An application of a splint purposeful resin-bonded fixed partial denture after orthodontic treatment: a case report

An adult male patient who had lost his maxillary left central incisor seven years ago in a traffic accident presented with a chief complaint about his unaesthetic appearance associated with the loss of his maxillary left central incisor space, a Class III molar occlusion, and an anterior open bite malocclusion due to tongue-thrust swallowing. Fixed orthodontic treatment was rendered following fan-type expansion of the maxilla. A Maryland bridge as a minimally invasive dentistry approach was used as a retention appliance and the patient's aesthetic appearance was restored.     

Nonsurgical endodontic treatment of a two-rooted maxillary central incisor

This case report presents an uncommon case of a two-rooted maxillary central incisor with a periapical radiolucent lesion. A 17-yr-old female patient was referred for dental consultation after a motorcycle accident. The maxillary left central incisor had a bifurcated root that was confirmed by radiographs taken at different angles. Nonsurgical endodontic therapy was performed. At the 1 yr recall examination, the tooth was asymptomatic and the radiograph showed that the periapical radiolucent lesion had healed.     

Enamel hypoplasia of a maxillary central incisor

This article describes a case of a permanent central incisor with enamel hypoplasia. A 7-year-old patient had suffered an injury in a car accident when she was 2 1/2 years old. The maxillary right central deciduous incisor was lost in the accident. At the time of examination a fistula was present buccally to the maxillary right permanent incisor, which had erupted only 3 mm into the mouth. The maxillary left central incisor had erupted fully. After clinical and radiographic examination the lost deciduous incisor was found in the bone buccally to the permanent incisor. The deciduous tooth was extracted surgically, the fistula healed and the gingiva became normal. The permanent incisor had a 3-mm-wide zone of hypoplastic enamel on the buccal surface of the crown.     

Delayed retrieval of a displaced maxillary third molar from infratemporal space via trans-sinusoidal approach: a case report and the review of the literature

Aim

The aim of this case report is to present the trans-sinusoidal pathway used to remove a displaced maxillary third molar from the infratemporal fossa and review the English literature regarding the techniques used.

Case report

A 21-year-old male patient was referred with the findings of an oroantral fistula on the left maxillary vestibular first molar region and slight restriction of mouth opening. The patient underwent a maxillary sinus surgery in order to remove a sinus retention cyst via Caldwell-Luc access in a dental clinic 4 years ago. A computerized tomography scan showed the inverted third molar to be located in the infratemporal fossa, just between zygomatic arch and lateral pterygoid plate. The tooth was accessed through the remaining lateral bone defect from the Caldwell-Luc approach of the lateral sinus wall. The bone defect was extended. The posterior bony wall of the maxillary sinus was removed via a surgical burr. After that, the displaced tooth was exposed. The tooth was mobilized via Warwick James elevator downwards and removed with a forceps.

Conclusion

Access for surgical removal of the tooth from the infratemporal fossa is not only difficult but also has potential for morbidity due to the structures running through it. Wide incision in the maxillary sulcus and blunt dissection are reported with lower success rates and usually necessitate a second intervention via extraoral route. Trans-sinusoidal approach might be an old fashioned but relatively successfully attempt in the removal of the upper third molars from the infratemporal fossa. Considering the time of removal, if no symptoms were present, it is beneficial to wait for a couple of weeks thus facilitating development of fibrous surrounding around the tooth.

     

Enamel hypoplasia of a maxillary central incisor

Abstract This article describes a case of a permanent central incisor with enamel hypoplasia. A 7-year-old patient had suffered an injury in a car accident when she was 21/2 years old. The maxillary right central deciduous incisor was lost in the accident. At the time of examination a fistula was present buccally to the maxillary right permanent incisor, which had erupted only 3 mm into the mouth. The maxillary left central incisor had erupted fully. After clinical and radiographic examination the lost deciduous incisor was found in the bone buccally to the permanent incisor. The deciduous tooth was extracted surgically, the fistula healed and the gingiva became normal. The permanent incisor had a 3-mm-wide zone of hypoplastic enamel on the buccal surface of the crown.     

A case of supernumerary primary and permanent canines

A case of supernumerary primary and permanent canines is presented. A 9Y4M-old boy was referred to our clinic for consultation regarding a maxillary supernumerary primary canine. An oral examination showed 2 primary canines with a similar morphology between the maxillary left lateral incisor and first primary molar. The primary canine in the opposite quadrant had the appearance of a fused-tooth, with composite resin restoration seen in the border. Orthopantomography revealed that permanent successors were present for each primary tooth in the maxillary left region, whereas only a single permanent canine was developing in the opposite quadrant. The 2 primary canines in the maxillary left region were extracted at 9Y4M. The mesially located permanent canine emerged into the oral cavity at 10Y1M and was extracted at 10Y9M. At 12Y2M, the other permanent canine located in the distal position had nearly reached the occlusal plane and the maxillary right permanent canine had arrived at the occlusal plane. Dental age was evaluated by assessing the tooth formation stages in 4 orthopantomographs taken between 8Y5M and 12Y2M, and found to be nearly the same as chronological age. However, the dental ages of the maxillary left permanent canine that had erupted earlier than the one located distally and of the left permanent canine were approximately 1 year behind chronological age. In addition, the dental age of the left permanent canine located distally was 2.5 years behind until the patient reached the age of 10Y9M, after which tooth development was accelerated following extraction of the mesially located permanent tooth.     

Accidental displacement of impacted maxillary third molar: a case report

An unusual case of an impacted right maxillary third molar that was accidentally displaced into the maxillary sinus during exodontia and was surgically retrieved almost 2 years later is described. The tooth was removed under general anesthesia, after maxillary sinus exposure through Caldwell-Luc approach. Postoperative recovery was uneventful. Six months after the retrieval surgery, the maxillary sinus was completely healed and the patient did not present any complaint.     

Lingual displacement of an entire lower third molar. Report of a case with suggestions for prevention and management

Perfect knowledge of regional anatomy is the main factor in the prevention of tooth displacement during lower third molar extraction. Some technical expedients should be used to avoid the occurrence of this accident and to manage it if it anyway happens. The patient was seen just 2 days after his left lower third molar was lingually displaced during surgical extraction. Two mucoperiosteal flaps were made under general anaesthesia, one on each side of the mandible, to obtain good exposure of the previous bone access and to retrieve the tooth. No further complications occurred. Lower third molar extraction becomes complicated if tooth displacement happens. Predisposing factors of this accident are analyzed and the rules to minimize the risk of its occurrence and to simplify the retrieval of the displaced tooth are discussed.     

Traumatic intrusion of primary tooth: follow up until eruption of permanent successor tooth

Abstract –  This paper presents a clinical case of a 2½-year-old boy who suffered dental trauma because of a fall from a bike. His father thought that the boy's central upper left incisor had been fractured. The clinical exam showed laceration of the upper maxillary frenum and a possible intrusion of the tooth, as the area was swollen. An upper maxillary occlusal X-ray confirmed the intrusion of the incisor. The procedure adopted was to wait for the re-eruption of the tooth. It was recommended that the boy stop using a pacifier and feeding bottle. The necessity of keeping the affected area clean was also emphasized. The patient was observed and, within 6 months, the central upper left incisor was found in occlusion. The successor permanent tooth was normal after 6 years.     

Multidisciplinary solution for an avulsed upper central incisor: case report

Abstract – This case report refers to an 18‐year‐old female who suffered from dental trauma when she was 7 years old caused by a bicycle accident. Her maxillary right central incisor was avulsed, and the left one was extrusively luxated. The left central incisor was correctly repositioned and immobilized with a semi‐rigid splint. The right one could not be found. She presented with class II malocclusion and severe negative arch‐length discrepancies in both arches. The treatment objectives were the following: recover smile esthetics by replacing the maxillary right central incisor, correct the class II relationship, and optimally reduce mandibular and maxillary crowding. Extractions of the maxillary left lateral incisor and the lower right first bicuspid were performed; thus, the maxillary right lateral incisor would function as a maxillary right central incisor, the canines would function as lateral incisors, and the first bicuspids would function as canines. This allowed for the malocclusion to be corrected while simultaneously reestablishing the smile esthetics, without the use of an osseointegrated implant. A good occlusion with coincident upper and lower midlines was achieved. After orthodontic therapy, the patient underwent periodontal surgery to improve her gingival margins. Subsequent teeth bleaching was performed, and the patient received six porcelain veneers. A combination of orthodontic space closure and prosthetic rehabilitation may be the best treatment option after severe traumatic tooth loss.     

Orthodontic treatment of an ankylosed maxillary central incisor through single-tooth osteotomy by using interdental space regained from microimplant anchorage

This case report describes the treatment of a boy, aged 13.6 years, whose ankylosed maxillary left central incisor had been avulsed and replanted 2.5 years earlier. Ankylosis of the tooth and adjacent alveolar process led to the development of infraocclusion, migration of adjacent teeth, midline deviation, and a vertical alveolar bone defect. Initially, distal tooth movement in the maxillary arch was performed with microimplant anchorage to gain space for repositioning the ankylosed tooth. Then a single-tooth osteotomy was performed in 1 surgical stage to allow for inferior repositioning of the tooth and bone. The ankylosed tooth was successfully leveled in the maxillary arch with a harmonic gingival margin. The total treatment period was 18 months, and the results were acceptable at 14 months after debonding.     

Orthodontic intervention to a patient injured in a traffic accident

This case report describes the orthodontic treatment of a 29-year-old male who lost the maxillary bilateral central incisors as a result of a traffic accident. After emergency treatment for facial fracture by a plastic surgeon, the patient visited our orthodontic clinic. He had a concave profile, Class I molar relationship with slight maxillary retrusion, and crossbite of the maxillary bilateral lateral incisors. The interdental space was insufficient for prosthetic treatment of the missing maxillary incisors. Therefore, we planned to distalize the maxillary and mandibular molars to obtain appropriate interdental space for the prosthetic treatment of the missing teeth and to correct the crowding of the mandibular anterior teeth. The anterior crossbite was corrected, and appropriate overjet and overbite were obtained with functional occlusion after prosthetic treatment. This case report shows that the favorable occlusion and facial profile are obtained by the interdisciplinary treatment and discusses the specific problems which seen after the traffic accident.     

Cracked Tooth Syndrome: Characteristics and Distribution among Adults in a Nigerian Teaching Hospital

This study highlighted the characteristics and distribution of cracked tooth syndrome (CTS) and the associated factors in adult attendees in the University of Nigeria Teaching Hospital. Three hundred seventy patients aged 18 years to 77 years with CTS-like conditions were included and studied over 12 months. The following information was recorded: suspected tooth and the dental arch, restorative status of the tooth, age and sex of the patient, results of bite test and transillumination, and the pulpal and periapical status of the tooth. CTS was seen most often in the 41 to 50 years age band (36.4%), in molars (63.6%), and in the maxillary arch (51.5%). Also, it was more frequent in men (55.8%). About 82% of CTS occurred in amalgam-restored teeth. All cases had a positive response to the bite test and a normal response to the electric pulp test. Only 10% gave a positive history of masticatory accident as against none with history of bruxism habits. It was concluded that patients with unexplained pain in a vital, amalgam-restored tooth (especially in maxillary molars), with or without a history of a masticatory accident, may have a cracked or fractured tooth.     

Apex formation during orthodontic treatment in an adult patient: report of a case

This clinical report describes an apexification procedure on a maxillary left central incisor in a 34-year-old male who was also receiving active orthodontic treatment. The pulp of the tooth had become necrotic following a traumatic injury when the patient was 8 years of age. Despite the tooth undergoing active orthodontic repositioning with fixed appliances, root-end closure occurred uneventfully and within 3 years.     

Maxillary fungus ball caused by retained foreign bodies for 25 years

We present a case of a maxillary fungus ball caused by retained foreign bodies for 25 years. The patient sustained a stab wound in the left face 25 years ago. The patient had no symptoms and complications of a foreign body, until the patient went to the hospital. The fungus ball and foreign bodies were removed via an endoscopic and Caldwell-Luc approach. We suggest the need for careful inspection and radiologic studies to localize occult foreign bodies in the sinonasal cavity or facial soft tissues after facial trauma.     

关节镜直视下取出误入上颌窦的牙或牙根

目的：介绍一种微创取出进入上颌窦内牙或牙根的方法。方法：2004年3月～2005年2月期间．3例患者在外院拔除上颌磨牙或牙根时，牙或牙根意外进入上颌窦，其中男l例，女2例；平均年龄36．5岁(28-40岁)；l例为左侧上颌第三磨牙，另外2例为上颌第一磨牙牙根。术前全景片证实上颌窦内有高密度异物。经上颌窦前壁开窗．在关节镜直视下取出进入上颌窦的牙或牙根。结果：关节镜直视下成功取出3例误入上颌窦的牙或牙根，术后创口均一期愈合，无任何并发症发生。结论：关节镜直视下取出误入上颌窦的牙或牙根是可行的，具有创伤小、视野清楚、操作时间短等优点；但须具有经过关节镜专门培训的人员方可进行。     

Unusual case of internal resorption in cervical region of maxillary left lateral incisor

We treated an unusual case of internal resorption of the maxillary left lateral incisor seen in a 15-year-old female. The patient was referred to our clinic complaining of repeated cold pain and spontaneous pain in the maxillary left lateral incisor region. An intraoral examination revealed that the tooth was a microdont with a large tubercle, with a pink spot observed in the mesiopalatal area, while radiograph revealed an unusual radiolucent lesion in the cervical area of the affected tooth. Our diagnosis was internal resorption and the affected tooth symptoms ceased after a pulpectomy was performed. Over the next 3 years, periodical examinations performed at 3-month intervals did not reveal further resorption.     

Accidental Extrusion of Sodium Hypochlorite in a Patient Taking Alendronate: A Case Report With an 8-Year Follow-up

Extrusion of sodium hypochlorite (NaOCl) is a very rare accident with the most common complications including pain, swelling, and hematoma. It can occur even if procedural guidelines, predisposing conditions, and risk factors are taken into consideration. A 59-year-old female patient was admitted to the endodontics department to treat a left maxillary first premolar (World Dental Federation tooth 24). The medical history included osteoporosis and systemic medication with alendronate. Initially, the diagnosis was “symptomatic irreversible pulpitis” with “normal apical tissues.” During instrumentation of the buccal canal, accidental extrusion of 2.5% NaOCl occurred into the periapical tissues, resulting from misinterpretation of the working length, and caused severe pain and bleeding. The canal was immediately flushed using copious irrigation with saline solution. An analgesic and corticosteroid were prescribed. At 3 and 7 days, ecchymosis and slight hematoma were observed extraorally in the area of the affected tooth and an intraoral ulceration at the apex of the affected tooth. At 15 days, minimal signs of ecchymosis were observed, and the treatment was resumed. At 30 days after the accident, there was complete remission of the sequelae. The clinical, radiographic, and tomographic assessment after 1 month, 1 year, and 8 years showed favorable case evolution. During the 8-year follow-up, the patient maintained the systemic use of alendronate. It can be concluded that NaOCl extrusion is an accident that causes patients and clinicians to experience an unpleasant consequence. The radiographic working length should always be determined carefully. A successful outcome can be achieved in patients who take alendronate.     

Traumatic displacement of maxillary permanent incisor into the nasal cavity

Purpose

The purpose of this paper was to describe a case of unviable alveolar repositioning of an intruded tooth into the nasal cavity and to bring the subject of intrusive tooth injury among patients with dentoalveolar fractures to the attention of trauma surgeons.

Patient

A 26-year-old male was involved in a car accident and crashed his mouth against the dashboard due to sudden deceleration. Intraoral examination revealed an anterior maxillary dentoalveolar fracture and absence of the central maxillary incisors, right lateral maxillary incisor, and left maxillary canine. Computed tomography showed a dislocated tooth in the nasal cavity. The “missing” left maxillary canine was easily recovered from the floor of the left nostril.

Conclusions

Because complete dislocation of a tooth can cause a frontal sinus abscess, an airway complication, a respiratory tract obstruction, and a complicated lung abscess or sinusitis, anytime a tooth is not accounted for after a dentoalveolar trauma, the possibility that it has been fully intruded should be considered. Computed tomographic scan should be a routine diagnostic study in all cases with associated missing anatomical structures in the oral and maxillofacial region. The need to involve the dental professional in the initial assessment of dental trauma in emergency rooms in hospitals is important in order to identify how many teeth might be missing after dental trauma and to correctly reposition the avulsed teeth when possible.     

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.