Maxillary lateral incisor agenesis and microdontia: Minimally invasive symmetric and asymmetric esthetic rehabilitation

Maxillary lateral incisor agenesis is a condition that significantly compromises smile esthetics, which is particularly worrying in young patients. This article shows how the combination of non-invasive treatments and current restorative options may improve clinical outcomes following orthodontic treatment for symmetric and asymmetric maxillary lateral incisor agenesis and microdontia. Teeth were treated with conservative resin restorations in three separate cases: two of congenitally missing maxillary lateral incisors (i.e., unilateral and bilateral) and one of microdontia. After presenting the clinical results, this article summarizes how bleaching, enameloplasty, and bonding with composite resin can enhance esthetics and functions following orthodontic space closure. The cases reveal that carefully planned, methodically executed orthodontic and restorative approaches can achieve predictable, esthetic outcomes that will improve the patient’s self-esteem with a minimally invasive solution.

Long-term follow-up of mandibular dental arch changes in patients with complete non-syndromic unilateral cleft lip, alveolus, and palate

Background Treatment of cleft lip and palate (CLP) requires a comprehensive interdisciplinary approach and long-term follow-up. Only a few studies are available that reported on changes after treatment, which showed that in particular the transverse dimension, in patients with CLP is prone to changes after treatment. However, those studies did not pay attention to concomitant changes in the mandibular arch that occur after treatment. Objectives To evaluate mandibular transverse dental arch dimensions and interarch transverse changes in patients with complete non-syndromic unilateral cleft lip, alveolus, and palate (CUCLAP) up to five years after treatment. Material and Methods Retrospective longitudinal study in 75 consecutive patients with CUCLAP directly after comprehensive treatment (T0), two (T2), and 5 years after treatment (T5). Great Ormond Street, London and Oslo (GOSLON) scores were available for all patients. Three-dimensional scans of all dental casts were made. Inter premolar and intermolar distances between the mandibular contralateral teeth were measured. The modified Huddart Bodenham (MHB index) was applied to assess the transverse interarch relationship. Paired t-tests and ANOVA were used to analyze transverse and interarch transverse changes. Linear regression analysis was done to define contributing factors. Results Paired t-tests showed a significant decrease of the mandibular inter first and second premolar distances (p < 0.05) and an increase of the inter second molar distance, whilst the MHB Index deteriorated at all time points for all segments and for the total arch score (p < 0.05). Linear regression showed no significant contributing factors on the decrease of the transverse distances. However, inter arch transverse relationship was significantly affected by age at the end of treatment, missing maxillary lateral incisor space closure, and the GOSLON Yardstick score at the end of treatment (p < 0.05), especially during the first two years after treatment. Conclusions Changes occurred in the mandibular arch expressed as changes in the transverse dimensions and interarch relationship measured by the MHB Index. A younger age at the end of treatment, space closure for a missing maxillary lateral incisor and a higher GOSLON score at the end of treatment negatively influence the interarch transverse deterioration especially in the first two years after treatment. For the transverse dimensional changes in the mandibular arch such influencing factors could not be determined.

Endodontic Management of a Maxillary Lateral Incisor with Dens Invagination and Periapical Lesion: A Case Report and Mini Review of the Literature

Dens invagination (DI) is a dental anomaly that can cause pulpal and periapical pathoses of the affected tooth. We describe the treatment of a healthy 18-year-old female with a chief complaint of recurrent facial swelling pertaining to a peg-shaped maxillary lateral incisor with DI. Examinations showed necrosis of the involved tooth with symptomatic apical periodontitis. Cone-beam computed tomography corresponded to Oehlers type II DI. Orthograde endodontic treatment was performed. To completely debride the canal and resolve the persistent purulent discharge, various methods and medicaments were used in separate sessions including passive ultrasonic activation of 5.25% sodium hypochlorite solution, calcium hydroxide mixed with 2% chlorhexidine, and double antibiotic paste as intracanal medicament. After resolution of the symptoms, the root canal and the invaginated space were filled by a mineral trioxide aggregate plug and backfilled with thermoplasticized gutta-percha. At the one-year follow-up, complete bone healing was noted in the affected periradicular area.

Inter-Incisive Index in South Bulgarians and Its Application in Aesthetic Dentistry

Background: In recent years, aesthetic dentistry has become a major focus for the public. Facial attractiveness plays a key role on modern society and the creation of harmonious smile is an aim for every dentist.The aim of this study was to define certain values of the inter-incisive index in South Bulgarians, the sexual dimorphism and bilateral asymmetry and to verify differences of this index between Bulgarians and other Balkan populations.Materials and methods: The present study included 86 males and 83 females of Bulgarian origin living in South Bulgaria aged 20-40 years. Mesiodistal dimensions of maxillary central and lateral incisors were measured by Dentistry Sliding Vernier Caliper. We used the technique of Martin-Saller, modified by Prof. Y. Yordanov. We calculated the inter-incisive index as ratio of the mesiodistal dimension of maxillary lateral incisor to the mesiodistal dimension of the maxillary central incisor. The measurements were analyzed with SPSS 23. The level of statistical significance was set at P< 0.05. Results: The inter-incisive index showed no statistically significant differences between left and right side of the dental arch in both sexes. We did not find statistically significant differences between males and females as well. On the other hand we found statistically significant differences in MD values of incisors between Bulgarians and other Balkan nations.Conclusion: Inter-incisive index shows no sexual dimorphism and bilateral asymmetry in South Bulgarians. This can be helpful in aesthetic dentistry, in prosthodontics and in orthodontic treatment planning.

Resolution of a large periapical lesion in an immature maxillary lateral incisor with the aid of triple antibiotic paste

Apexification procedures are frequently performed on immature permanent teeth with incomplete root formation, open apices and necrotic pulp status with or without periapical lesions in order to induce a calcific barrier prior to root canal therapy. The elimination and control of infection in the root canal space is critical to the success of these procedures. A healthy 21-year old male presented with pulpal necrosis, a large periapical lesion, incomplete root formation and an open apex on a maxillary right lateral incisor. Triple antibiotic paste was used to achieve antimicrobial control after traditional calcium hydroxide paste medicament failed to resolve the symptoms. Obturation was achieved using MTA and the conventional apexification technique. Excellent healing of the large periapical lesion was achieved without surgical intervention and the 4-year follow-up CBCT demonstrated complete bone fill of the lesion. Clinicians should be aware that alternative antimicrobial medicaments, such as triple antibiotic paste, may be beneficial in situations where conventional medicaments prove unsuccessful. The use of triple antibiotic paste may result in sufficient healing of the periapical lesion to justify placement of an MTA apical barrier without the need for surgical intervention

Analyses of oligodontia phenotypes and genetic etiologies

Oligodontia is the congenital absence of six or more teeth and comprises the more severe forms of tooth agenesis. Many genes have been implicated in the etiology of tooth agenesis, which is highly variable in its clinical presentation. The purpose of this study was to identify associations between genetic mutations and clinical features of oligodontia patients. An online systematic search of papers published from January 1992 to June 2021 identified 381 oligodontia cases meeting the eligibility criteria of causative gene mutation, phenotype description, and radiographic records. Additionally, ten families with oligodontia were recruited and their genetic etiologies were determined by whole-exome sequence analyses. We identified a novel mutation in WNT10A (c.99_105dup) and eight previously reported mutations in WNT10A (c.433 G > A; c.682 T > A; c.318 C > G; c.511.C > T; c.321 C > A), EDAR (c.581 C > T), and LRP6 (c.1003 C > T, c.2747 G > T). Collectively, 20 different causative genes were implicated among those 393 cases with oligodontia. For each causative gene, the mean number of missing teeth per case and the frequency of teeth missing at each position were calculated. Genotype–phenotype correlation analysis indicated that molars agenesis is more likely linked to PAX9 mutations, mandibular first premolar agenesis is least associated with PAX9 mutations. Mandibular incisors and maxillary lateral incisor agenesis are most closely linked to EDA mutations.

Endodontic management of dens invaginatus of maxillary lateral incisor: A case report

Dens invaginatus is a developmental malformation of teeth with the enfolding of enamel and dentin into the pulp chamber and sometimes into the root that most commonly affects the maxillary lateral incisors. This anomaly may increase the risk of pulpal disease and can potentially complicate treatment due to its aberrant anatomy, thus posing a diagnostic challenge. Similarly, the incomplete elimination of the invagination and debridement may create dead space within the canal leading to the failures. This case reports the endodontic management of the Oehler’s type II Dens invaginatus.

Anterior fracture tooth management using richmond crown-A case report

Maxillary central incisor is the most commonly affected tooth during trauma followed by maxillary lateral incisor and mandibular incisors. Trauma to the anterior tooth requires urgent care because of the essentiality of preserving the natural tooth. When a complicated crown a fracture takes place, it necessitates endodontic treatment and restoration of a fractured crown segment with post in the canal. This case report describes a patient with a broken central incisor and treated with a Richmond crown.