socioeconomic status, prevalence, and pattern of presentation of the developmental hard-tissue dental anomalies were determined. RESULT: Two hundred and seventy six (26.6%) children had dental anomalies. Of these, 23.8% had one anomaly, 2.5% had two anomalies, and 0.3% had more than two anomalies. Of the children with anomalies, 49.3%were male, 50.7%were female, and 47.8%, 28.6% and 23.6% were children from low, middle and high socioeconomic classes, respectively. More anomalies were seen in permanent than primary dentition. Anomalies of tooth structure were most prevalent (16.1%); anomalies which affect tooth number were least prevalent (1.3%). Dens evaginatus, peg-shaped lateral, macrodontia, and talon cusp were more prevalent in the permanent dentition, and dens evaginatus peg-shaped lateral and macrodontia were more prevalent in the maxilla. There were significantly more macrodontia anomalies in males and in children of high socioeconomic status. CONCLUSION: This large survey of dental hard-tissue anomalies found in the primary dentition and mixed dentition of children in Nigeria provides anthropological and clinical data that may aid the detection and management of dental problems of children in Nigeria.

Primary double teeth and their effect on permanent successors.

AIM: Understanding the effects of primary double tooth (PDT) on permanent successors is important to ensure healthy permanent occlusion and aesthetics. The aim of this study is to determine the prevalence and type of PDT, their effect on permanent successors, and the accompanying dental anomalies/pathologies in a Turkish population. MATERIALS AND METHODS: Study design: The records of 63 PDTs in 54 healthy Caucasian children among 10,000 patients were investigated. PDTs were classified according to Aguilo's classification. RESULTS: The prevalence of PDT was 0.6%. Of the 63 PDTs, 14.3% were type I, 11.1% were type II, 31.7% were type III, and 41.3% were type IV; one (1.6%) was a triple tooth. Aplasia of the permanent lateral incisor was observed most frequently in association with type I (56%) PDT. All PDTs associated with a supernumerary permanent tooth were type IV. Dental anomalies/pathologies such as odontoma, talon cusp were observed. Caries involvement was observed most frequently in type IV (58.3%) PDT. STATISTICS: The chi-squared test was used to determine whether successor aplasia depended on PDT type, and contingency coefficients (%) were calculated to determine the degree of association between aplasia and PDT type. CONCLUSION: Clinicians should assess PDT clinically and radiographically to determine whether they are associated with aplasia of permanent lateral incisors (type I) or supernumerary permanent teeth (type IV). Type IV of PDT should be sealed with sealant or resin.

In vitro analysis of extracted dens invaginatus using various radiographic imaging techniques.

AIM: Dens Invaginatus (DI) is a rare malformation of the teeth, showing a broad spectrum of morphologic variations. The aim of this study was to perform in vitro radiographic analyses of three extracted dens invaginatus (DI) teeth with complex root anatomy using plain radiographs, CBCT, MRI and micro CT techniques. MATERIALS AND METHODS: Study design: Three maxillary lateral incisors (A, B and C) from two patients were extracted due to poor prognosis and were radiographically analysed. Initially, conventional two dimensional digital radiographs were taken. Subsequently CBCT, micro CT and MRI analyses were performed. RESULTS: According to the Schulze and Brand system of classification, teeth A, B and C were classified as A2, B3 and B2 respectively. To detect the relationship between the invagination to the oral cavity and pulp chamber, conventional two dimensional radiographs were of no help. CBCT and MRI images were found to be complementary to each other but provided lesser structural detail than micro CT images. CONCLUSION: Reporting on these three DI teeth, normal conventional radiographs did not provide detailed structural information about the malformation due to geometric distortion and lack of information. Even though Oehlers classification system is the most widely used, classification by Schulze and Brand is more applicable in rare and deviant teeth.

Uncommon true isolated macrodontia of a maxillary tooth.

Macrodontia is a rare dental anomaly which consists on the presence of any tooth or teeth larger than the average. In the present report the case of a child with an uncommon true isolated macrodontia of a maxillary central incisor is presented. The maxillary left central incisor was considered a macrodontic tooth since its mesiodistal crown dimension was 12.41 mm while the mesiodistal crown dimension of the maxillary right central incisor was 10.06 mm. The radiographic examination confirmed an enlarged maxillary left central incisor and a normal developing dentition. The patient did not report esthetic complaints, however, due the presence of anterior open bite and crowding, he was referred to orthodontic clinic. Thus, it must be point out the importance of the radiographic diagnosis to support the clinical findings, helping to plan and provide better treatment for the patient.

Is there a relationship between increased tooth number and increased tooth size? A case report.

UNLABELLED: A unifying theory has been proposed that links anomalies of tooth size and number. Application of this theory suggests that anomalies of tooth size and number may share a common aetiology but could also be predicted. This article highlights an association between macrodontia and hyperdontia as demonstrated by two clinical cases. These cases demonstrate a localized association and effect on the dentition and highlight the possible predictive application of this theory. CLINICAL RELEVANCE: Clinicians should be made aware of the possibility of supernumeraries associated with macrodont teeth.

Henry Moon and his molars.

Henry Moon qualified in London in medicine and dentistry, emigrated to New Zealand, eventually returning to London. He is known for his observations of the malformation of tooth cusps in children with congenital syphilis.

A Rare Bilateral Presentation of Multiple Dens Invaginatus, Shovel-Shaped Incisor and Talon Cusp With Mesiodens.

The aim of this paper is to describe a unique and unusual case of concomitant appearance of morphological dental anomalies in the maxillary anterior region, along with its management in a patient with no systemic abnormality. This case report describes the clinical and radiographic features of talon cusp, dens invaginatus, shovel-shaped incisors and a supernumerary tooth occurring in a single patient, which is a rare presentation. All 4 permanent maxillary incisors had dens invaginatus, the permanent maxillary canines showed the presence of talon cusps, the permanent maxillary central incisors were shovel-shaped and an erupted mesiodens was also observed. Treatment included restorative, surgical and orthodontic approaches.

Dens evaginatus: the hornet's nest of adolescent orthodontics.

Dens evaginatus is a rare dental anomaly that occurs during tooth development and results in an abnormal protrusion from the occlusal surface of the affected tooth, often in the area of the central groove between the buccal and lingual cusps. Of clinical importance to the orthodontist is that these occlusal tubercles fracture easily or can be worn away, resulting in direct pulp exposure in a noncarious tooth. This can cause severe complications, including loss of tooth vitality, facial infection in the form of an abscess or cellulitis, or osteomyelitis of the jaw. If extraction of premolars is indicated for orthodontic treatment after careful diagnosis and treatment planning, it is paramount to establish the health of the premolars that will remain in the dentition before extracting the teeth.

Fracture reattachment in an immature permanent incisor with talon's cusp. A rare case report.

AIM: To report the successful and conservative management of a fractured immature permanent maxillary incisor tooth with talon cusp by fracture reattachment. SUMMARY: Coronal fractures of the maxillary anterior teeth are common dental injuries. Among these, the complicated fractures especially in immature teeth require an unambiguous treatment without any delay. When the tooth fragment is available and there is no (or minimal) violation of the biological width, reattachment is the preferable choice. It is a conservative procedure in which the original anatomic form, color, tooth contour, surface texture and aesthetics are preserved. The prognosis of this procedure depends on the patient's cooperation, good understanding about the treatment limitations and periodic follow up. This report emphasises the management of coronal fracture in immature teeth by reattachment.