A new system for classifying tooth, root and canal anomalies.

Understanding the normal anatomical features as well as the more unusual developmental anomalies of teeth, roots and root canals is essential for successful root canal treatment. In addition to various types of root canal configuration and accessory canal morphology, a wide range of developmental tooth, root and canal anomalies exists, including C-shaped canals, dens invaginatus, taurodontism, root fusion, dilacerations and palato-gingival grooves. There is a direct association between developmental anomalies and pulp and periradicular diseases that usually require a multidisciplinary treatment approach to achieve a successful outcome. A number of classifications have categorized tooth, root and canal anomalies; however, several important details are often missed making the classifications less than ideal and potentially confusing. Recently, a new coding system for classifying root, root canal and accessory canal morphology has been introduced. The purpose of this article is to introduce a new system for classifying tooth, root and canal anomalies for use in research, clinical practice and training, which can serve as complementary codes to the recently described system for classifying root, as well as main and accessory canal morphology.

Diferentes métodos biométricos para el diagnóstico de taurodontismo / Different biometric methods for the diagnosis of taurodontism

El taurodontismo es una anomalía del desarrollo que afecta a la morfología del tejido pulpar. Los dientes con esta alteración, presentan una amplia cámara pulpar en sentido ocluso-apical más allá de la unión amelocementaria. El objetivo de este artículo es describir de forma sintetizada y actualizada los métodos biométricos que pueden ser utilizados en el diagnóstico de taurodontismo en dentición permanente. Éstos nos permiten determinar no sólo la presencia de taurodontismo sino también el grado en el que esta alteración puede presentarse (hipertaurodontismo, mesotaurodontismo e hipotaurodontismo). A pesar de la evolución que han experimentado a lo largo del siglo pasado, la principal desventaja que presentan estas valoraciones métricas en la actualidad, es la dificultad para localizar los puntos de referencia de una forma reproducible sobre radiografías panorámicas (AU)

Taurodontism is a developmental anomaly that affects the morphology of the pulp tissue. The teeth with this alteration, present a large pulp chamber in occlusal-apical sense beyond the amelocementary union. The objective of this article is to describe in a synthesized and updated way the biometric methods that can be used in the diagnosis of taurodontism in permanent dentition. These allow us to determine not only the presence of taurodontism but also the degree to which this alteration can occur (hypertaurodontism, mesotaurodontism and hypotaurdontism). In spite of the evolution that they have undergone during the last century, the main disadvantage that present these metric valuations at present, is the difficulty to locate the points of reference of a reproducible form on panoramic radiographs (AU)

Dens invaginatus in a geminated maxillary lateral incisor.

Dens invaginatus (DI) and gemination are two developmental abnormalities that are well reported in the dental literature, but their coexistence in a single tooth is rare. Such situations worsen the risk factors associated with these anomalies, and the treatment plan should be customised as they possess altered morphology and anatomy. A 19-year-old girl came for evaluation of a cracked tooth in the front region of the upper jaw. The tooth showed clinical features of gemination and radiographic features of DI, and was diagnosed as DI in geminated maxillary lateral incisor. The differential diagnoses based on clinical appearance without radiographic investigation may warrant the treatment approach if these two abnormalities coexist in a single tooth. The report also highlights the importance of three-dimensional imaging in diagnosis and treatment planning of teeth with altered pulp canal anatomy. There are few reported cases in the literature detailing the treatment options for these two anomalies occurring in the same tooth.

Conservative treatment and follow-up of type III dens invaginatus using cone beam computed tomography.

Dens invaginatus is a well-recognized phenomenon, and its endodontic treatment poses a challenge, especially for peri-invagination lesions with vital pulp. Here we describe the outcome of conservative treatment and follow-up in a case of type III dens invaginatus. Cone-beam computed tomography was used for diagnosis and follow-up. Pulp vitality was preserved with endodontic treatment of only an invaginated canal. At the 24-month follow-up examination, the tooth was asymptomatic and repair of the lesion was evident radiographically. This case was managed successfully with endodontic treatment of the invagination. (J Oral Sci 56, 307-310, 2014).

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.

Dental abnormalities and preventive oral care in Schimke immuno-osseous dysplasia.

BACKGROUND: Schimke immuno-osseous dysplasia (SIOD) is a rare, severe, autosomal recessive disorder that results in spondyloepiphyseal dysplasia, renal dysfunction, immunodeficiency, facial dysmorphism and growth failure. Little is known about oral features associated with SIOD. Some of the dental anomalies encountered are specific to SIOD and have only been reported in individuals with SIOD. CASE REPORT: This paper describes the clinical and radiographic dental manifestations of SIOD in two Caucasian brothers. Both lived to be about 10 years old. After a variety of symptoms were reported, a diagnosis of SIOD was finally made when the brothers were, respectively, 5 and 8 years old. At that time, dental anomalies, such as dyschromia, bulbous crowns, short and thin roots, had not been taken into account to establish the diagnosis. However, knowledge of the dental features characteristic of this disease could have helped make the diagnosis. Although both were caries- and periodontal disease-free, special attention was focused on prevention, including dietary counselling, plaque control, oral hygiene instructions and the use of fluoridated toothpaste. FOLLOW-UP: The two patients were followed every 6 months, for over 2 years (until their death), by both a private dentist and a university hospital dentist, which helped them maintain good oral health. Oral hygiene was assessed at each appointment and fissure sealants were placed by the private practitioner on their first permanent molars. CONCLUSION: This report describes dental anomalies specific to SIOD that could facilitate diagnosis. Clinicians and dentists should work in collaboration to diagnose and treat children with SIOD. These patients require regular and specific dental management because of their fragile health and their characteristic dental anomalies. Ideally, preventive visits should be scheduled every 6 months in addition to curative visits as needed.

Management of dentinogenesis imperfecta: a review of two case reports.

Dentinogenesis imperfecta (DI) is an inherited disorder that affects dentin and often manifests as tooth discoloration; in addition, the dentition is also extremely susceptible to wear. Treatment of DI focuses primarily on protecting affected dentin, reducing sensitivity, and improving esthetics. Routine restorative materials, such as amalgams and composites, may be used. In more severe cases, the treatment of choice is full coverage crowns, while bonding of veneers may be used to improve the esthetics of the anterior teeth. This study presents two cases of Type II DI in the same family and the management of each case. Restorative management included amalgams, composite veneers, crowns, bridges, and overdentures.

Surgical resection technique of a fused supernumerary lateral incisor: a clinical report and review of the literature.

This case report presents the surgical and restorative management of a fused supernumerary left lateral incisor. The diagnosis was confirmed using conventional radiographs and CT. The case report discusses the value of CT for evaluation of the root relationships and describes the varied morphology associated with supernumerary incisors, the surgical resection technique, partial pulpotomy, and restoration with composite resin after mechanical exposure of the remaining tooth's pulp.

Regional odontodysplasia. A literature review and three case reports.

AIM: The purpose of this article is to report some unusual characteristics related to gender, location and manifestations of severe Regional Odontodysplasia detected in three subjects. Regional Odontodysplasia is a rare disturbance of dental development whose aetiology is still unknown. Anomalies involve enamel, dentin, pulp and dental follicle causing atypical structure, colour, shape, size and eruptive disturbances of the affected teeth. Its early onset may lead to craniofacial development disturbances. CASES REPORTS: This article reports three cases with unusual characteristics observed in male children who were assisted by a paediatric dentist. Generally the disease affects one hemiarch and it is very rare that it crosses the midline as in one of the presented cases. Regional Odontodysplasia has been predominantly described in the maxilla and in women, however these three cases are in boys and two of them occured in the mandible. CONCLUSION: Regional Odontodysplasia is a rare disease, causing severe dental, growing and craniofacial development anomalies. Treatment needs to be personalised, aiming at preservation of the affected teeth taking into account their risk to develop severe infections. Parents should be made aware of the need for an extensive follow-up.

Talon cusp in a primary incisor: a rare entity.

This case report describes the presence of a talon cusp in a right primary incisor in a 6-year-old girl. It is a rare entity with only three cases having been reported from the Indian population. The talon cusp showed presence of wear facets along with altered morphology of the involved tooth. No treatment was done apart from sealing the cusp-tooth interface with fissure sealant.

3-D imaging in post-traumatic malformation and eruptive disturbance in permanent incisors: a case report.

Injury to the primary dentition is one of the common problems of childhood. Disturbances during crown development of the permanent teeth result in morphologic alterations. This case report highlights the role of 3-D imaging when conventional dental radiographs are not enough to answer our clinical questions regarding future eruptive disturbances. 3-D imaging can many times give us a definitive diagnosis and improve the treatment planning after early injuries in the deciduous dentition. The current status of multislice computed tomography (CT) and cone beam CT (CBCT) as diagnostic tools in pediatric dental population is also discussed briefly.

Histological and immunohistochemical analyses of molar tooth germ in enamelin-deficient mouse.

Amelogenesis imperfecta (AI) is associated with mutations in a number of genes, including AMELX and ENAM. However, the precise mechanism leading to enamel malformation in different AI types remains to be elucidated. In the present study, we investigated morphological change in tooth germ obtained from ENAM-mutant mice (Enam(Rgsc521) homozygotes) as a model for human AI using histological and immunohistochemical methodologies. The results showed that ameloblasts detached from developing dentin and lost cell polarity in mutant mice at post-natal day 3. Cyst-like structures, including amelogenin-immunopositive materials, were observed between these detached cells and the dentin. No enamel-like structure, however, was observed in the cusp of the crown. These results suggest that enamelin acts as an adhesion molecule and is involved in ameloblast cell differentiation during the early stages of tooth development.

Disruptions of the pulp-dentin complex in an investigated case of pink secondary retained molar.

A pink retained left mandibular first molar without carious lesions was diagnosed in a healthy 12-year-old girl presenting normal clinical tests. An orthopantomogram failed to detect other retained teeth. Both periapical radiography and computed tomography showed the absence of a periodontal ligament space in the bifurcation area and the presence of radiolucency or calcifications in the pulp cavity. The coronal part of the removed tooth was subjected to histological and immunohistochemical analysis using anti-PCNA (proliferation marker) and anti-p53 (apoptosis marker) antibodies. Root surfaces were observed by scanning electron microscopy. The pink color of the molar reflected the extension of resorptive tissue into the clinical crown and the underlining proliferation of pulp vessels. Ankylosis observed in the bifurcation area was also detected in the coronal part of the pulp. Whereas odontoblasts secreted tertiary dentin despite no evidence for a carious lesion, only osteocytes in the newly formed bone were apoptotic and the root surfaces were free of resorption lacunae. The etiopathology of the lesion in this case indicated a pulp origin, suggesting that new therapies targeting this tissue should be developed.

Dens invaginatus: a qualitative-quantitative analysis. Case report of an upper second molar.

Dens invaginatus (D.I.) is a developmental anomaly caused by the infolding of the surface of a tooth crown before calcification has occurred. Its aetiology is controversial and remains unclear. It occurs in all dentitions with a prevalence that ranges from 0.25% to 7.74% and is mostly seen in the maxillary permanent incisors, particularly in the lateral incisors. Posterior teeth are infrequently involved. The purpose of this study was to investigate the morpho-structure of a second upper molar dens invaginatus compared with a control tooth. Ground and decalcified sections were prepared and histo-morphological evaluation of dental tissues was performed by using light microscopy, microradiography, and confocal laser scanning microscopy analysis (CLSM). The mechanical behaviour was tested by means of microhardness (HV) test. The results of our investigation showed structural anomalies of hard tissues, such as a difference in enamel prism diameter, in number and diameter of peripulpal dentinal tubules and in surface and diameter of cementocyte lacunae between D.I. and control tooth.

Tratamento pulpar indireto em molar decíduo com resina composta: importância do diagnóstico e acompanhamento de três anos / Indirect pulp treatment of primary molar with composite resin: diagnosis importance and three years follow-up

O tratamento pulpar indireto é uma alternativa conservadora viável para manutenção da integridade pulpar. Entre os materiais indicados para essa técnica destacam-se o hidróxido de cálcio, por sua ação bacteriostática e bactericida e o cimento de ionômero de vidro, por sua ação antimicrobiana, adesão à estrutura dentária e liberação de flúor. O sistema adesivo é mais uma alternativa para proteção do complexo dentino-pulpar, pois proporciona um bom selamento marginal na interface dente-restauração. O objetivo deste estudo foi avaliar clínica e radiograficamente o tratamento pulpar indireto em molar decíduo com sistema adesivo e resina composta, após observação da indicação clínica. Após três anos de acompanhamento observou-se sucesso clínico eradiográfico o que faz com que essa técnica seja indicada como uma alternativa conservadora de tratamento para lesões de cárie profundas.

Indirect pulp treatment is a viable conservative alternative for keeping the integrity of the pulp. Among the indicated materials for this technique, calcium hydroxide presents bacteriostatic and bactericide action, glass ionomer presents antimicrobial capacity, adhesion dental structure and fluorid release. The adhesive system is another alternative to protect the dentin-pulp complex therefore it provides good marginal seal at the interface tooth-restoration. The aim of this study was to evaluate clinic and radiographic indirect pulp treatment in deciduous teeth with adhesive system and composite resin. After three years of surviving, the results shows clinic and radiographic success, what makes this technique indicated for a conservative alternative treatment.

Dentinogenesis imperfecta: a review and case report of a family over four generations.

Dentinogenesis imperfecta (DGI) is one of the most common hereditary disorders of dentin formation. It follows an autosomal dominant pattern of transmission, affecting both the formation and mineralization of dentin. Either or both primary and permanent dentition is affected by it. This paper briefly reviews the manifestations of DGI Type II (DGI1) and presents a case report of a family affected with DGI1 over four generations.

A dentin sialophosphoprotein mutation that partially disrupts a splice acceptor site causes type II dentin dysplasia.

The dentin sialophosphoprotein (DSPP) gene on chromosome 4q21.3 encodes the major noncollagenous protein in tooth dentin. DSPP mutations are the principal cause of dentin dysplasia type II, dentinogenesis imperfecta type II, and dentinogenesis imperfecta type III. We have identified a DSPP splice junction mutation (IVS2-6T>G) in a family with dentin dysplasia type II. The primary dentition is discolored brown with severe attrition. The mildly discolored permanent dentition has thistle-shaped pulp chambers, pulp stones, and eventual pulp obliteration. The mutation is in the sixth nucleotide from the end of intron 2, perfectly segregates with the disease phenotype, and is absent in 200 normal control chromosomes. An in vitro splicing assay shows that pre-mRNA splicing of the mutant allele generates wild-type mRNA and mRNA lacking exon 3 in approximately equal amounts. Skipping exon 3 might interfere with signal peptide cleavage, causing endoplasmic reticulum stress, and also reduce DSPP secretion, leading to haploinsufficiency.

Combined endodontic and surgical management of a mandibular lateral incisor with a rare type of dens invaginatus.

Dens invaginatus is a developmental malformation of teeth that most commonly affects permanent maxillary lateral incisors. Presence of dens invaginatus in mandibular permanent teeth is relatively rare. The purpose of this report is to describe the combined nonsurgical and surgical management of a mandibular lateral incisor associated with a rare type of dens invaginatus. Pulp involvement of the malformed tooth, periapical abscess, and severe periodontal destruction were observed. The signs (sinus tracts) and symptoms ceased after completion of the treatment. Satisfactory healing of the periradicular lesion was observed at the 6-month and 2-year follow-up examinations.

Survey of talon cusps in the permanent dentition of a Turkish population.

AIM: Talon cusp is the name given to the accessory tubercles located on the lingual faces of anterior teeth. The occurrence of talon cusps has been reported among Europeans and Asians. However, there are few reports of this anomaly in Caucasians as well as a paucity of literature on its characteristics. Today there are seven million Turkish citizens of Caucasian origin that have settled in the Marmara, Central-Anatolia, East-Anatolia, and Black Sea regions of Turkey. The aim of this study is to present 27 Caucasian cases with 33 taloned teeth. This study is the first that was undertaken to investigate the characteristics of talon cusps in a group of Turkish people. METHODS AND MATERIALS: A survey of 27 patients examined in the Department of Oral Diagnosis and Radiology at Ondokuz Mayis University in Samsun, Turkey between January, 2003 and June, 2006 was conducted. Their ages ranged from seven to 33 years. A total of 33 talon cusps were diagnosed in the 27 patients. The patients' records and radiographs were evaluated and the following variables were studied: age, sex distribution, affected tooth, type of talon cusp, radiographic evidence of pulp extension, and associated dental anomalies and complications. RESULTS: There were 13 male and 14 female patients with a gender ratio of approximately 1:1. Ten of 33 talon cusps (30%) were seen in maxillary right central incisors while four cases (12%) were in maxillary left central incisors and nine cases (27%) were in maxillary right lateral incisors. Eight cases (24%) were seen in maxillary left lateral incisors, one case (3%) was in a mandibular right central incisor, and one case (3%) was in a mandibular left canine. Fifteen (15) of the 33 talon cusps were Type 1 talons (45%), while eight cases (24%) were Type 2 talons and ten cases (30%) were Type 3 talons. Twelve of the 33 talon cusps (36%) showed radiographic evidence of pulpal extension into the tubercule on periapical radiographs. One patient had gemination (3%) on the maxillary permanent incisors and two patients had mesiodens (6%) in the maxillary anterior region. CONCLUSION: The talon cusp remains as one of the more uncommon dental anomalies worldwide and in Turkey and presents with different clinical features. CLINICAL SIGNIFICANCE: The talon cusp may be more likely to be associated with other odontogenic anomalies and some systemic conditions; early recognition of this anomaly is essential to provide proper treatment.

Dens invaginatus. Part 1: classification, prevalence and aetiology.

AIM: To review and discuss the aetiology, prevalence and classification of this dental anomaly together with the morphology of an invagination and the most appropriate nomenclature. SUMMARY: This review considers the different possible nomenclatures and concludes that dens invaginatus is the most appropriate description. The paper highlights the different reported prevalence figures and concludes that the problem is probably one of the most common of the dental developmental abnormalities with maxillary lateral incisors most commonly affected. The paper suggests that the classification system described by Oehlers (1957a) is probably the most clinically relevant and that the morphological features associated with this problem may increase the risk of pulpal pathology developing and complicate any possible endodontic treatment. KEY LEARNING POINTS: * The aetiology of dens invaginatus is still unknown, although there is some evidence that it may be genetic in origin. * The problem is probably more prevalent than most clinicians are aware of and this is because of the diagnostic difficulties associated with the anomaly. * The nature of the problem may increase the risk of pulp disease and complicate any root canal treatment.