Endodontic retreatment of a lower canine associated with a periapical lesion: case report of an unusual anatomy

ObjectivesTo describe the endodontic orthograde retreatment of a lower canine with a rare anatomy, affected by a symptomatic periapical lesion.Materials and methodsA 30-year-old Caucasian woman came to our office reporting severe pain and swelling located at the right mandible. A two-roots/two-canals configuration was discovered for the lower canine which sustained the periapical infection; a missed lingual canal was not recognized and treated at the previous primary endodontic therapy.A full pre-operative examination and diagnosis, the application of modern endodontic strategies along with the use of magnification technologies (like the Surgical Operating Microscope - SOM) and proper disinfection protocols were employed for endodontic re-treatment.Result and conclusionsHealing of the periapical infection was clinically and radiographically confirmed at a 9-month follow-up. Endodontists should know the anatomical variations of human teeth and be vigilant about them when approaching treatments. More than a single radiographic projection is recommended in the diagnostic phase.Careful procedures related to instrumentation, cleaning and filling of the entire root canal system enhance the potential for healing of apical lesions.     

Tooth autotransplantation using an interdisciplinary approach to rehabilitation in a young patient: Case report with 7-year follow-up

This case report demonstrates the possibility of functional and aesthetic rehabilitation using an interdisciplinary approach in a child following avulsion of a tooth. Autotransplantation after the development of calcific metamorphosis of the pulp and acute apical periodontitis provided satisfactory repair after root canal treatment. A 7-year-old white boy avulsed the right maxillary central incisor (tooth 11). The extra-alveolar time exceeded 60 minutes, and this triggered external replacement resorption of the avulsed tooth. At 11 years of age, the child underwent tooth autotransplantation. After 4 years of follow-up, intraoral clinical and radiographic examination led to the diagnosis of calcific metamorphosis of the pulp and acute apical periodontitis. The patient had minimally invasive root canal treatment, orthodontic treatment and esthetic rehabilitation with a porcelain crown. Control periapical radiography and tomography of the autotransplanted tooth after 7 years revealed bone repair in the periapical region. This case report indicates that tooth autotransplantation can be used to replace anterior teeth after avulsion followed by replacement resorption. Interdisciplinary management helped to maintain the esthetics and function of the rehabilitated area.     

双侧上颌第一前磨牙三根三根管1例

前磨牙是切牙和磨牙之间的一个过渡牙。其根管系统变异较大,大多数上颌第一前磨牙为双根管,三根管较少见,研究表明上颌第一前磨牙三根管发生率为0~5%。然而,双侧上颌第一前磨牙三根管未见报道。该文报告了一个罕见的病例：双侧上颌第一前磨牙三根三根管。     

An unusual maxillary first molar with four roots and six canals: a case report

This case report presents an unusual maxillary right first molar with four roots and six canals. Endodontic treatment was provided and final restoration was accomplished with composite resin. Treating extra canals in maxillary first molars may be challenging. Inability to find and properly treat the root canals may cause failures. Complete clinical and radiographic examination and a thorough knowledge of the morphology of these teeth is necessary for successful clinical results.     

数字化根管定位导板应用于完全钙化根管的临床报道1例

髓腔完全钙化的牙齿需要行根管治疗时,精确定位并疏通钙化根管、避免侧穿是困扰临床医生的一大难题.随着锥形束CT、口内扫描和3D打印技术的逐步成熟,数字化根管定位导板技术可以通过计算机辅助设计定位到狭窄的根管通路,最大程度地保存牙体组织,提高根管治疗的安全性和成功率,该文报道1例将数字化根管定位导板应用于髓腔完全钙化的前牙...     

Utility of injectable bisphosphonates in enhancing orthodontic retention in a goat model: A split-mouth study

ObjectiveThe aim of this study was to evaluate the utility of bisphosphonates in reducing relapse after orthodontic tooth movement when injected intra-periodontally in a goat model.MethodsRight and left second incisors of four goats were extracted and the first and third incisors were approximated orthodontically and retained. A bisphosphonate gel was injected into the mesial and distal periodontal spaces of first and third incisors on one side, while the first and third incisors of the other side received normal saline as a control. After 12 weeks of retention, the orthodontic appliance was removed and teeth were relieved from any active force. Following 6 weeks from appliance removal, millimetric measurements were performed to calculate the amount of relapse of orthodontically moved incisors. Histological and microcomputed tomographic examination was performed to assess the periodontal space and surrounding alveolar bone of the study and control incisors.ResultsThe millimetric measurements and microcomputed tomographic scanning revealed that the orthodontically moved incisors in the side of bisphosphonate injection had significantly less relapse (p ≤ 0.05) and significantly narrower periodontal ligament width (p ≤ 0.05) than in the control side, respectively. Histologically, newly formed bone projecting into the periodontal ligament was observed in the side of bisphosphonate injection with newly formed cementum overlying areas of resorbed cementum.ConclusionThe results suggest that bisphosphonate injection has the potential to enhance post-orthodontic stability and repair of root resorption following orthodontic treatment.     

Hemisection for treatment of an advanced endodontic-periodontal lesion: a case report

AIM: To emphasize the importance of primary endodontic treatment when dealing with endo-perio lesions and to demonstrate the considerable healing potential of the endodontic aspect. CASE REPORT: After several years of unsuccessful symptomatic periodontal treatment, an advanced endo-perio lesion on a right-mandibular first molar was successfully treated by root-canal treatment and hemisection after the re-evaluation of the lesion. This successful treatment appeared to have a positive effect on the patient's general well-being. KEY LEARNING POINTS: The origin of a combined endo-perio lesion is indicated by its clinical and radiographic appearance. The periodontal situation is often misinterpreted. The prognosis for the endodontic element of treatment is excellent. Local pathologic processes in the oral cavity may affect a patient's general health.     

上颌第二磨牙腭侧双根双根管1例

上颌第二磨牙根管系统变异较大,多为三根管,有时可见颊根融合,腭侧双根管较为罕见.报告1例较为罕见的上颌第二磨牙腭侧双根双根管病例,提示在接诊过程中,临床医师应对上颌第二磨牙的髓腔解剖形态做到心中有数,结合现代牙科辅助手段,做好根管治疗.     

Esthetic restorations of maxillary anterior teeth with orthodontic treatment and porcelain laminate veneers: a case report

If orthodontists and restorative dentists establish the interdisciplinary approach to esthetic dentistry, the esthetic and functional outcome of their combined efforts will be greatly enhanced. This article describes satisfying esthetic results obtained by the distribution of space for restoration by orthodontic treatment and porcelain laminate veneers in uneven space between maxillary anterior teeth. It is proposed that the use of orthodontic treatment for re-distribution of the space and the use of porcelain laminate veneers to alter crown anatomy provide maximum esthetic and functional correction for patients with irregular interdental spacing.     

Internal and external resorption in a lower molar with an associated endodontic‐periodontic lesion: A case report

This article describes a unique case in which both internal and external inflammatory resorption and endodontic‐periodontic lesions were present at the same time in the patient's left mandibular first molar. Based on clinical and radiographic findings, it was determined that the nature of this case was a pulpal infection‐induced inflammatory resorption and furcation lesion. After root canal therapy, the furcation lesion and external inflammatory resorption were completely resolved. This case indicates that the correct diagnosis of the stimulating factor for tooth resorption and determination of the primary origin of endodontic‐periodontic lesions are critical for clinical management and success.     

Condylar resorption during active orthodontic treatment and subsequent therapy: report of a special case dealing with iatrogenic TMD possibly related to orthodontic treatment

A 28-year-old female underwent orthodontic treatment for approximately 22 months. During the later stages of this treatment, the patient reported right shoulder and neck-muscle pain. In addition, temporomandibular joint disorder (TMD) with a 'clicking' sound during mastication commenced 5 months prior to treatment completion. Specific medication to deal with these symptoms was suggested by medical specialists, as were some stress-relief methods, although the pain still progressed, and subsequent clinical and radiographical examinations were undertaken by another orthodontist. Right mandibular condylar resorption was observed from both the panorex and temporomandibular joint (TMJ) radiographs. No clinical signs of rheumatic disease were observed, although bruxism was noted. Following the termination of the orthodontic treatment by the second practitioner, the patient was treated with splint therapy 1 month subsequent to which, the previous symptoms of pain in the shoulder and neck, and the clicking sound during mastication had subsided. During the 14-month period of splint therapy and follow-up, new bone growth in the right condyle was observed from radiographs.     

Root canal treatment on a patient with zinc oxide allergy: a case report

AIM: To describe successful root canal treatment of a patient with a true zinc oxide allergy and to discuss allergic reactions to dental materials. SUMMARY: Dental materials have been reported as aetiologic agents for both local and systemic allergic reactions. It is essential for the oral healthcare provider to recognize the clinical symptoms associated with allergic reactions and to modify dental treatment, if necessary, to prevent these reactions from occurring. This article describes an unusual case of a patient with an allergy to zinc oxide. To our knowledge, this is the first case of successful root canal treatment of a patient with confirmed zinc oxide allergy to be reported in the dental literature. KEY LEARNING POINTS: Medical and dental histories must be evaluated to prevent medical complications secondary to dental treatment. Any patient suspected of having an allergy to dental materials should be referred to a healthcare professional capable of performing and interpreting allergy tests prior to dental treatment.     

Endodontic treatment of an immature maxillary lateral incisor with type II dens invaginatus in an orthodontic patient: A case report

This paper presents a case report of an immature maxillary lateral incisor with type II dens invaginatus, with a periapical lesion. The tooth was treated with MTA apical barrier followed by root filling with thermoplasticised GP and restoration with resin composite. Three-year radiographic follow-up showed healing of the apical lesion and normal clinical parameters.     

Combined orthodontic and prosthodontic treatment in an adolescent patient with traumatically ankylosed incisors: A case report

Symmetric extraction of premolars is a frequently used orthodontic treatment for dental crowding and protrusion. However, when a patient has incisors with ankylosis, the establishment of a treatment protocol often plagues orthodontists. An adolescent patient with a history of incisor trauma sought treatment for dental protrusion and crowding. Upon percussion of his infrapositioned maxillary central incisors, characteristic dull metallic sounds were noted, and a lack of normal mobility of these teeth under the application of external forces was detected. Follow-up radiographs after the trauma showed replacement root resorption of the maxillary central incisors. Based on clinical and radiological findings, ankylosis of the maxillary central incisors was tentatively diagnosed. A combination of orthodontic and prosthodontic treatment options involving extraction of the maxillary central incisors and mandibular first premolars was chosen to resolve the functional and esthetic problems. After treatment, well-aligned dentition, improved smile esthetics, and a more harmonious facial profile were achieved, and these outcomes remained stable during the follow-up period. This case report illustrates a viable treatment strategy for tackling predicaments caused by ankylosed incisors, which is unusual in the literature.     

Maxillary bone lesions in McCune-Albright syndrome: a case report

Objectives

In this study, we report on the clinical maxillary manifestations of a patient affected by McCune-Albright syndrome and the implications for orthodontic therapy.

Materials and methods

A male, 8-year-old patient was examined at the Department of Orthodontics of the University of L’Aquila for a problem of anterior open-bite. In the clinical examination, a small swelling of the left hemi-maxilla was seen in the area corresponding to the root apex of 16 and under the tooth buds of 14 and 15. In a panoramic radiograph, a radio-opaque area was detected in this zone. From the computer tomography examination, a bone lesion was identified.

Results

Identification of this bone lesion led to the clinical-instrumental diagnosis of McCune-Albright syndrome. This was then confirmed in the histological diagnosis.

Conclusions

It is always useful to have diagnostic doubts about atypical clinical manifestations at the craniofacial level, as they are often local signs of a systemic syndrome. This is important for patient health, and also for orthodontic treatment planning.     

意向性牙再植术治疗上颌侧切牙畸形舌侧沟1例

本病例为上颌侧切牙畸形舌侧沟致牙周牙髓联合病损病例,唇腭根面的凹陷、腭侧窄而深牙周袋、根管系统的峡部、破坏严重的唇腭骨板和迁延不愈的瘘道等,给控制根管内外感染保留该牙提出了严重挑战。本病例采用显微根管治疗技术、意向性牙再植术以及纳米生物活性材料,实现了对该患牙的感染控制、患牙保留以及牙周新附着的形成。     

Allergy to acrylate in composite in an orthodontic patient: a case report

Acrylate allergies have been reported in dental professionals as a result of repeat exposure to various acrylate monomers and in dental patients with removable prostheses or longstanding composite restorations. To date, there is only one report of an allergic reaction in a young patient from small volumes of resin-based orthodontic adhesive. This case report demonstrates a recent case of gingival inflammation and lip oedema attributed to an acrylate allergy arising from the composite adhesive used with fixed appliances. The impact on orthodontic treatment is reported and the wider implications for dentistry are discussed.