A rare presentation of dens invaginatus in a mandibular lateral incisor occurring concurrently with bilateral maxillary dens invaginatus: case report and review of literature

BACKGROUND: Dens Invaginatus (DI), commonly known as dens in dente, is a developmental malformation of tooth that most commonly affects permanent maxillary lateral incisor teeth. Deciduous teeth are infrequently affected. Presence of DI in mandibular permanent teeth is extremely rare. Further, the presence of DI bilaterally in the maxillary lateral incisors of the same patient is even more unusual. METHODS: In this article, an unusual case of DI affecting a mandibular lateral incisor tooth is described. This malformation was uncovered after a full mouth radiographic examination when the patient presented for dental treatment unrelated to this finding. In addition, the various radiographic appearances of DI as they present within the maxillary and mandibular teeth are described. Essential clinical considerations and treatment options are presented. A review of the pertinent literature is undertaken and a table summarizing previous published findings of mandibular DI is presented. RESULTS: A review of the literature indicates that DI in mandibular teeth is extremely rare with only 10 other cases involving 13 teeth reported previously. CONCLUSIONS: Although this is an extremely rare case, DI is an anomaly that should be familiar to all practising dentists due to the clinical implications of potential sequelae of pulpal involvement.     

Multiple dens invaginatus affecting maxillary lateral incisors and a supernumerary tooth

Abstract Dens invaginatus is a developmental variation resulting from an alteration in the normal growth pattern of the dental papilla of a tooth. This anomaly occurs predominantly in maxillary permanent lateral incisors. Multiple occurrence in maxillary incisor teeth in the same patient has frequently been reported, and examination of bilateral teeth for the anomaly is often carried out routinely. This paper reports an unusual case of multiple invaginations, including dens invaginatus affecting maxillary lateral incisors and a supernumerary tooth and minor imaginations of the upper canines. Moreover, the case illustrates the importance of examining all the teeth in patients who present with dens invaginatus and palatal pits in incisors and canines. The possibility that the supernumerary tooth had resulted from gemination of the lateral incisor tooth germ is discussed.     

Multiple dens invaginatus in two brothers

Abstract Dens invaginatus is a developmental variation resulting from an alteration in the normal growth pattern of the dental papilla of a tooth. They predominantly occur on maxillary permanent lateral incisors. Their occurrence in several maxillary incisor teeth in an individual has been frequently reported, and the examination of bilateral teeth for the anomaly is well accepted. However, the present case illustrates the importance of examining both maxillary and mandibular incisors in patients who present with a dens invaginatus, in addition to other members of the family.     

Delayed eruption of mandibular primary central incisors in a child with severe lingual inclination and their spontaneous movement to appropriate positions

We previously reported a quite uncommon case of delayed eruption of primary mandibular bilateral incisors with severe lingual inclination identified in a Japanese girl aged 2 years 8 months. An intraoral examination demonstrated the tooth crown morphology of the primary mandibular incisors in the lingual submucosal area, while radiographic examinations of the affected teeth revealed what appeared to be a standard root morphology and the permanent successors located close to the affected teeth. We decided to perform periodical examinations at least until the roots of the permanent successors were sufficiently formed and here report recent findings in this case. At 2Y10M, the edge of the tooth crown of the primary mandibular left central incisor had emerged into the oral cavity and one-third of the tooth crown was identified at 2Y11M. Thereafter, the tooth crown of the primary mandibular right central incisor was identified under the mucosa at 3Y1M. A periapical radiograph taken at 3Y7M demonstrated formation of the permanent successors under development. At 3Y10M, nearly the entire part of the tooth crowns of both affected teeth had emerged and then they started to move gradually in a labial direction. At 4Y2M, the crowns of the affected were nearly within the dental arch, while periapical radiograph images showed straight roots for the affected teeth and the developing permanent successors. We intend to continue to perform periodical examinations to follow the development of the permanent successors until eruption.     

Horizontal impaction of primary mandibular bilateral central incisors identified in 2-year-8-month-old girl

A girl aged 2 years and 8 months came to our clinic for consultation with regard to unerupted primary mandibular bilateral central incisors. An intraoral examination revealed that the teeth had not emerged into the oral cavity and showed a tooth crown morphology similar to that of the primary mandibular incisors, which appeared in the lingual submucosal area outside of the mandibular dental arch. Periapical radiographs demonstrated that the tooth crowns of both affected teeth were severely displaced to the lingual side. Computed tomography examinations were performed to clarify the three-dimensional positions of the affected teeth and their permanent successors, which revealed that the affected teeth were located in their estimated positions and had a standard root morphology. In addition, the permanent successors, which had not initiated root formation, were located close to the affected teeth. We decided to postpone extraction of the affected teeth and perform periodical examinations until the roots of the permanent successors are sufficiently formed. At the age of 2 years and 10 months, the edge of the tooth crown of the primary mandibular left central incisor was found emerged into the oral cavity. According to her parents, the patient did not complain of the emerging edge and no abnormal conditions were observed around the tooth.     

Talon's cusp: report of four unusual cases

Talon cusp is a developmental dental anomaly thought to arise as a result of evagination on the surface of a tooth crown before calcification has occurred. The etiology remains unknown. The incidence is 0.04-10%. Any tooth may have a talon cusp but most of the cases involve maxillary lateral incisors, with some instances of bilateral involvement. The anomaly has been reported to be rare in the mandible. This article reports four cases of talon cusp. The first and the second cases describe bilateral involvement of talon cusp on palatal surfaces of maxillary primary centrals; in the third case talon tubercle occurs on palatal surfaces of both maxillary permanent lateral incisors and the maxillary left central incisor and in the last case a talon cusp in the lingual surface of mandibular permanent lateral incisor.     

Management of a fused central incisor in association with a macrodont lateral incisor: a case report

Fusion is developmental anomaly of the dental hard tissue and is defined as the joining of 2 developing tooth germs resulting in a single large tooth structure. Different treatment methods can be used according to the requirements of the situation. The purpose of this case report was to present the multidisciplinary treatment of a patient who had a permanent maxillary left central tooth fused with a supernumerary incisor and a macrodont permanent maxillary right lateral incisor. In the radiographic evaluation, it was determined that the fused tooth had 2 separate roots. The supernumerary tooth was extracted after hemisection, and endodontic treatment was performed on the remaining portion. The distal side of the macrodont lateral incisor was recontoured, and the right central incisor was reshaped with a strip crown to provide aesthetic appearance and to gain space for the alignment of teeth. Following the restoration of the incisors, orthodontic treatment was provided.     

Hypoplasia in crown of primary mandibular left lateral incisor identified in infant Japanese girl

A girl aged 0 years 11 months was referred to our clinic by a local pediatrician for examination of a missing tooth crown of a primary mandibular left lateral incisor. Our intraoral examination showed that seven primary incisors had emerged into the oral cavity, while no tooth crown was noted in the region of the primary mandibular left lateral incisor. A calcified structure was identified close to the gingival margin, which had a bone-like appearance and color, with no inflammation seen in the gingiva around the structure. Furthermore, the pulp space could be seen through the layer of hard tissue located close to the gingival region. A periapical radiograph taken at the first visit demonstrated a root-like structure with dentin and pulp, whereas enamel was not detected. The structure was speculated to be the root of the primary mandibular left lateral incisor, which was in the developmental stage. As there were no abnormal signs or symptoms, we decided to perform periodical examinations at 3-month intervals. Periapical radiographs taken at 1Y0M and 1Y7M showed root formation with no unusual conditions observed around the affected tooth.     

Management of intrusive luxation of maxillary incisors with dens in dente: a case report

Abstract – Intrusive luxation is one of the most severe types of dental traumatic injuries. The risk of occurrence of pulpal necrosis and inflammatory or replacement resorption is high. In an attempt to prevent or delay the appearance of such lesions, endodontic intervention is required soon after the occurrence of trauma. A 17‐year‐old boy reported to the Department of Conservative dentistry and Endodontics, KLE VK Institute of Dental Sciences, Belgaum, 2 days after a fall from a bicycle. Clinical and radiographic examination revealed an intrusive luxation of the left maxillary central incisor and lateral incisor. There were complicated crown fracture with the right maxillary central incisor and uncomplicated crown fracture with the left maxillary central incisor. Also, all the incisors showed the presence of Oelhers type II Dens‐in‐dente. The management was hence challenging. Immediate surgical repositioning was performed and the teeth were stabilized with a composite resin splint. Endodontic therapy was initiated with the right maxillary central incisor, and the canal was sealed with calcium hydroxide dressing. After 3 weeks, pulp sensitivity was repeated with the maxillary left central and lateral incisors. The result was negative. Considering the incidence of pulp necrosis and root resorption in intruded teeth with complete root formation, they also were dealt in a similar manner as the maxillary right central incisor. The splint was removed after 1 month. After 6 months of calcium hydroxide therapy, there was a satisfactory apical and periodontal healing. At this stage, the teeth were obturated and the fractures were restored with composite resin. A 1‐year follow up revealed a satisfactory clinical and radiographic outcome.     

Light-force technique for the early treatment of an ectopic tooth

Free crown tipping can be useful when teeth do not erupt in their physiologic sequence and a real intraosseous migration and eruption of a single tooth into a distant ectopic position can be observed. This article presents a case of an ectopic mandibular lateral incisor treated early, with the light-force technique and uncontrolled forces, and finished with the bidimensional edgewise appliance. A Caucasian female patient, 10 years 10 months of age, had a mandibular left lateral incisor displacement, with the lateral incisor crown positioned mesial to left second primary molar. An early treatment was planned to correct the mandibular left lateral incisor displacement and to allow proper eruption of the mandibular left canine and first premolar. A second phase of treatment, in permanent dentition, was planned for the dental Class II subdivision on the right and deep bite correction. Phase 1 treatment was completed after 10 months; phase 2 treatment was initiated in the permanent dentition and lasted 18 months. Treatment achieved the following outcomes: (1) mandibular lateral incisor in corrected position; (2) full canine and molar Class I relationship; (3) overjet and overbite within the normal limits; (4) symmetric arches; and (5) a balanced profile. The radiograph evaluation revealed good root parallelism and mandibular left lateral incisor light root resorption. The light-force technique is not only a possible alternative but the ideal appliance for treatment in the mixed dentition, when the permanent teeth should be controlled.     

Rapidly progressive internal root resorption: a case report

Abstract – The etiology of internal root resorption is not fully understandable, trauma and chronic pulpitis are considered the main risk factors. Usually the process is asymptomatic and diagnosed upon routine radiographic examination. This case report presents a rapid progression of internal resorption related directly to traumatic injury. A 16‐year‐old female arrived at the emergency room after a mild extrusion of the mandibular incisors. The initial treatment included repositioning and splinting of the teeth. Radiographs performed at repositioning and splinting demonstrated normal configuration of the incisor’s roots. Ten months later progressive internal resorption of the left mandibular first incisor was diagnosed. While treating this tooth similar process was detected in the right mandibular second incisor and in the mandibular left second incisor. The lower right first incisor reacted inconsistently to vitality test. As a result of the severe and rapidly progressive nature of the process, root canal treatments were performed in all lower incisors. The follow‐up radiographs demonstrate arrest of the internal resorption process.     

Permanent mandibular incisor with multiple anomalies - report of a rare clinical case

Permanent mandibular central incisor is rarely affected by tooth shape anomalies of crown and root. Co-occurrence of multiple anomalies in a permanent mandibular central incisor is extremely rare. This paper reports an unusual concurrent combination of multiple dental anomalies affecting both the crown and root of a permanent mandibular left central incisor - talon cusp, dens invaginatus, short root anomaly and macrodontia -, which has not previously been reported together. Case management is described and implications are discussed. The dentist should be aware of these rare entities in order to provide an accurate diagnosis and management for which detailed examination of the tooth both clinically and radiographically is very important.     

Simultaneous presence of a congenitally missing premolar and supernumerary incisor in the same jaw: report of case

Supernumerary teeth and hypodontia can be regarded as opposite developmental phenomena. An eight-year-old girl presented a concomitant occurrence of a supernumerary tooth and two congenitally missing teeth. The supernumerary tooth was found in the left maxillary incisor region, while the left second premolar in the maxilla and the left lateral incisor in the mandible were congenitally missing. The supernumerary tooth showed a similar color and morphology to those of the maxilla lateral incisor, and the lateral incisor on the mesial side was diagnosed as a supernumerary tooth from dental age, eruption time, and mesiodistal crown dimension. The supernumerary incisor was guided labially to cure an anterior cross-bite, and the lateral incisor, canine, and first premolar were guided distally to compensate for the space left by the congenitally missing left second premolar.     

Incidence and distribution of root canal treatment in the dentition among a Jordanian sub population

AIM: To determine and compare the incidence of endodontically treated teeth in the maxilla and mandible, and to present the frequency of endodontic treatment for each tooth in the dentition in a group of the Jordanian population; then to compare these results with previously published surveys. METHOD: A total of 1,404 root canal treated teeth were examined clinically and radiographically. RESULTS: Most teeth were treated in a one visit procedure (40.1%). The results showed that 77.7% of the treated teeth were in the maxilla and 22.3% were in the mandible. Posterior teeth accounted for 39.0% of all treated teeth, among which, 20.3% were molars. The most frequently treated tooth was the maxillary central incisor tooth (39.6%), with the maxillary lateral incisor second (10.1%). Furthermore, the maxillary incisors alone accounted for almost half (49.7%) of the cases. The maxillary first molar was the third most frequently treated tooth (8.2%) with the mandibular first molar at 7.5%.The lowest frequency of treatment was for mandibular lateral incisors and canines which made up only 1.1% and 1.9% respectively. CONCLUSION: Comparison with previously published surveys revealed a lower percentage of molar endodontics than in other surveys.     

Primary double tooth: report of a rare correlation with the permanent dentition.

Double tooth is a developmental anomaly that is seen more frequently in the primary than the permanent dentition. Double tooth involving primary canines and lateral incisors is found only in the mandible. The succeeding permanent lateral incisor is often found missing congenitally in the same region. This article reports a rare case of a double tooth involving a mandibular primary canine and lateral incisor. Instead of agenesis, the double tooth has been succeeded by a permanent supernumerary tooth in the same region.     

Nonsurgical endodontic retreatment of geminated teeth: a case report

The purpose of this case presentation is to describe nonsurgical retreatment of anterior teeth with gemination. A 21-year-old male patient was referred for endodontic treatment of his maxillary left lateral incisor. In the clinical examination, a large crown was observed in the left maxillary incisor region when compared with the right maxillary lateral incisor. In the present case, a tooth gemination of a maxillary lateral incisor has been described. A periapical radiograph showed that the tooth had partially separated two crowns having a single root and one root canal, but the access cavity of the distal crown had not been opened, and the root canal had been obturated with single cone technique. Nonsurgical endodontic retreatment was decided for geminated lateral incisor. At the 6-month follow-up, the tooth was asymptomatic and there was no radiolucency around the apical region.     

The prevalence and pattern of hypodontia of the permanent teeth and crown size and shape deformity affecting upper lateral incisors in a sample of Jordanian dental patients

OBJECTIVE: The aim of this study was to determine the prevalence and pattern of hypodontia and the extent of congenital malformation in the permanent teeth of a sample of Jordanian adults. MATERIAL AND METHODS: Clinical examinations were carried out on 1045 dental patients aged 16 to 45 years to record any congenital absence of teeth except 3rd molars and to note any crown shape or size deformities affecting the upper lateral incisor. The congenital absence of permanent teeth was confirmed by taking complete dental history and orthopantomograms. Impacted teeth and teeth lost as a consequence of extraction or trauma were recorded as present. RESULTS: The prevalence of hypodontia was found to be 5.5% of the sample and the lower second premolar was the most frequently missing tooth. The number of missing upper lateral incisors was significantly higher than that of lower lateral incisors, (p < 0.05). Peg-shaped and reduced size upper lateral incisors were observed in 2.3% and 2.9% of the sample respectively. There were no significant differences according to gender, location of tooth according to arch or side of the jaw and hypodontic pattern. CONCLUSION: The prevalence of hypodontia was 5.5%, that of peg-shaped lateral incisor was 2.3% and that of reduced crown size was 2.9%.     

Hemisection of a fused tooth

Fusion is a developmental anomaly which occurs due to a union of 1 or more adjacent teeth during morphodifferentiation of the dental germs. The present case report presents the hemisection of a maxillary central incisor fused with a supernumerary tooth. A 10-year-old boy was referred to clinic with the chief complaint of the presence of a large anterior tooth. Intraoral and radiographic investigations indicated fusion between the left central incisor and a supernumerary tooth. The fused tooth was separated with a diamond bur, and the supernumerary tooth was extracted. The left central incisor was restored with composite resin and the diastema between the maxillary central incisors was closed with orthodontic treatment. The left central incisor was still healthy after a follow-up examination period of 24 months. An ideal overjet and overbite relation was achieved at the end of the orthodontic treatment. Hemisection can be considered as an appropriate treatment alternative for a permanent tooth fused with a supernumerary tooth.     

Dentigerous cyst containing multiple impacted teeth: a rare case report

The dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. It is one of the most prevalent types of odontogenic cysts associated with erupted, developing, or impacted tooth, particularly the mandibular third molars, the other teeth that are commonly affected are maxillary canines. The present case report is unique as it enclosed three permanent maxillary teeth: the central incisor, lateral incisor, and canine that had to be extracted during surgical enucleation of the cyst.