Dilaceration of maxillary central incisor: a literature review

Abstract

-The main purpose of this review is to present the aetiological factors and the mechanism that cause dilaceration of the maxillary central incisors. In early developmental stages, the permanent tooth germ of the maxillary incisor is situated palatally and superiorly to the apex of the primary incisor and gradually changes direction in a labial direction with its crown coming closer to the resorbing primary root. For reasons of this close relationship between the permanent tooth germ and the apex of the primary incisor, it is believed that an acute trauma to the primary predecessor can cause dilaceration of the long axis of the permanent successor. Clinically, dilaceration can be revealed by palpation high in the labial sulcus or in the hard palate, while its radiographic view is characteristic. The therapeutic approach to the dilacerated maxillary central incisors has to be carefully planned and needs the cooperation of several specialities to attain the final objective.

Cellular and molecular mechanisms of tooth root development

“…This finding is consistent with recent work demonstrating that the neurovascular bundle secretes factors that contribute to stem cell maintenance and homeostasis . Dilaceration is another malformation of the tooth root, typically observed as part of an eruption disorder (Topouzelis et al, 2010). It is characterized by a sharp curvature in the apex of the tooth that is frequently the consequence of indirect trauma to the primary teeth.…”

Developmental anomalies affecting the morphology of teeth – a review

“…Pulp necrosis and periapical inflammation may be a common finding even in the absence of decay because the bent portion acts as a nidus for bacterial entry due to defective enamel and dentin [3]. Some syndromes and developmental anomalies such as Smith Magenis syndrome, hypermobility type of Ehlers-Danlos syndrome, Axenfeld-Rieger syndrome, and congenital ichthyosis have been associated with dilaceration [25,76].…”

The aberrant central incisor

“…The position and severity of the dilaceration depends on the timing and degree of the intrusion injury in relation to root development of the permanent central incisor. Roughly 20-30% of all dilacerations occur as a result of a traumatic injury to the primary tooth 18 , with around 70% being developmental in origin 3 .…”

“…This can be assessed with a lateral cephalogram 18 or with Cone Beam Computed Tomography (CBCT) 19 ( Figure 7). Should alignment be planned, the root apex of the dilacerated tooth will be translated a significant distance and is at high risk of external root resorption 20 .…”