Piezosurgical management of sealer extrusion‐associated mental nerve anaesthesia: A case report

The present report describes a case where sealer extrusion (Sealapex) occurred during root canal obturation of a left lower second premolar tooth, and the patient experienced sudden pain and followed by complete anaesthesia of the lower lip. After 3 weeks of conservative therapy and an unaltered anaesthesia period, piezosurgical removal of the extruded sealer and root‐end resection was performed despite the direct contact with the mental neurovascular bundle. At suture removal, 1 week after surgery, there was no improvement in sensation. Two weeks after the operation, the patient reported some changes, including a short paraesthesia period alternating with anaesthesia. At the fourth post‐operative week, neurosensory function recovered completely. This case represents successful use of the piezoelectric technique for mental nerve decompression and periapical surgery of a lower second premolar with close contact of the mental nerve.     

Delayed eruption of premolars with periodontitis of primary predecessors and a cystic lesion: a case report

Apical periodontitis after pulp therapy in a primary tooth can cause delayed eruption of the permanent successor. A case of bilateral delayed eruption of mandibular premolars is presented. The patient. a 13-year-old girl, was referred by her dentist. Oral findings showed that the right first and left second primary molars were retained. Other premolars had erupted. An orthopantomogram revealed apical periodontitis, affecting both retained primary molars. The right first mandibular premolar was impacted against the alveolar bone and root of the second premolar, and there was a large cystic lesion in close association with the left second mandibular premolar. Both primary molars were extracted, and the cystic lesion was treated by marsupialization. Fenestration and traction were performed on the right first premolar. Correct tooth alignment was achieved with orthodontic appliances. If the problem had been detected earlier, treatment of the premolars might have been easier. Clinical and radiological follow-up, therefore, of primary teeth that have undergone pulp therapy procedures should be performed until eruption of succedaneous teeth.     

Displaced calcium hydroxide paste causing inferior alveolar nerve paraesthesia: report of a case

A patient presented with an intraoral red, painful, and hard swelling in the lower right jaw. Radiographs showed a 2 x 1 cm area of radiopaque material surrounding the apex of the second premolar. The material, according to the patient's dentist, was calcium hydroxide paste used as a temporary dressing material in the root canal. The patient developed paraesthesia in her lower lip probably due to a neurotoxic effect caused by calcium hydroxide. The foreign material was surgically excavated from the spongious bone, directly adjacent to the nerve, and the patient later regained her sensation in the lip. A histopathological analysis revealed necrosis, deposits of foreign bodies, and inflammatory cells and foreign-body giant cells. This report illustrates the toxicity and adjacent clinical symptoms of calcium hydroxide paste when displaced into bone tissue close to the alveolar inferior nerve. It also demonstrates the benefits of removing such displaced material before symptoms progress.     

The location of the mental foramen in a selected Malay population

Knowledge of the position of the mental foramen is important both when administering regional anesthesia and performing periapical surgery in the mental region of the mandible. This study determines the position of the mental foramen in a selected Malay population. One hundred and sixty nine panoramic radiographs of Malay patients retrieved from a minor oral surgery waiting list were selected to identify the normal range for the position of the mental foramen. The foramen was not included in the study if there was any mandibular tooth missing between the lower left and right first molars (36-46). The findings indicated the most common position for the mental foramen was in line with the longitudinal axis of the second premolar (69.2%) followed by a location between the first and second premolar (19.6%). The right and left foramina were bilaterally symmetrical in three of six recorded positions in 67.7% patients. The mental foramen was most often in line with the second premolar.     

Paraesthesia—a consequence of a controversial root-filling material? A case report

Summary. This is a report of a case where a patient suffered paraesthesia following root filling of her lower left second molar. The Swedish health authorities considered that as a formaldehyde containing root filling cement had been used, the dentist had not worked in accordance with science and proven experience.     

Ameloblastoma--a diagnostic problem

A 50-year-old female was referred by her dental practitioner. She had a periapical radiolucency associated with the lower right second premolar tooth. The tooth was root treated and subsequently apicected. Tissue curetted at the time of surgery was shown to be a solid ameloblastoma which was managed initially by marginal excision. Histopathological examination of the resection specimen demonstrated tumour at the inferior margin. A segmental resection of the mandible with an immediate reconstruction using a free tissue transfer of the iliac crest was therefore performed. The case shows the need for vigilance in dealing with periapical pathology and underlines the importance of sending all tissue specimens for histopathological analysis.     

Treatment of space loss caused by submerged maxillary second primary molar

Submersion is a clinical term describing a tooth depressed below the occlusal plane. In this case report, we present the treatment of a patient who had totally submerged primary maxillary second molar, which caused impaction of the second premolar and space loss in the maxillary arch due to tipping of adjacent teeth. A 12-year-old girl was referred to the pediatric dentistry clinic. The intra-oral examination revealed that right maxillary second primary molar was localized buccal side of posterior maxillary alveolar process, being almost completely covered by gingiva and adjacent teeth inclined closing the space of the related teeth completely. Periapical radiograph demonstrated that maxillary second premolar was impacted. Based on clinical and radiographic findings, maxillary primary second molar was extracted. Headgear was used for the distalization of maxillary right first molar in order to create space for the impacted second premolar. Eruption begun spontaneously 6 months later.     

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目的探讨第二双尖牙先天缺失时合适的治疗方法。方法分析总结2000—2008年治疗的14例第二双尖牙先天缺失患者的临床资料,并结合国内外相关文献,寻找第二双尖牙先天缺失病例合适的治疗方法。结果14例患者中13例选择正畸关闭牙间隙矫治,完成时间为18～36个月,平均27个月,矫治后上下牙列排列整齐,前牙覆、覆盖正常,尖牙中性关系。1例选择集中间隙镶牙的治疗方法,矫治时间10个月。矫治后曲面断层片显示牙根平行,缺牙区牙槽骨无缺损、吸收。结论第二双尖牙的先天缺失应及早发现,并给予适当的治疗,如果患者选择正畸关闭牙间隙的矫治方法,要注意前牙支抗的严格控制,以防破坏侧貌的丰满度。     

Inadequate treatment: a pathway to surgery

A patient developed postendodontic pain 3 years after undergoing root canal therapy in a maxillary first premolar tooth. Radiographic examination revealed that a recently extracted impacted second premolar had originally obscured the x-ray view of a third root on the first premolar. Endodontic therapy in the unfilled root was rejected because the tooth had been restored with full coverage. Apicoectomies and retroseals were performed on all roots, and the tooth became asymptomatic.     

A patient with protrusion and multiple missing teeth treated with autotransplantation and space closure

Objective:To present a patient treated with submerging autotransplantation (SA) of an immature premolar and subsequent orthodontic space closure (OSC) and to report a 10-year follow-up result.Case and Method:A 10-year-old boy had multiple missing premolars with an asymmetric pattern (maxillary right first and second premolars, teeth 14 and 15; maxillary left second premolar, tooth 25; and mandibular right second premolar, tooth 45). After considering several treatment options, tooth 35 with immature root development underwent SA into the missing site of tooth 15 at a depth 5 mm below the occlusal plane and was stabilized with sutures to create a symmetric missing condition of the premolars in the four quadrants.Results:Three months after autotransplantation, spontaneous eruption of the transplanted tooth was observed. Nine months after autotransplantation, presence of the lamina dura of the transplanted tooth was confirmed with a periapical radiograph. Active orthodontic treatment was initiated to reduce lip protrusion by closing the missing spaces of teeth 14, 25, 35, and 45 and to correct dental midline deviation. After 33 months of active orthodontic treatment, Class I canine and molar relationships were obtained. During the 10-year follow-up, the pulp vitality of the transplanted tooth was maintained without any pathologic findings, including root resorption or pulp canal obliteration.Conclusions:In a patient with lip protrusion and multiple congenitally missing premolars with an asymmetric pattern, SA of one premolar from the normal quadrant into the quadrant missing two premolars with subsequent OSC of the missing sites of the other premolars can be an effective treatment modality.     

Unusual tooth sensation due to maxillary sinusitis--a case report

Maxillary sinusitis can cause pain or discomfort to the maxillary dentition but no report of patients complaining of a "jumping tooth sensation" during sinusitis has been recorded in the literature. This article presents a case of an unusual localised sensation from a maxillary right second premolar experienced while undergoing root canal treatment. This sensation was felt during walking while the patient was suffering an episode of influenza. This sensation first occurred following debridement of the root canal. However, it persisted even after the root canal had been sealed. A hypothetical explanation of this manifestation is proposed.     

Injury of the inferior alveolar nerve after overfilling of the root canal with endodontic cement: a case report

The inferior alveolar nerve (IAN) contains mainly sensory fibers. Within the mandibular canal, the IAN runs forward in company of the inferior alveolar artery, and together they are called the inferior alveolar neurovascular bundle. Disturbances of the IAN and mental nerve will predominantly give sensitivity symptoms in the soft tissue of the lower lip and chin. We present a case report of endodontic overfilling involving the mandibular canal. A 52-year-old woman was seen in our outpatient clinic for pain and numbness in the left lower lip and chin, which developed following an endodontic treatment for her mandibular left second premolar. The panoramic radiograph showed radiopaque material in the inferior alveolar canal region, with an extension from the left canine to the second premolar. This case report shows an unusual complication of mandibular second premolar root canal overfilling. The patient underwent treatment with corticosteroids, and after 2 months, the clinical examination revealed an improved clinical situation with a disappearance of the hypoesthesia but with a persistence of the pain. After 4 months, the pain had almost entirely disappeared. In conclusion, even if in our case no surgical treatment was used and although spontaneous resorption has been described for some materials, early surgical exploration with removal of the material and decompression of the IAN is suggested, irrespective of the material used, because the severity of nerve damage can increase with the duration of the injury.     

Orthodontic and prosthetic rehabilitation of unilateral free-end edentulous space

Most patients prefer fixed dentures, even in the presence of uni and bilateral free-end saddle. The most suitable treatment for this is an implant or implant-supported prosthetic restoration. A combined prosthetic and orthodontic treatment with distalization of a posterior tooth towards the edentulous region is an alternative approach. This study involved a 34.3 year old female patient who had a free-end edentulous space on the left mandibula and missing 1st and 3rd molars on the right mandibula. The patient was offered both a removable partial denture and implant treatment options. A detailed explanation of her situation and suitable treatments were given but she refused both options. Therefore, an alternative combined treatment involving prosthodontic and orthodontic disciplines was performed. The second premolar tooth was distalized orthodontically and used as a distal bridge abutment. After 65 months, prosthetic restoration was functional and abutment teeth and periodontium were pathology free, and the patient was satisfied with the results.     

Treatment of lower second premolar agenesis by autotransplantation: four-year evaluation of eighty patients.

The frequency of agenesis of the second lower premolar is 2.5-4%. In growing patients, early extraction of the deciduous molar and subsequent closure of the space is a common therapy, but in some cases space closure is deemed unlikely and autotransplantation is an alternative. The aim of the study was to analyze the outcome of autotransplantation in replacing missing lower second premolars and to evaluate the associated presurgical orthodontic treatment. The material consisted of records of all patients with teeth transplanted to the lower second premolar region during the period 1988-89 at the Department of Oral Surgery, Eastman Institute, Stockholm. The following variables were registered: sex, age, number of transplanted teeth, donor tooth, root development, recipient site, orthodontic treatment, persisting temporary molar, total number of congenitally missing teeth, the surgeon responsible, and clinical and radiological follow-up variables. Of 110 transplanted teeth, 99 had not completed root formation, and in 11 teeth the root formation was completed. The success rates after 4 years were 92% and 82%, respectively. Both premolars and molars served as donor teeth, but the main donor tooth was the upper second premolar. Fourteen percent had been orthodontically treated only because of the transplantation, i.e. to open the space for the donor tooth. Treatment of agenesis of the second lower premolar by autotransplantation has a good prognosis. In growing individuals the transplant not only maintains growth and development of the alveolar ridge but also provides a permanent solution to the agenesis.     

Long-term follow-up of delayed development of maxillary right second premolar with inversely positioned corresponding primary molar

Impaction is defined as a condition in which a tooth fails to erupt within a normal range of functional position. The condition is generally found in permanent teeth, while impaction of primary teeth is considered to be uncommon. We previously presented a rare case of delayed development of a maxillary right second premolar with an inversely positioned corresponding primary molar identified in a girl aged 10 years and 4 months. In the present report of the same patient, we show transitional changes in location and developmental stage of the affected permanent tooth and impacted primary tooth noted during periodical examinations over a 5.5 year period. At 13 years and 2 months, the root of the permanent tooth began to develop, after which the root extended to half of the entire length at 15 years and 3 months. At the most recent examination conducted at 15 years and 9 months, the permanent successor had emerged into the oral cavity and the impacted primary molar maintained a similar position close to the inferior wall of the maxillary sinus without any symptoms. Throughout the observation period, the dental age of the maxillary right second premolar was calculated to be approximately 3 to 4 years behind those of the other second premolars. Our findings in the present case led us to consider that careful observation of the developmental stage of an unerupted permanent tooth is important, while no intervention is required before confirming tooth development as the patient grows, even if the dental age of the corresponding tooth is much later than the ages of other teeth.     

A relatively minor adult case becomes significantly complex: A lesson in humility.

A 41-year-old white woman with no particular concerns about facial esthetics was first seen with bilateral Class II molar relationship, a Class I right canine, and a Class II left canine. Overjet was 3 mm and overbite was 0.5 mm, with no incisor contact. A maxillary right premolar was missing for unknown reasons and all 4 third molars had previously been extracted. The maxillary midline was 2 mm to the right of the facial midline, and the mandibular midline was 3.5 mm to the left of the maxillary midline. There was 7 mm of crowding in the maxillary arch and 6 mm of crowding in the mandibular arch, with an increased curve of Spee. The patient had a well-positioned maxilla, a retrognathic mandible with increased convexity, a Class II denture base relationship, and a vertical facial pattern. The treatment plan consisted of extracting the maxillary left first premolar and the mandibular left central incisor. After 4 months of treatment, an open bite from second premolar to second premolar was noted. After 6 months of treatment, the patient expressed concern with her chin position and mentalis hyperactivity. It was apparent that the orthodontic treatment had resulted in molar extrusion, which the musculature was not able to withstand. Treatment continued and the case was set up for posterior maxillary impaction and mandibular advancement surgical procedures.     

Unerupted second primary mandibular molar positioned inferior to the second premolar: case report.

This report is a clinical case of a 7-year-old child who presented right impacted second primary mandibular molar. This tooth was positioned inferior to the second premolar successor and a supernumerary tooth superior to the second premolar. Clinical examination did not reveal systemic diseases ot trauma in the facial region. Treatment consisted of the extraction of the impacted second primary molar and the supernumerary tooth. Periodic examination was indicated for follow-up.     

Autotransplantation of a premolar tooth in a case of dental bimaxillary protrusion with multiple missing permanent premolars

This paper describes orthodontic treatment combined with autotransplantation of a premolar tooth in a girl aged 8 years 10 months with dental bimaxillary protrusion associated with congenitally missing bilateral lower second premolars and the upper left first and second premolars. We transplanted the right second premolar to the socket of the left second deciduous molar tooth prior to comprehensive orthodontic treatment, and the other socket spaces were closed orthodontically appliances. Good occlusion and facial esthetics were achieved, and these results have been maintained for 3 years after completion of the active treatment.     

成年患者自体牙移植并正畸治疗1例

报告1例成年患者牙列拥挤并前突,通过把正畸治疗并将需拔除的35移植至25,排齐和内收上下牙列,移植的自体牙同时完成了牙周膜和牙髓愈合,维护了牙弓的完整性.     

Pulpalgia contributing to temporomandibular disorder-like pain: a literature review and case report

BACKGROUND: Dentists need to be cognizant that temporomandibular disorder (TMD) -like pain can be caused by a tooth pulpalgia. The author provides suggestive symptom characteristics and definitive diagnostic techniques. CASE DESCRIPTION: A patient had severe bilateral TMD-like pain, which increased when something cold touched a premolar and when the patient lay down, and which awakened her several times every night. The author identified the offending tooth and administered a ligamentary injection along the tooth, which eliminated her bilateral TMD-like pain. Occlusal adjustment of her tooth reduced her pain, and subsequent endodontic therapy eliminated her pain. To the author's knowledge, this is the first report of a pulpalgia in a posterior tooth causing bilateral TMD-like pain. CLINICAL IMPLICATIONS: Pulpalgia may cause symptoms that mimic TMD or may contribute to TMD signs and symptoms. When patients with TMD-like pain report feeling increased pain due to a cold stimulus' coming into contact with a tooth, practitioners should ensure that a pulpalgia is not contributing to their pain.