Long-term prognosis after decoronation of avulsed teeth with replacement resorption: a report of three cases.

The complications of replacement resorption following tooth injury in growing children include infrapositioning of the tooth, tilting of the adjacent teeth, and alveolar ridge deformity. Decoronation is a conservative treatment method that facilitates bone preservation. The current case report focuses on the long-term preservation of alveolar ridge dimension following decoronation in three patients. Decoronation was performed prior to occurrence of the pubertal growth spurt, and the patients' ridge width and vertical apposition were monitored for at least 4 years. Timely intervention and regular monitoring are essential for maximization of the benefits of decoronation, a simple procedure that preserves esthetics and minimizes the need for further treatments. The importance of space management for prosthetic treatment has also been highlighted. The findings of this study show that infrapositioned teeth in growing children can be treated successfully using decoronation.

Factors associated with the survival of primary maxillary anterior teeth after intrusive luxation: a retrospective longitudinal study.

PURPOSE: To evaluate the survival rate of primary maxillary anterior teeth following intrusive luxation and identify associated factors. METHODS: A retrospective longitudinal study was conducted at a primary dental trauma centre using 88 dental records of children with intrusive luxation between 2007 and 2018. The variables of interest were time the tooth remained in the alveolus, degree of intrusion, accentuated overjet, lip protection, visible plaque, compromised germ of the permanent successor, clinical signs of infectious and inflammatory processes, endodontic treatment, pulp canal obliteration, sex, age at the time of trauma, family income, mother's schooling, and immediate care. Descriptive, bivariate, and Cox regression analyses were performed (p < 0.05; 95% CI). RESULTS: The 88 dental records of children with intrusive luxation included 128 teeth. Survival rate throughout the follow-up period was 65.6% (n = 84). Age older than three years and eight months (HR 2.28; 95% CI 1.04-4.99; p = 0.039), the development of an infectious process (HR 3.51; 95% CI 1.39-8.86; p = 0.008), development of an inflammatory process (HR 2.35; 95% CI 1.17-4.71; p = 0.016) and compromised germ of the permanent successor (HR 4.38; 95% CI 1.99-9.61; p < 0.001) were associated with a lower survival rate of intruded primary maxillary anterior teeth. CONCLUSION: The survival rate during the follow-up period of intruded primary maxillary anterior teeth was considered high. A significantly lower survival rate was associated with age, the occurrence of an infectious process and inflammatory process, and the compromised germ of the permanent successor.

Is it necessary to remove bone-impacted teeth? A retrospective study.

BACKGROUND: In clinical practice, it is risky to extract bone-impacted teeth and they're prone to a variety of complications, such as pathological fracture, adjacent tooth fracture, maxillary sinus perforation, and so on, making it difficult for clinicians to decide whether to extract them. PURPOSE: In order to illustrate our opinions on the possibility of extracting full third molars (M3), 360 examples of complete third molars were analyzed in this study. MATERIALS AND METHOD: We investigated 2189 patients, and 261 of them provided CBCT images of 360 teeth. assessing the degree of second molar(M2) root absorption in connection to age, impacted relationship, contact part, calculating the odds ratio (OR) and 95% confidence interval using the Logistic regression analysis equation. RESULT: Bone-impacted M3 occurred in 11.92% (261/2189) of patients with "impacted teeth" diagnoses. There was a significant difference between the occurrence of M2ERR and the contact parts (P value<0.001), and only the type of vertical impaction differed significantly from Level 3 (P < 0.05). CONCLUSIONS: 1) M3 should be removed if root resorption has not occurred in M2. 2) Root resorption is more likely to occur when M3 crown and M2 apical contact. 3) Enough experience, precise preoperative assessment can reduce the dangers to a minimum.

Management of transverse root fractures in dental trauma.

The management of complex dental trauma can be modulated according to the emergencies that may arise over time. Clinical management of transverse root fractures may require different therapies based on situations, such as delay and error in the treatment of an avulsion trauma associated with apical third root fracture, patient's poor compliance, or external and internal root resorption. The primary aim of this article was to review studies regarding root fractures in the permanent dentition and root fracture management. The secondary aim was to present the inflammatory reaction and the complications (i.e., infections) that may occur if the International Association for Dental Traumatology (IADT) guidelines are not followed. In addition, a scenario is devised in which endodontic surgery, despite the baseline patient's conditions and negative prognosis, can help to inhibit the inflammatory root resorption and allow the preservation of soft and hard tissues within a long follow-up from the injury, for the purpose of demonstrating the next possible implant-prosthetic rehabilitation.

The diagnostic value of orthopantomograms in detecting resorption of lateral incisors associated with ectopic canines: a CBCT study.

OBJECTIVE: To examine the diagnostic value of orthopantomograms (OPG) in the identification of root resorption of lateral incisors, secondary to an impacted canine, as confirmed by a cone-beam computed tomography (CBCT) scan. DESIGN: Retrospective observational cohort study. SETTING: South Wales secondary care setting: Royal Gwent Hospital, Newport and Nevill Hall Hospital, Abergavenny. METHODS: A total of 40 consecutive patients with impacted canines between January 2018 and December 2019 were selected. For each patient, one consultant orthodontist examined the OPG in isolation to detect the presence and extent of resorption of lateral incisors. The CBCT report was then studied to confirm the presence and extent of pathology. Sensitivity, specificity, accuracy, positive predictive values and negative predictive values were calculated. RESULTS: In total, 19 maxillary right canines, 18 maxillary left canines, one mandibular right canine and two mandibular left canines were examined. Impactions were more prevalent in the maxilla (92.5%) with higher predilection towards female patients (65%). There was higher prevalence of root resorption in the maxillary right quadrant (57.1%), in concordance with other studies. OPGs were found to have a sensitivity of 81.0% and a specificity of 10.5%, with an accuracy value of 47.5%. Positive and negative predictive values were found to be 50.0% and 33.3%, respectively. The extent of root resorption was incorrectly estimated from the OPG in 84% of cases. Correct estimation occurred in 16% of cases, with overestimation and underestimation occurring in equal proportion (42%). CONCLUSION: This study demonstrates the limitations of plain film radiographs and the merits of using CBCT in the accurate diagnosis of resorption of lateral incisors with an associated impacted canine. It also gives an indication into the location prevalence of resorption in a small cohort of patients. This preliminary study establishes the basis for future, larger-scale studies where outcomes can be generalisable at a population level.

A case of Invasive Cervical Root Resorption in a 12 y.o. female patient.

Invasive Cervical Root Resorption (ICRR) has a poor known aetiology, compared with typical external root resorption it appears very aggressive, posing a high risk of tooth loss. ICCR is often misdiagnosed, the resorption is caused by cells of the peridontium penetrating the outer surface of the root in the cervical region, spreading out throughout the root dentin. ICCR is usually detected in the adulthood on permanent teeth, anyway in a small amount of cases is possible to observe ICCR on impacted permanent canines during the adolescence and first adulthood.The aim of this paper is to present our experience with a ICCR case occurred in a young woman previously treated for an impacted canine with orthodontic therapy.

Influence of maxillary canine impaction characteristics and factors associated with orthodontic treatment on the duration of active orthodontic traction.

INTRODUCTION: Orthodontic traction of a maxillary impacted canine (MIC) increases the orthodontic treatment time. Therefore, the objective of this study was to evaluate the influence of MIC characteristics and factors associated with orthodontic treatment on the duration of active orthodontic traction. METHODS: This follow-up and retrospective study included 45 MICs orthodontically tractioned into the occlusal plane with the use of a standardized protocol. MIC characteristics, including type, sector, side, location, height, and complexity of impaction, as well as α and ß angles and canine root length and area were measured. Likewise, factors associated with orthodontic treatment, including sex, age, malocclusion, premolar extractions, previous incisor root resorption, ANB, APDI, and SNA angles, and PNS-ANS distance were also evaluated. The statistical analysis included multiple linear regressions to estimate the influence of all variables on the duration of traction (α = 0.05). RESULTS: Sex had significant influence (P = 0.027) on the time of traction; in female patients, the time was 2.05 months more than in male patients. Bilateral impaction treatment increased the time by 2.74 months compared with unilateral cases (P = 0.001). Traction of bicortically centered impacted canines increased the duration of traction by 2.85 months (P = 0.001). Finally, the traction time increased in 2.35 months (P = 0.046) when the impaction sectors were 4 or 5 (close to the midline). CONCLUSIONS: The duration of active orthodontic traction of MIC is mainly influenced by sex, bilateral type, bicortically centered location, or when MIC is located in sector 4 or 5 close to midline, increasing the traction time by some months.

Pronóstico en ortodoncia de incisivos con reabsorción radicular por caninos impactados: Revisión bibliográfica / Prognosis in orthodontic treatment of root resorption of teeth caused by impacted canines: A literature review

Introducción: Los caninos posicionados ectópicamente, conllevan alta prevalencia de incisivos laterales con reabsorción radicular (RR), proceso que cesa cuando la noxa es removida. La presente revisión bibliográfica evaluó el pronóstico de incisivos laterales maxilares con RR por caninos impactados.Revisión: Existen diversas clasificaciones para determinar el grado de RR, y su severidad contribuye a plantear los objetivos del tratamiento ortodóncico. Los dientes con RR leves sin compromiso pulpar, han mostrado tener un buen pronóstico a largo plazo, por lo que la decisión de no extraerlos sería adecuada. En dientes con RR moderada con pérdida de vitalidad pulpar, el tratamiento endodóntico es indicado, existiendo una alta tasa de permanencia, en casos que la reabsorción involucre hasta el tercio medio radicular. Los dientes con RR severa tienen un pronóstico dudoso. Seguimientos de hasta 23 años, demuestran que es posible la conservación de dientes con RR severa sin agravar su condición, incluso en aquellos sometidos a extensos movimientos ortodóncicos. La extracción o mantención del diente afectado debe decidirse ponderando el grado de RR, la estabilidad post-tratamiento, la discrepancia de espacio óseo-dentaria, la experiencia clínica del tratante y la consideración de que un canino ubicado en su posición fisiológica entrega la funcionalidad necesaria para una oclusión orgánica y una estética ideal. Conclusiones: Es posible mantener dientes con RR severa a largo plazo sin cambios en su vitalidad, coloración o aumento de movilidad. Sin embargo, son necesarios más estudios que justifiquen la determinación de extraer o no, dientes con RR severa por impactación de caninos

Introduction: Ectopically positioned canines have a high prevalence of lateral incisors with root resorption (RR). The process of RR ceases when the injury is removed. The present literature review evaluated the prognosis of maxillary lateral incisors with RR produced by impacted canines. Review: The severity of RR contributes to plan the objectives of orthodontic treatment. Mild RRs with no pulp involvement, have been shown to have a good prognosis in the long term. Therefore, the decision of not extracting a tooth with mild RR would be adequate. In moderate RR with loss of vitality, endodontic treatment is indicated. A high rate of success has been reported in cases of RR of up to the middle radicular third. Teeth with severe RR have a doubtful prognosis. Reports of 23-years follow up cases show that preservation of teeth with severe RR is possible, without a deterioration in its condition, even when extensive orthodontic movements have been applied. The decision on extracting or preserving the affected teeth must be made after considering the degree of RR, the tooth space discrepancy, post-treatment stability of the affected teeth and the clinician's expertise. Also, considering that canines in its physiological position give the required functionality for an organic occlusion and ideal esthetics. Conclusion: It is possible to keep teeth with severe RR in the long term without changes in its vitality, color alterations or increased mobility. However, further studies are needed that justify the decision on extracting or preserving teeth with severe RR

Orthodontic-surgical retreatment of facial asymmetry with occlusal cant and severe root resorption: A 3-year follow-up.

Our objective was to report the orthodontic and surgical retreatment of a patient who had undergone a prolonged orthodontic treatment with extractions, but who had unsatisfactory results and persistent side effects. The man, aged 25 years 3 months, sought treatment with major complaints of facial and smile asymmetries. The clinical examination showed a mandibular deviation to the right and a maxillary occlusal cant. A Class II Division 1 subdivision right was observed. Radiographic examination showed extensive root resorptions in the maxillary second premolars and absence of the 4 first premolars. The maxillary midline was deflected 2 mm to the left, and the mandibular midline was shifted 5 mm to the right. Aligning and leveling were performed with orthodontic fixed appliances, with a standard edgewise system (0.022 × 0.028 in), followed by LeFort I maxillary impaction and bilateral sagittal split osteotomy with asymmetrical advancement. Retreatment showed outstanding results that remained stable after 3 years of follow-up. Root resorption in the second premolars did not seem to increase. Orthodontic-surgical intervention is the main choice for correcting esthetic and functional problems in facial asymmetry, particularly in cases of retreatment.

Management of root resorption with mineral trioxide aggregate complicated by a luxation injury: report of a case with six-year follow-up.

Trauma to the oral region occurs frequently, comprising 5% of all injuries. The most common dental injuries are lateral luxations which can be seen with a prevalence of up to 27% among dental injuries. Ectopic eruption of maxillary canines can lead to root resorption on maxillary lateral incisors especially on apical and middle thirds of the roots. Half of these resorbed lateral incisors show severe resorption, in which the pulp is exposed. This case report describes non-surgical treatment with mineral trioxide aggregate (MTA) and a six-year follow-up of a maxillary lateral incisor, resorbed by ectopic eruption of the canine and affected by lateral luxation injury. The tooth was asymptomatic, and radiographic examination showed that the resorbed region had been successfully repaired with new hard tissue deposition within the six-year follow-up. MTA can be considered an effective repair material in nonsurgical treatment of this type of root resorption.

Root perforations: aetiology, management strategies and outcomes. The hole truth.

The purpose of this clinical article is to emphasise that root perforations can occur both during and after endodontic treatment. These reduce the chance of a successful treatment outcome and can jeopardise the survival of the tooth. The aetiology and diagnosis of root perforations are described. The article also focusses on the non-surgical and surgical management of root perforations and describes how selection of the appropriate treatment depends on an accurate diagnosis.

Asymptomatic, nonexpansile radiopacity of the jaw associated with external root resorption: a diagnostic dilemma.

Incidental radiopacities of the jaws are commonly identified on routine intraoral and extraoral radiographs. Dentists should be able to develop a differential diagnosis of these lesions. This article presents 2 cases in which mandibular radiopacities associated with external root resorption were identified incidentally and discusses the differential diagnosis of these lesions. Both patients were referred by their general practitioners to dental specialists for further evaluation of homogenous osteosclerotic foci surrounding and resorbing the roots of the permanent mandibular right first molar. The lesions were asymptomatic, caused no cortical expansion, and were static over time. The clinical and radiographic features were consistent with a diagnosis of idiopathic osteosclerosis (IO). External root resorption is present in 10%-12% of cases of IO and often involves the permanent mandibular first molars.

Dental Management of a Patient with Multiple Idiopathic Cervical Root Resorption.

Multiple Idiopathic Cervical Root Resorption (MICRR) is a rare condition. It initiates at the cemento-enamel junction of multiple teeth. The lesions continue to grow until they unite, thereby undermining the entire coronal structure of affected teeth. Its distribution can vary from a single region to the entire dentition and the number of teeth affected by resorption tends to increase as the condition is followed over time. The teeth themselves appear clinically normal. The aetiology of MICRR is unknown and it is considered to be a diagnosis of exclusion. The condition tends to be progressive. Consequently, root treatments/surgical curettage and restoration of the lesions have been unsuccessful at arresting the condition. Affected teeth are often extracted in anticipation of catastrophic fracture and have been replaced with partial or complete dentures. In this case report, we describe how a young female patient was dentally managed over 10 years and ultimately rehabilitated with dental implants. CPD/CLINICAL RELEVANCE: Patients suspected of having multiple idiopathic cervical root resorption may require specialist, multidisciplinary care and require referral to an appropriate secondary care unit for treatment planning and potential oral rehabilitation.

Splinted Porcelain Laminate Veneers With a Natural Tooth Pontic: A Provisional Approach for Conservative and Esthetic Treatment of a Challenging Case.

Esthetic rehabilitation of discolored anterior teeth is always a great challenge, especially in the presence of pathology. Fortunately, conservative management in the esthetic zone has become more feasible in compromised cases because of the development of restorative materials and advances in dental adhesives. This report presents a complicated case of a patient with tetracycline-related discoloration, multiple root resorption, and a periapical lesion. Treatment was conservative and used a natural tooth pontic and splinted porcelain laminate veneers.

Sobretratamento: uma alternativa eficaz na terapia com implante em elemento unitário com reabsorção radicular em paciente portador de periodontite crônica: relato de caso / Overtreatment: an effective alternative in implant therapy on a single tooth with root resorption in patient with chronic periodontitis: a case report

Paciente do sexo masculino, 54 anos de idade, leucoderma, compareceu a uma clínica privada para tratamento odontológico. Na anamnese, verificou-se tratar de um paciente saudável sistemicamente; os exames clínico e radiográfico demonstraram reabsorção dos terços apical e médio da raiz do dente 21. A opção de tratamento foi a realização da extração do elemento dentário e realização de implante imediato com carga tardia, utilizando-se o dente do próprio paciente como provisório fixado aos dentes vizinhos. O paciente foi informado sobre os detalhes das fases pré-, trans- e pós-cirúrgica, e autorizou a execução do tratamento e da documentação fotográfica com fins de publicação e divulgação. A utilização de periótomo foi necessária para uma exodontia atraumática. Após remoção atraumática da raiz, e com o osso alveolar remanescente preservado, optou-se por realizar a instalação imediata do implante (Neodent, Curitiba/PR, Brasil), com formato cônico e encaixe cone morse. O espaço alvéolo- implante foi preenchido com Bio-Oss®; removeu-se do palato um enxerto conjuntivo subeptelial, rotacionado para vestibular, e fez-se a obliteração do alvéolo — nessa fase, é importante garantir a imobilidade do enxerto, para sua revascularização. Passou-se, então, à fase protética do provisório, utilizando a coroa do elemento extraído como provisório e estabelecendo um pôntico, afixado com resina composta nos elementos 11 e 22. Assim, após a etapa de provisório utilizando o pôntico reembasado com resina composta, começou-se a confecção da coroa protética final. Após acompanhamento de três anos do caso, foi possível concluir que a associação das técnicas obteve resultados estéticos previsíveis e satisfatórios para a prevenção da saúde peri-implantar, conforme planejado...

A male, 54‐year‐old, Caucasian patient attended a private clinic for dental treatment. Hismedical history revealed a systemically healthy patient. Clinical and radiographic examination revealed resorption in the apical and middle thirds of tooth 21 root. A treatment option was to perform extraction of tooth 21 and implant placement with late loading, using patient's own tooth as a provisional secured to adjacent teeth. The patient was made aware of the details before, during and after surgery, and authorized the implementation of treatment and photographic documentation for purposes of publication and dissemination. The use of Periotome was required for atraumatic extraction. After atraumatic removal of the root, andwith the remaining alveolar bone being preserved, we chose to perform immediate implantplacement (Neodent‐Curitiba‐PR, Brazil). The implant was of conical shape and of the MorseTaper type. The alveolar‐implant space was filled with Bio‐Oss®, subepithelial connective graftwas harvested from the palate, with buccal rotation, and alveolar obliteration was carried out. At this stage, it is important to ensure graft immobility for vascularization. Subsequently, the prosthetic phase was carried out with the crown of the extracted tooth used as a temporary tooth, establishing a provisional pontic secured to between teeth 11 and 22 with compositeresin. Accordingly, after the temporary tooth phase with a pontic secured with composite resin, the final prosthetic crown was manufactured. After a three‐year follow‐up, we conclude that the combination of techniques yielded predictable and satisfactory outcomes for themaintenance of peri‐implant health, as planned ...

Treatment of Ectopic Permanent Maxillary First Molar Using a K-loop.

Ectopic eruption of permanent maxillary first molar can cause root resorption of adjacent primary second molar, thus leading to early loss of primary maxillary second molar. Therefore, it is necessary to correct ectopic maxillary first molar. This case report demonstrates that K-loop can be used as a simple, comfortable, and easier method to correct ectopic eruption of permanent maxillary first molar in existing severe root resorption on adjacent primary second molar.

Orthodontic treatment in patient with idiopathic root resorption: a case report.

Multiple idiopathic external root resorption is a rare pathological condition usually detected as an incidental radiographic finding. External root resorption of permanent teeth is a multifactorial process related to several local and systemic factors. If an etiological factor cannot be identified for root resorption, the term "idiopathic" is applied. This report presents a case of multiple idiopathic apical root resorption. The condition was found in a young female patient seeking orthodontic treatment due to malocclusion. This kind of resorption starts apically and progresses coronally, causing a gradual shortening and rounding of the remaining root. Patients with this condition are not the ideal candidates for orthodontic treatment; however, the aim of this report is to describe an unusual case of idiopathic root resorption involving the entire dentition, and to present the orthodontic treatment of this patient. It describes the progress and completion of orthodontic therapy with satisfactory end results.

Orthodontic treatment of severe anterior open bite and alveolar bone defect complicated by an ankylosed maxillary central incisor: a case report.

Incisor trauma is common in children, and can cause severe complications during adolescent growth and development. This report describes the treatment of a 16-year-old patient with severe anterior open bite due to ankylosis of the maxillary left incisor after dental trauma as an 8-year-old. No examination or active treatment was undertaken until he was 16 years old. Clinical examination revealed that the maxillary left incisor was severely intruded accompanied by a vertical alveolar bone defect. Orthodontic treatment combined with surgical luxation took 3 years and 7 months. During treatment, the intruded incisor was moved to the occlusal level and the alveolar bone defect was restored, achieving normal occlusion. After two years of retention, the maxillary left incisor was retained in a stable normal position with a slightly reduced overbite. This case demonstrates that surgical luxation with orthodontic traction can be an effective approach, especially when the ankylosed tooth has a single root. Long-term monitoring of orthodontic stability and the maintenance of periodontal health are crucial in the post-treatment period.

Management of mucosal fenestration with external root resorption by multidisciplinary approach.

Mucosal fenestration is a clinical condition in which the overlying gingiva is denuded and the root is exposed to the oral cavity. Invasive cervical resorption is an entirely uncommon entity and its aetiology is poorly understood. This case presents an invasive cervical resorption of maxillary right central incisor with fenestration at the cervical third of the tooth. The resorption area was chemomechanically debrided. It was then restored with Mineral Trioxide Aggregate over which pink glass ionomer cement (GC Fuji VII) was placed. Lateral pedicle flap was used to cover the fenestration. The resorptive defect was restored using tooth coloured restorative resin after removal of the pink glass ionomer cement. Orthodontic treatment was continued for correction of malocclusion.

Impact of cone-beam computed tomography on orthodontic diagnosis and treatment planning.

INTRODUCTION: In this study, we measured the impact of cone-beam computed tomography (CBCT) on orthodontic diagnosis and treatment planning. METHODS: Participant orthodontists shown traditional orthodontic records for 6 patients were asked to provide a diagnostic problem list, a hypothetical treatment plan, and a clinical certainty. They then evaluated a CBCT scan for each patient and noted any changes, confirmations, or enhancements to their diagnosis and treatment plan. RESULTS: The number of diagnosis and treatment plan changes varied widely by patient characteristics. The most frequently reported diagnosis and treatment plan changes occurred in patients with unerupted teeth, severe root resorption, or severe skeletal discrepancies. We found no benefit in terms of changes in treatment plan for patients when the reason for obtaining a CBCT scan was to examine for abnormalities of the temporomandibular joint or airway, or crowding. Orthodontic participants who own CBCT machines or use CBCT scans frequently in practice reported significantly more diagnosis and treatment plan changes and greater confidence after viewing the CBCT scans during the study. CONCLUSIONS: The results of this study support obtaining a CBCT scan before orthodontic diagnosis and treatment planning when a patient has an unerupted tooth with delayed eruption or a questionable location, severe root resorption as diagnosed with a periapical or panoramic radiograph, or a severe skeletal discrepancy. We propose that CBCT scans should be ordered only when there is clear, specific, individual clinical justification.