Cervical enamel projections from a periodontal perspective: A scoping review.

Cervical enamel projections (CEPs) represent a unique developmental and anatomical anomaly wherein the enamel structure extends apically beyond the cemento-enamel junction of the tooth. In this scoping review, the existing literature on CEPs was evaluated to delineate their characteristics, prevalence, predilection for specific teeth and surfaces, clinical significance, and management approaches. Searches were conducted on MEDLINE (PubMed), Cochrane Library, and Embase databases using the keywords "enamel projection(s)" or "ectopic enamel." In total, 24 studies meeting inclusion criteria were included in the review. The prevalence of CEPs varied widely (8.3%-85.1%), predominantly manifesting as grade I or grade III. Mandibular first and second molars exhibited a higher incidence of CEPs, with a notable predilection for buccal surfaces. The consensus in most studies was that CEPs are associated with localized periodontal diseases. Recommendations inclined toward the removal of ectopic enamel during periodontal surgery to enhance periodontal attachment formation. However, decision-making should involve careful consideration of the benefits and drawbacks based on individual circumstances.

Endodontic treatment of a taurodontic premolar with five canals.

Taurodontism is a morpho-anatomical abnormality in the shape of a tooth. An enlarged pulp chamber, apical displacement of the pulpal floor and no constriction at the level of the cemento-enamel junction are the characteristic features. Special care is required in all aspects of endodontic treatment of a taurodontal tooth, including identifying the orifice, canal exploration, cleaning, shaping and obturation of the root canal. This case report describes the successful endodontic treatment of a taurodontic mandibular second premolar with five root canals.

Cervical enamel projections and associated pouch-like opening in mandibular furcations.

BACKGROUND: Cervical enamel projections (CEPs) have been listed among the tooth-associated risk factors that could lead to isolated furcation defects around molar teeth. This is more likely when Grade III CEPs are present. However, the histologic aspects of the CEP interface with regard to the presence or absence of cementum over the enamel projection within the furcation have not been well described. This study was initially undertaken to evaluate this relationship. METHODS: Thirty-five mandibular molars with Grade III CEPs were selected from a collection of extracted teeth and evaluated for the presence of cementum covering these areas by stereomicroscopy, light microscopy, and scanning electron microscopy (SEM). RESULTS: Sixteen of the 35 teeth (45.7%) with Grade III CEPs appeared completely covered by cementum. SEM evaluation showed the presence of a narrow pouch-like opening between cementum and enamel in 15 of 16 teeth (93.8%). Light microscopy evaluation confirmed the presence of the pouch along with some indication of residual degenerated mesenchymal tissue within the defects. SEM evaluation showed the presence of globular bodies in this pouch. CONCLUSIONS: This study reports on the presence of a pouch-like opening between the enamel and cementum in mandibular molars with Grade III CEPs. The clinical significance of these cementum pouches has yet to be determined but bacterial contamination of these pouch-like structures in areas of furcation periodontal breakdown may serve as a nidus for recolonization and disease recurrence or for the development of furcation caries if exposed to the oral cavity after surgical procedures.

A rare case of dens evaginatus and dens invaginatus in the same tooth, with a review of treatment options.

Dens evaginatus (DE) and dens invaginatus (DI) are rare developmental anomalies of tooth formation. These variations in odontogenesis have been individually observed and reported in the literature. This report describes the radiographic appearance and management of a 16-year-old boy who came to the clinic with a rare occurrence of both DE and DI in the same tooth and examines the criteria used in identifying and classifying such anomalies. This report also discusses the importance of early identification and efficient management of dental anomalies, which can prevent irreversible pulpal pathology that requires endodontic therapy or tooth loss.

The anatomy of two-rooted mandibular canines determined using micro-computed tomography.

AIM: To investigate the internal and external anatomy of extracted human mandibular canines with two roots and two distinct canals using micro-computed tomography (µCT). METHODOLOGY: Fourteen two-rooted human mandibular canines were scanned using a high-resolution µCT system (SkyScan 1174v2; SkyScan N.V., Kontich, Belgium). The images were processed to evaluate the size of the roots, the furcation regions, the presence of accessory canals, the mean distances between several anatomical landmarks, the position of the apical foramina, the direction of root curvatures, the cross-sectional appearances (SMI index), the volume and surface areas of the root canals. RESULTS: Root bifurcation was located in both apical (44%, n = 6) and middle (58%, n = 8) thirds of the root. The size of the buccal and lingual roots was similar in 29% of the sample. From a buccal view, no curvature towards the lingual or buccal direction occurred in either roots. From a proximal view, no straight lingual root occurred. In both views, S-shaped roots were found in 21% of the specimens. Location of the apical foramen varied considerably, tending to the mesio-buccal aspect of both roots. Lateral and furcation canals were observed mostly in the cervical third in 29% and 65% of the sample, respectively. The structure model index (SMI) index ranged from 1.87 to 3.86, with a mean value of 2.93 ± 0.46. Mean volume and area of the root canals were 11.52 ± 3.44 mm(3) and 71.16 ± 11.83 mm(2), respectively. CONCLUSIONS: The evaluation of two-rooted mandibular canines revealed that bifurcations occurred in the apical and middle third. S-shaped roots were found in 21% of the specimens. Mean volume, surface area and SMI index of the root canals were 11.52 mm(3), 71.16 mm(2) and 2.93, respectively.

Cervical enamel projections in unusual locations: a case report and mini-review.

BACKGROUND: Periodontitis is primarily a bacteria-induced disease that can be modified by tooth-related local factors. Cervical enamel projections (CEPs) are a common tooth anomaly that can act as contributing factors in the development of periodontitis. They are most commonly found at the buccal surfaces of mandibular molars. METHODS: A 57-year-old female was referred to our clinic for treatment of chronic periodontitis. A clinical examination revealed moderate attachment loss that was localized to the palatal side of the maxillary second molars. The rest of the dentition was less affected, with a diagnosis of generalized slight chronic periodontitis. An initial non-surgical periodontal treatment was provided followed by apically positioned flap surgery in the maxillary right and left posterior areas. At the time of surgery, CEPs were found where the periodontium was most affected. RESULTS: Because surgical intervention exposed the CEPs, they were not removed. After the active therapy, which resulted in inflammation resolution and maintainable probing depths, the patient was placed on a 3-month recall for periodontal maintenance. CONCLUSIONS: CEPs were found in an unusual location on the palatal roots of maxillary second molars. The findings of this case report confirm the role of CEPs as a local contributing factor in localized chronic periodontitis.

Oral features in Apert syndrome: a histological investigation.

OBJECTIVES: The number of publications on the oral features in Apert syndrome is limited. The present study investigated dental tissues in Apert syndrome histologically, to determine the nature and extent of anomalies, to provide some insight into the nature of the condition, and to explain how observed anomalies may affect the dental management of individuals with Apert syndrome. SETTING AND SAMPLE POPULATION: Extracted primary and secondary teeth were collected from patients with Apert who had attended the Australian Craniofacial Unit, Adelaide, South Australia. The total study sample comprised 13 individuals, aged from 14 to 21 , with nine men and four women. MATERIAL AND METHODS: A total of 40 teeth were available for histological examination (the number belonging to each individual varied from 2 to 5 per patient). The teeth were sectioned longitudinally, and one-half of each tooth underwent decalcification. Sections were stained with H&E for routine histological examination. Ground sections were prepared from undecalcified tooth halves. RESULTS: Histological assessment of the dental hard tissues revealed an intact enamel and dentinal structure but some irregularities were noted in the region of the dentino-enamel junction (DEJ), which could affect caries progression and also make dental management more difficult. CONCLUSION: This study identified histological anomalies of the DEJ of Apert syndrome teeth. An improved appreciation of the nature and extent of dental anomalies in Apert syndrome should assist clinicians when undertaking management of affected individuals.

Regional distribution of interglobular dentine in human teeth.

Interglobular dentine (IGD) is an area of poorly mineralized dentine matrix. It has been reported that there is an association between the retraction of odontoblast processes (OP) and the formation of IGD. A variation of the extent of OP has been described depending on the region of the tooth and age. This study aimed to find out the regional distribution of IGD in human teeth to observe any association between the extent of OP and the pattern of distribution of IGD. Ground sections were prepared from 52 extracted permanent teeth and the presence of IGD was observed in different regions of the crown and the root. The highest occurrence of IGD was found in the cervical and middle thirds followed by intercuspal, and coronal third in the crown. Statistical analysis of data depicted that the occurrence of IGD differed according to the region of the tooth. In roots, the highest occurrence of IGD was seen in the cervical third followed by the middle third. Previous reports have shown that OP extend up to the dentine-enamel junction in the coronal region and to the inner one-third of the cervical region. The varied pattern of distribution of IGD in the crown and root observed in our results corresponds to the above findings. Therefore, it is reasonable to surmise that there is an association between the distribution of IGD and the extent of OP. This allows us to confer that IGD tends to form in areas where OP do not extend to the dentine-enamel junction.

Semi talon and trace talon: report of two cases.

BACKGROUND: Talon cusp is a relatively rare developmental anomaly characterised by the presence of an accessory cusp-like structure projecting from the cingulum area or cemento-enamel junction of the maxillary or mandibular anterior teeth in both the primary and permanent dentition. It is frequently seen in the permanent laterals. CASE REPORT: The paper presents two cases of talon cusp of semi talon and trace talon type.

Dens invaginatus and talon cusp co-occurring in a mandibular central incisor: a case report.

Talon cusp and dens invaginatus are tooth shape anomalies that rarely affect mandibular teeth. Their co-occurrence in a single tooth is uncommon. The purpose of this report was to present a rare case of both talon cusp and dens invaginatus in a permanent mandibular central incisor. The diagnosis of dens invaginatus was made from routine radiographs taken to investigate a possible pulpal extension within the taloned cusp. Since the invagination did not communicate with the oral cavity, no treatment was indicated. The talon cusp was slightly grinded and smoothened to eliminate tongue irritation.

Talon cusp: an overview with case reports of 3 clinical variants.

Talon cusp is a dental anomaly, which is present as an accessory cusp and is seen both in the deciduous and permanent dentition. It may occur unilaterally or bilaterally and has been reported mostly in maxillary teeth, with a few cases occurring in the mandible. Talon cusp is usually asymptomatic; however, there are many clinical problems associated with it. Talon cusp is clinically manifested in three forms: talon, semi-talon and trace talon. In this article, we present four case reports of talon cusp with an overview of different clinical variants of talon cusp, classification, etiopathogenesis, associated syndromes, clinical problems, and treatment modalities.

Implication of cervical enamel projection to furcation involvement in molars. A pilot clinical study.

The aim of this study was to investigate the correlation of cervical enamel projection (CEP) with furcation involvement (FI) and compare the healing response of molars with or without CEP after surgery. A total of 30 patients contributing 78 maxillary and mandibular first or second molars were included. Plaque Index (PII), Gingival Index (GI), probing pocket depth (PPD) and probing attachment level (PAL) were measured before surgery and 1 and 3 or 6 months postoperatively. During surgery, CEPs were identified and classified with a modified grading system from Masters & Hoskins (24). FI was measured horizontally from the buccal aspect into the furcation with a graduated probe to the nearest mm. Any measurement > or = 1 mm was considered as FI. CEPs were found in 33 molars (42%). Grade III CEPs were found in 14 teeth, Grade IIIb in 4 teeth, Grade II in 1 tooth and Grade I in 14 teeth. The results showed no significant correlation of CEP with FI. Nor was CEP significantly affecting the PPD and PAL 3 or 6 months after surgery. However, FI was a significant factor in the further loss of PAL after surgery. Further studies, involving larger sample size may be necessary in order to give more conclusive results.

Dens evaginatus of anterior teeth (talon cusp): report of five cases.

The talon cusp, or dens evaginatus of anterior teeth, is a relatively rare dental developmental anomaly characterized by the presence of an accessory cusplike structure projecting from the cingulum area or cementoenamel junction. This occurs in either maxillary or mandibular anterior teeth in both the primary and permanent dentition. This article reports five cases of talon cusp, two of them bilateral, affecting permanent maxillary central and lateral incisors and canines that caused clinical problems related to caries or occlusal interferences.

Bilateral talon cusp: case report.

Talon cusp is an uncommon condition often present in the maxillary incisors and mandibular premolars. Morphologically, this anomaly has a well-delineated cusp that extends at least half the distance from the cementoenamel junction or cingulum area to the incisal edge. The alteration can cause clinical problems such as caries or occlusal interference. Management of the talon cusp varies according to the circumstances of the individual case and should be as conservative as possible. Presented is a case of bilateral bifid talon cusp in maxillary central incisors that was successfully managed with conservative therapy.

Localised enamel hypoplasia of human deciduous canines: genotype or environment?

A discrete area of defective enamel formation that appears on the labial surface of the crowns of deciduous canine teeth has been described in both recent and prehistoric human populations, with reported frequencies varying from 1 to 45 per cent. Suggestions about the aetiology of this localized hypoplasia range from genotypic factors to environmental conditions and systemic effects. The major aims of this study were to describe the frequency of occurrence and pattern of expression of the lesion in Australian Aboriginal and Caucasian ethnic groups, and to clarify the role of genetic factors by examining a sample of twins. The study sample consisted of dental casts of 181 pairs of Australian Caucasian twins, 215 Aborigines and 122 Caucasian singletons, together with 253 extracted deciduous canines. Examination of dental casts and extracted teeth was undertaken under 2x magnification with emphasis being placed upon location and expression of the lesion. The defect was observed in 49 per cent of twins and 44 per cent of Aborigines, but only 36 per cent of singletons. The percentages of affected teeth in each group were: 18 per cent in twins, 17 per cent in Aborigines and 13 per cent in Caucasians. A significant proportion of the defects occurred on the mesial aspect of the labial surface, in the middle area incisocervically, with the majority in the lower jaw. A number of significant differences in frequency were observed between groups, sexes, arches and sides. The results confirm some of the findings of previous studies, but also suggest that none of environmental, genetic or systemic factors can be ruled out as being involved in aetiology of the defect. The higher incidence of the lesion occurring on the mesial aspect of the labial surface is suggestive of physical trauma. Also, the vulnerability of the prominent developing mandibular canine, with its thin or missing labial covering of bone, would be expected to lead to higher prevalence of the lesion in the lower jaw. Although not definitive, the results of concordance analyses in twins were suggestive of a possible genetic predisposition in the formation of the lesion. Further research with a greater clinical orientation and emphasis on determining specific aetiological factors within any given environment in different ethnic groups may provide better insight into the ambiguous aetiology of the hypoplastic enamel defect.

Enamel pearls and cervical enamel projections on 2 maxillary molars with localized periodontal disease: case report and histologic study.

Presented here is an unusual case of teeth with aberrant enamel. One small and 3 large enamel pearls were identified in 2 maxillary third molars of a patient. One long enamel projection was connected to one of the large enamel pearls, along with 2 short cervical enamel projections. The ectopic enamel was associated with advanced localized periodontal destruction. After extraction, the molars were investigated radiographically and under the scanning electron microscope. The 3 large pearls contained distinct dentinal cones. The enamel of the pearls and the long cervical projection exhibited most of the structural attributes of crown enamel but were somewhat irregular, with variable shape and course of the prisms. Morphologic considerations suggest that these enamel pearls were aberrations and should not be regarded as attempts at new cusp or new tooth formation.

Cervical enamel projection and intermediate bifurcational ridge correlated with molar furcation involvements.

In this study, we investigated the cervical enamel projection (CEP) and intermediate bifurcational ridge (IBR) correlated with localized molar furcation involvement (FI). Study samples consisting of 87 hopeless permanent mandibulars (56 first and 31 second molars), which required extraction for periodontal therapy, were randomly collected from the School's Dental Clinic. The furcal defects, CEPs, and IBRs of molars were diagnosed via clinical probing, periapical radiographs, and inspection of ground tooth sections of extracted teeth with a stereomicroscope. Prevalence and distribution of molars with CEPs and/or IBRs were also analyzed. Probing depths (PD), clinical attachment loss (CAL), gingival index (GI), and plaque index (PLI) were measured for the buccal and lingual surfaces of molar furcal areas. Moreover, the relationships between the molar FI with and without CEPs and IBRs and periodontal status were analyzed using Student's paired t-test. Based on those results, we can conclude the following: 1) among 87 molars with FIs examined, 63.2% (55/87) had cervical enamel projections and bifurcational ridges, and the prevalence was greatest in mandibular first (67.9%, 38/56) and second (54.8%, 17/31) molars; and 2) the differences in mean PD, CAL, PLI, and GI between the molars with and without CEPs and IBRs were highly significant (P < 0.001) in the mandibular first and second molars.

The relationship between cervical enamel projection and class II furcation defects in humans.

The purposes of the present study were to examine the frequency of cervical enamel projection in mandibular molars with class II furcation defects and to examine the response of these teeth to guided tissue regeneration procedures. Probing depth and vertical and horizontal periodontal attachment levels were recorded with a constant-force electronic periodontal probe. Following surgical exposure of the bifurcation and prior to membrane placement, the cervical enamel projection was examined and then graded clinically; photographs were taken to allow further examination of the bifurcation. An overall improvement in clinical parameters was observed in most sites. Cervical enamel projection was present in 82.1% of all molars examined. Grade II was the most prevalent (34.8%). Patients with any degree of cervical enamel projection demonstrated significantly higher mean probing depths at baseline than did patients without cervical enamel projection. Likewise, pretreatment probing attachment levels were higher in patients with some degree of cervical enamel projection. However, greater posttreatment horizontal and vertical attachment gains were observed in sites with a baseline cervical enamel projection.

Cervical enamel projection related to furcation involvement.

Reviewing the literature the authors show the importance of cervical enamel projections (CEP) in the involvement of molar furcation. The dento-gingival relationship of CEP structure is peculiar for not having connective attachment but only long junctional epithelium. In numerous studies, most mandibular and maxillary molars presented CEP, mainly of little extension, with an incidence ranging from 8.8 to 87.4%. The studies showed a relationship between cervical enamel projection and the presence of inflammatory periodontal disease, and furcation involvement of molars. These data suggest that a detailed clinical trial must be carried out as well as early diagnosis of periodontal disease at the region of furcation.