Rehabilitation of Dentofacial Asymmetry Secondary to Unilateral Temporomandibular Joint Ankylosis with Dual Distraction and Fixed Orthodontics - Stability at Three-year Follow-up.

Optimal rehabilitation of asymmetric dentofacial deformity secondary to unilateral temporomandibular joint (TMJ) ankylosis is often a challenge. The purpose of this case series is to present an insight into esthetic, occlusal and functional rehabilitation of two patients with varying degree of asymmetric Class II dentofacial deformities secondary to long-standing unilateral TMJ ankylosis. The patients were treated with one-stage surgical protocol employing simultaneous dual distraction technique along with interpositional arthroplasty. Dual distraction technique entailed the simultaneous use of two distractors which allowed for proper control of proximal condylar segment during the course of distraction and lowering the risk of ankylosis recurrence. Thereafter, comprehensive fixed orthodontic mechanotherapy involving the use of temporary anchorage devices was instituted to align and level the compensated dentition. Post-treatment records showed significant improvements in skeletal disharmony and functional stability with good functional occlusion. At the three-year follow-up, the morphological and functionally acceptable results were reasonably well-maintained, with no signs of relapse. Through the two cases reported here, we would like to highlight that one-stage concurrent arthroplasty and dual distraction technique is a safe, stable, and reliable approach for surgical and functional rehabilitation of an adult asymmetric dentofacial deformity secondary to unilateral TMJ ankylosis. Meticulously executed comprehensive orthodontic manipulations involving use of acrylic bite-blocks, elastic traction, and temporary skeletal anchorage device play a crucial role in enhancing the final occlusal outcomes.

A Modified Hyrax Assembly for Intrusion of a Traumatically Extruded Incisor: An Innovative Technique.

This case report demonstrates an innovative technique involving concomitant correction of a traumatic extrusive luxated tooth, the mobility of which was being aggravated by anterior occlusal contacts, along with transverse rapid maxillary expansion to capitalize on the advantage of residual growth and simplify the need for comprehensive fixed orthodontic appliance. By incorporating a molar tube into the acrylic splint of the bonded Hyrax expander adjacent to the buccal surfaces and parallel to the buccal cusps of the maxillary first molars, effective intrusion of traumatically extruded upper incisor was achieved concomitantly using a modified intrusion arch during the passive stabilization period after expansion, thereby reducing treatment time. This enabled the immediate correction of extruded tooth and reduced the overall treatment duration and the complexity of post-expansion fixed mechanotherapy, improving compliance and uplifting the self-esteem of the patient. The modified bonded Hyrax assembly can serve as a versatile interim appliance for the simultaneous management of a variety of orthodontic problems such as crowding, spacing, and incisor proclination without compromising the basic integrity of the bonded assembly.

Interceptive orthodontic management of mandibular lateral incisor-canine transposition using simplified and efficient biomechanical approach: A case report.

PURPOSE: Ectopic eruption anomaly, manifesting as tooth transposition, often presents a complex therapeutic challenge. Mandibular lateral incisor- canine transposition, although observed with rarity, tends to have major impact on development of proper dentition and adversely influence physical, nutritional, aesthetic and overall psychosocial well being of the patient. This report chronicles individualized one-phase orthodontic management of the case of incomplete transposition between mandibular right lateral incisor and canine in a 9-year-old boy during mixed dentition period. METHODS: Interceptive orthodontic treatment was initiated with placement of 2×4 fixed appliance in lower arch. A combination of continuous arch wire technique involving the use of improved superelastic nickel-titanium wire in conjunction with TMA rectangular wire loop was utilized to achieve biomechanically efficient mesial movement of mandibular lateral incisor. Treatment continued with sequential bonding of brackets to the rest of the mandibular dentition until the levelling and alignment of the buccal segment dentition was achieved. RESULTS: Well-timed early interceptive treatment involving simplified and controlled movements helped reinstate tooth order, promote free eruption of buccal segment teeth, reduce anchorage burden and achieve predictable and biologically compatible outcome without the use of lingual arch as an additional source of reinforcing anchorage. CONCLUSION: From an aesthetic, occlusal and functional standpoint, the treatment approach used in the reported case and the therapeutic outcome proved to be highly satisfactory. By optimizing the eruption and alignment patterns of the permanent teeth, preadolescent interceptive orthodontic treatment helps mitigate the burden of malocclusion and risks of complex orthodontic treatment in permanent dentition.

Correlation between scientometrics and altmetrics score of scholarly literature of Medical Journal Armed Forces India.

Background: Present article was an attempt to study correlation of scientometrics and altmetrics of scholarly output of Medical Journal Armed Forces India (MJAFI) during the period from 2010 to 2018. Methods: The study was carried out by "DIMENSIONS", Webometric Analyst 4.1, VOSviewer, version 1.6.10, database to identify year-wise number of publications, their accessibility, altmetric attention, field citation ratio, and relative citation ratio of top 100 articles between 2010 and 2018. Pearson correlation test was used to assess data statistically using SPSS software, version 21. Results: The study found that maximum publications were in 2015, i.e. 21.44% followed by 2018, i.e. 11.52% with 1053 articles open access and 318 articles closed access (1371). Total 317 altmetric attention received by total 1371 articles, and "Clinical Sciences" category published most of publications with 0.55 mean field citation ratio (FCR) and 0.31 mean relative citation ratio (RCR). The positive correlation value between citations and altmetric scores obtained was 0.88. It was also observed that the topmost article among the top 100 has a maximum RCR (8.24) and FCR (19.3). Conclusion: Present study found that articles published in MJAFI are getting favorable attention at both academic as well as social platform; however, the constant improvement and rigorous maintenance of standards is utmost important by publishing high-quality evidence-based studies and its subsequent dissemination at both academic and non-academic platform, which might be beneficial to not only medical field but also well-being of entire human race.

Management of skeletal Cl III malocclusion using simultaneous alternate rapid maxillary expansion and constriction (Alt-RAMEC) and facemask protraction in adolescence.

Cl III malocclusion with a significant skeletal component presents a therapeutic challenge during adolescence. This article presents the encouraging results of an individualized two-stage treatment approach adopted for successful nonsurgical correction of severe skeletal Cl III malocclusion in an adolescent girl after the onset of puberty. An orthopedic approach involving simultaneous alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol and protraction facemask (PFM) therapy was adopted in phase 1 to correct the sagittal skeletal discrepancy. In phase 2, fixed orthodontic therapy aided by the interim use of a modified occlusal settling appliance was undertaken to obtain well-interdigitated occlusion. Meticulously planned and well-executed orthopedic and orthodontic approach, combined with good patient compliance and favorable growth pattern, helped establish well-balanced facial harmony with a proper maxillomandibular relationship and satisfactory overjet and overbite. The results remained stable during the 4-year follow-up. Alt-RAMEC-PFM therapy accompanied by fixed mechanotherapy is a viable option to treat severe skeletal Cl III malocclusion in adolescents.

Comparative evaluation of duration of extraction space closure and degree of root resorption with conventional and self-Ligation brackets.

Introduction: Determination of difference between conventional and passive self-ligating brackets (SLBs) in respect of extraction space closure, patient perception and root resorption. Material and Methods: Eighty patients were divided into four groups of 20 each with age-sex-matched control using a simple randomisation technique and allocation concealment with a closed opaque envelope method. Group 1 consisted of conventional brackets with Connecticut New Archwire (CNA) wire mushroom loop, group 2 consisted of conventional brackets with TAD (AbsoAnchor, Korea) supported retraction, group 3 consisted of passive SLB with CNA archwires (Libral Traders, India) mushroom loop and group 4 consisted of passive SLB brackets with TAD (AbsoAnchor, Korea) supported retraction. The rate of retraction, root resorption and patient satisfaction were assessed. All conventional brackets (Orthox, USA) and passive SLBs (CaptainOrtho, India) had 0.018 Roth prescriptions with a slot size of 0.018 × 0.025. Results: Retraction was the fastest in group 2 with a mean of 1.266 ± 0.14 mm/4 week and a duration of 23.40 weeks. Similarly, group 4 showed the most sluggish movement with a mean of 1.182 ± 0.80 mm/4 weeks with a total duration of 25 weeks; howeverdifferencesce among groups were not statistically significant (P = 0.470). Conclusion: SLBs have advantage of better patient comfort, less pain and reduced chairside time. Though the present study found increased treatment duration with SLB along with friction mechanics, refuting the previous claims of reduced friction with SLBs, however, the difference was not statistically significant and results have to be extrapolated with caution and experience considering other advantages of SLBs.

Evaluation of pre- and post-treatment masticatory and bite force efficiency in patients undergoing fixed orthodontic treatment and orthognathic surgery using T-Scan Novus occlusal analysis: A factorial randomized controlled trial.

Introduction and Background: Orthodontic and orthognathic surgical treatment require quantified occlusion finish to rule out any temporomandibular disorders. Hence, the present study was proposed to analyze the occlusal efficiency in patients undergoing fixed orthodontic and combined orthodontic-orthognathic surgery using digital occlusal analysis. Methodology: A randomized multi-arm controlled trial was conducted on 55 patients divided into four groups, that is, group I: class I crowding/proclination required extraction for fixed orthodontic treatment, group II: class II div 1 required orthodontic treatment and/or myofunctional therapy, group III: skeletal class II required combined orthodontic and orthognathic surgical treatment, and group IV: skeletal class III required combined orthodontic and orthognathic surgical treatment. The pre-treatment, before debonding, and 1 year after debonding assessment of occlusion were carried out using T-Scan. The repeated analysis of variance (rANOVA) test along with post-hoc analysis was carried out for intra-group and inter-group assessments using SPSS (version 21, USA). The significance level was set at a 'P' value less than 0.05. Results: rANOVA measurement in groups I, II, and III showed a significant difference with respect to maximum bite force difference between right and left sides, anterior and posterior region, and left lateral disclusion time. However, group IV showed a significant difference with respect to maximum bite force in the anterior and posterior region as well as right and left lateral disclusion time only. Further application of the post-hoc Tukey test found a significant difference between the To value to T1 and T2 among all four groups. Conclusion: Improved bite force was found in all malocclusion groups which was gradual in improvement from pre-treatment to post-treatment and a subsequent retention phase. The study also reported the utility of digital occlusal assessment devices as reliable, repeatable, reproducible, and user-friendly in the determination of dynamic occlusion.

Aerosol generating procedural risks and concomitant mitigation strategies in orthodontics amid COVID-19 pandemic - An updated evidence-based review.

IMPORTANCE: The ongoing COVID-19 pandemic has posed unique challenges to orthodontic profession by adversely impacting provision of in-office orthodontic care due to prevailing uncertainty around risks pertaining to splatter and 'aerosol-generating procedures' (AGPs). This review aims to provide an insight into the prevailing and emerging evidence informing potential risks related to splatter and AGPs, and risk mitigation strategies employed for reducing the potential risk of SARS-CoV-2 transmission from dental bioaerosols. METHODS: PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, LILACS, WHO COVID-19 databases and preprint databases were searched for eligible English language publications. Citation chasing was undertaken up until the review date of 4 January 2021. Study selection, data extraction and risk of bias assessment was undertaken independently in duplicate, or else by consultation with a third author. RESULTS: Following filter application and duplicates removed, a total of 13 articles assessing procedural mitigation measures were included. Seven included studies revealed overall low-risk of bias. The overall risk varied from unclear to high for rest of the studies, with the most concerning domains being blinding of the participants and the personnel and blinding of the outcome assessors. Accumulated consensual evidence points towards the use of dental suction devices with wide bore aspirating tips as effective procedural mitigation strategies. Variations in the literature can be observed concerning aerosol transmission associated with water spray use during debonding. Emerging direct evidence consistently supports adjunctive use of pre-procedural povidone-iodine mouthrinse to mitigate direct transmission risk in the orthodontic practice. CONCLUSIONS: A thorough risk assessment concerning AGPs and implementation of consistent and evidence-based procedural mitigation strategies may play an indispensable role in navigating optimal orthodontic practice through unforeseen similar pandemic threats. High-quality robust research focussing on more biologically relevant models of dental bioaerosols in orthodontic settings is warranted.

Effects of maxillary expansion on hearing and voice function in non-cleft lip palate and cleft lip palate patients with transverse maxillary deficiency: a multicentric randomized controlled trial / Efeitos da expansão maxilar na função auditiva e vocal em pacientes sem fissura labiopalatina e com fissura labiopalatina e deficiência maxilar transversa: um estudo controlado multicêntrico e randomizado

Abstract Introduction The association between the treatment of transverse maxillary deficiency and the recovery of hearing and voice functions has gained attention in recent years. Objective This prospective controlled trial aimed to evaluate the effects of rapid maxillary expansion on hearing and voice function in children with non-cleft lip palate and bilateral cleft lip palate with transverse maxillary deficiency Methods 53 patients (26 non-cleft and 27 bilateral cleft lip palate; mean age, 11.1 ± 1.8 years) requiring rapid maxillary expansion for correction of narrow maxillary arches were recruited for this trial. Eight sub-groups were established based on the degree of hearing loss. Pure-tone audiometric and tympanometric records were taken for each subject at four different time periods. The first records were taken before rapid maxillary expansion (T0), the second after expansion (T1) (mean, 0.8 months), the third after three months (T2) (mean, 3 months) and the fourth at the end of retention period (T3) (mean, 6 months). ANOVA and Tukey HSD post-hoc tests were used for data analysis. Additionally, voice analysis was done using an updated PRAAT software program in a computerized speech lab at T0 and T2. A paired-samplet-test was used for comparisons of mean values of T0 and T2 voice parameters within both groups. Results Rapid maxillary expansion treatment produced a significant increase in the hearing levels and middle ear volumes of all non-cleft and bilateral cleft lip palate patients with normal hearing levels and with mild conductive hearing loss, during the T0-T1, T1-T2, T0-T2, and T0-T3 observation periods (p < 0.05). The significant increase was observed in right middle ear volumes during the T0-T1, T0-T2 and T0-T3 periods in non-cleft patients with moderate hearing loss. For voice analysis, significant differences were observed only between the T0 and T2 mean fundamental frequency (F0) and jitter percentage (p < 0.05) in the non-cleft group. In the cleft group, no significant differences were observed for any voice parameter between the T0 and T2 periods. Conclusion Correction of the palatal anatomy by rapid maxillary expansion therapy has a beneficial effect on both improvements in hearing and normal function of the middle ear in both non-cleft and bilateral cleft lip palate patients. Similarly, rapid maxillary expansion significantly influences voice quality in non-cleft patients, with no significant effect in BCLP patients.

Resumo Introdução A associação entre o tratamento da deficiência maxilar transversa e a recuperação das funções auditivas e vocais ganhou atenção nos últimos anos. Objetivo Avaliar os efeitos da expansão rápida da maxila na função auditiva e vocal em crianças sem fissura labiopalatina e com fissura labiopalatina bilateral com deficiência maxilar transversa. Método Foram recrutados para este estudo 53 pacientes (26 sem fissura e 27 com fissura labiopalatina bilateral; média de 11,1 ± 1,8 anos) que necessitam de expansão rápida da maxila para correção de arcos maxilares estreitos. Oito subgrupos foram estabelecidos com base no grau de perda auditiva. Registros audiométricos e timpanométricos de tons puros foram obtidos para cada indivíduo em quatro períodos. Os primeiros registros foram obtidos antes da expansão rápida da maxila (T0), o segundo após a expansão (T1) (média de 0,8 meses), o terceiro após três meses (T2) (média de 3 meses) e o quarto no fim do período de retenção (T3) (média de 6 meses). Anova e o teste post-hoc de Tukey HSD foram usados para análise dos dados. Além disso, a análise da voz foi feita com um programa PRAAT atualizado em um laboratório de fala computadorizadaem T0 e T2. Foi usado um teste t de amostras pareadas para comparação dos valores médios dos parâmetros de voz em T0 e T2 nos dois grupos. Resultados O tratamento com expansão rápida da maxila produziu um aumento significativo nos níveis auditivos e nos volumes da orelha média de todos os pacientes sem fissura e pacientes com fissura labiopalatina bilateral e níveis auditivos normais e com perda auditiva condutiva leve, durante os períodos de observação T0-T1, T1-T2, T0-T2 e T0-T3 (p < 0,05). Aumento significativo foi observado nos volumes da orelha média direita durante os períodos T0-T1, T0-T2 e T0-T3 em pacientes sem fissura e com perda auditiva moderada. Para a análise de voz, diferenças significantes foram observadas apenas entre a frequência fundamental média T0 e T2 (F0) e a porcentagem de jitter (p < 0,05) no grupo sem fissura. No grupo com fissura, não foram observadas diferenças significantes para nenhum parâmetro de voz entre os períodos T0 e T2. Conclusão A correção da anatomia palatal pela expansão rápida da maxila tem um efeito benéfico tanto na melhoria da audição quanto na função normal da orelha média em pacientes sem fissura e com fissura labiopalatina bilateral. Da mesma forma, a expansão rápida da maxila influencia significativamente a qualidade da voz em pacientes sem fissura, sem efeito significativo em pacientes com fissura labiopalatina bilateral.

Effects of maxillary expansion on hearing and voice function in non-cleft lip palate and cleft lip palate patients with transverse maxillary deficiency: a multicentric randomized controlled trial.

INTRODUCTION: The association between the treatment of transverse maxillary deficiency and the recovery of hearing and voice functions has gained attention in recent years. OBJECTIVE: This prospective controlled trial aimed to evaluate the effects of rapid maxillary expansion on hearing and voice function in children with non-cleft lip palate and bilateral cleft lip palate with transverse maxillary deficiency METHODS: 53 patients (26 non-cleft and 27 bilateral cleft lip palate; mean age, 11.1±1.8 years) requiring rapid maxillary expansion for correction of narrow maxillary arches were recruited for this trial. Eight sub-groups were established based on the degree of hearing loss. Pure-tone audiometric and tympanometric records were taken for each subject at four different time periods. The first records were taken before rapid maxillary expansion (T0), the second after expansion (T1) (mean, 0.8 months), the third after three months (T2) (mean, 3 months) and the fourth at the end of retention period (T3) (mean, 6 months). ANOVA and Tukey HSD post-hoc tests were used for data analysis. Additionally, voice analysis was done using an updated PRAAT software program in a computerized speech lab at T0 and T2. A paired-samplet-test was used for comparisons of mean values of T0 and T2 voice parameters within both groups. RESULTS: Rapid maxillary expansion treatment produced a significant increase in the hearing levels and middle ear volumes of all non-cleft and bilateral cleft lip palate patients with normal hearing levels and with mild conductive hearing loss, during the T0-T1, T1-T2, T0-T2, and T0-T3 observation periods (p<0.05). The significant increase was observed in right middle ear volumes during the T0-T1, T0-T2 and T0-T3 periods in non-cleft patients with moderate hearing loss. For voice analysis, significant differences were observed only between the T0 and T2 mean fundamental frequency (F0) and jitter percentage (p<0.05) in the non-cleft group. In the cleft group, no significant differences were observed for any voice parameter between the T0 and T2 periods. CONCLUSION: Correction of the palatal anatomy by rapid maxillary expansion therapy has a beneficial effect on both improvements in hearing and normal function of the middle ear in both non-cleft and bilateral cleft lip palate patients. Similarly, rapid maxillary expansion significantly influences voice quality in non-cleft patients, with no significant effect in BCLP patients.

A simplified de novo approach for vector control in facemask therapy.

One of the most common clinical challenges encountered with facemask therapy for early correction of skeletal Class III malocclusions is the delivery of appropriate direction of force for effecting the pure translation of maxilla. This technical note describes a novel method involving the use of Begg's auxiliary for achieving efficient and predictable delivery of protraction forces. With this modified assembly, effective vector control for facemask can be achieved without the need to remove the bonded Hyrax assembly. This chairside modification is an effective and invaluable method for predictable force delivery in facemask therapy.

Interim use of a maxillary lip bumper during interdisciplinary management of ectopically erupted incisor teeth.

INTRODUCTION: Ectopic eruption, manifesting as an aberration in the normal path of eruption of a tooth, can adversely impact facial aesthetics, phonetics and psychosocial development. DESCRIPTION: This case series describes the orthodontic management of two adolescent patients with different clinical presentations of ectopically erupted maxillary central incisors secondary to trauma during the primary dentition period. The therapy primarily included periodontal soft-tissue surgery accompanied by orthodontic traction to align the ectopic incisors. Frenectomy was performed in one patient and surgical excision of a hypertrophied pseudo-pouch in the second patient. A modified maxillary lip bumper was used concomitantly for management of associated soft-tissue trauma, thus facilitating healing and aiding orthodontic traction. RESULTS: Appropriately planned interdisciplinary management involving the interim use of a modified lip bumper allowed proper alignment of the ectopically positioned incisors with a stable outcome at three-year follow-up. CONCLUSION: Fixed orthodontic therapy with concurrent use of modified maxillary lip bumper is an effective approach to treat incisors erupted ectopically in relation to the upper lip and frenum.

Effects of Low-Intensity Pulsed Ultrasound Therapy on the Temporomandibular Joint Complex in Conjunction With a Fixed Functional Appliance: A Prospective 3-Dimensional Cone Beam Computed Tomographic Study.

OBJECTIVES: This prospective study aimed to analyze 3-dimensional changes in the temporomandibular joint (TMJ) complex with a synergistic effect of functional jaw orthopedics using a fixed functional appliance and low-intensity pulsed ultrasound (LIPUS) therapy. METHODS: Forty patients with skeletal class II malocclusion were randomly assigned to 4 groups (2 control groups and 2 test groups) of 10 patients each. After insertion of the fixed functional appliance, the test group was stimulated with LIPUS therapy in the TMJ region bilaterally for 20 minutes daily for first 10 days and thereafter at least 3 times per week until complete mandibular advancement was achieved. Three-dimensional images obtained with a cone beam computed tomographic scanner were used to analyze the changes in the TMJ complex at the prefunctional stage and after completion of functional appliance therapy. Direct intragroup and intergroup comparisons for different morphometric variables were conducted with the Student t test. RESULTS: The 40 patients included 20 male and 20 female patients between the ages of 12 and 16 years (mean age ± SD, 13.2 ± 1.8 years). Both the test groups and the control groups showed statistically significant variable changes in condylar head position and morphometric changes in relation to the joint space analysis (mean differences, -1.000 and -1.080 mm; P < .05). However, no significant differences were found during the intergroup comparisons at the prefunctional and postfunctional stages for the variables examined, except for the measurements of the linear distance of the condyle to the external auditory meatus on both the right and left sides at the prefunctional phase. CONCLUSIONS: Low-intensity pulsed ultrasound therapy positively affects the quantum of the joint space, thus proving to be a promising adjunct in enhancing treatment outcomes of functional jaw orthopedics in growing patients with skeletal class II malocclusions.

Skeletal Class III correction in permanent dentition using reverse twin block appliance and fixed mechanotherapy.

The orthodontic management of patients with Class III malocclusion poses numerous prognostic and treatment challenges to the clinician. Various removable, orthopaedic, myofunctional and fixed appliances have been recommended for the correction of Class III malocclusion. The Reverse Twin Block (RTB) is a simple and well tolerated appliance which has often been used for the early management of such cases in mixed dentition. Cases reporting use of RTB in permanent dentition are however, limited. This article presents an insight into the encouraging results of reverse twin block (RTB) appliance used in conjunction with fixed mechanotherapy for the successful treatment of a 12-year-old patient presenting with skeletal Class III malocclusion and a concave facial profile. The RTB appliance helped establish a favourable environment for unrestricted maxillary growth, at the same time redirecting the mandibular growth to a clockwise direction and correcting the incisal relationship. The favourable treatment outcome and long-term stability achieved substantiates the feasibility of RTB appliance in mild to moderate skeletal Class III malocclusions in permanent dentition cases.

Interdisciplinary management of an impacted dilacerated maxillary central incisor.

INTRODUCTION: Tooth dilacerations are dental anomalies characterized by an abrupt deviation in the longitudinal axis of a tooth. They may occur either in the crown, between the crown and root, or in the root. Although not so common, impacted maxillary incisors exhibiting root dilaceration pose a diagnostic and treatment challenge to the clinician. DESCRIPTION: This case report describes the management of a horizontally impacted and dilacerated maxillary central incisor in a 12-year-old girl. Cone-beam computed tomographic scans were used to accurately localize the position of the dilacerated tooth, and to assess the extent of root formation and degree of dilaceration present in the root. Treatment included surgical exposure and orthodontic traction, followed by root canal treatment and apicoectomy. RESULTS: Through a meticulously planned interdisciplinary approach, the impacted dilacerated central incisor was properly aligned and demonstrated good stability after the long-term follow-up. CONCLUSION: Taking into consideration the concerns and expectations of the patient, communicative feedback between the oral surgeon, orthodontist and endodontist helped achieving successful esthetic, structural and functional outcome in the present case.

Interdisciplinary management of an impacted dilacerated maxillary central incisor

ABSTRACT Introduction: Tooth dilacerations are dental anomalies characterized by an abrupt deviation in the longitudinal axis of a tooth. They may occur either in the crown, between the crown and root, or in the root. Although not so common, impacted maxillary incisors exhibiting root dilaceration pose a diagnostic and treatment challenge to the clinician. Description: This case report describes the management of a horizontally impacted and dilacerated maxillary central incisor in a 12-year-old girl. Cone-beam computed tomographic scans were used to accurately localize the position of the dilacerated tooth, and to assess the extent of root formation and degree of dilaceration present in the root. Treatment included surgical exposure and orthodontic traction, followed by root canal treatment and apicoectomy. Results: Through a meticulously planned interdisciplinary approach, the impacted dilacerated central incisor was properly aligned and demonstrated good stability after the long-term follow-up. Conclusion: Taking into consideration the concerns and expectations of the patient, communicative feedback between the oral surgeon, orthodontist and endodontist helped achieving successful esthetic, structural and functional outcome in the present case.

RESUMO Introdução: as dilacerações dentárias são anomalias caracterizadas por desvio acentuado no eixo longitudinal de um dente. Elas podem ocorrer na coroa, entre a coroa e a raiz, ou na raiz. Apesar de não serem muito comuns, os incisivos superiores impactados apresentando dilaceração radicular representam um desafio para o clínico, quanto ao diagnóstico e tratamento. Descrição: o presente relato de caso descreve o tratamento de um incisivo central superior impactado horizontalmente e com dilaceração, em uma menina com 12 anos de idade. Tomografias computadorizadas de feixe cônico foram utilizadas para localizar com precisão a posição do dente dilacerado e avaliar o grau de formação e de dilaceração da raiz. O tratamento incluiu exposição cirúrgica e tração ortodôntica, seguida de tratamento do canal radicular e apicectomia. Resultados: por meio de uma abordagem interdisciplinar meticulosamente planejada, o incisivo central impactado com dilaceração foi devidamente alinhado e demonstrou boa estabilidade em acompanhamento de longo prazo. Conclusão: levando-se em consideração as preocupações e expectativas da paciente, a comunicação interativa adotada entre o cirurgião oral, ortodontista e o endodontista ajudou na obtenção de resultados estéticos, estruturais e funcionais satisfatórios no presente caso.