Interdisciplinary management of an impacted dilacerated maxillary central incisor

Abstract

Introduction: Tooth dilacerations are dental anomalies characterized by an abrupt deviation in the longitudinal axis of a tooth. They may occur either in the crown, between the crown and root, or in the root. Although not so common, impacted maxillary incisors exhibiting root dilaceration pose a diagnostic and treatment challenge to the clinician. Description: This case report describes the management of a horizontally impacted and dilacerated maxillary central incisor in a 12-year-old girl. Cone-beam computed tomographic scans were used to accurately localize the position of the dilacerated tooth, and to assess the extent of root formation and degree of dilaceration present in the root. Treatment included surgical exposure and orthodontic traction, followed by root canal treatment and apicoectomy. Results: Through a meticulously planned interdisciplinary approach, the impacted dilacerated central incisor was properly aligned and demonstrated good stability after the long-term follow-up. Conclusion: Taking into consideration the concerns and expectations of the patient, communicative feedback between the oral surgeon, orthodontist and endodontist helped achieving successful esthetic, structural and functional outcome in the present case.

Endodontics-orthodontics interrelationship: a review.

“…In a case report with interdisciplinary patient management, the orthodontic-surgical extrusion of the impacted maxillary canine and periaradicular surgery of the deviated root of an adjacent premolar showed successful treatment outcomes (Pedullà et al, 2015). Periradicular surgery to remove the dilacerated root of the right maxillary incisor that performed after orthodontic traction resulted in successful outcomes; having good periodontal and orthodontic stability (Singh et al, 2018). Another case reporting a combination of orthodontic tooth movement and periradicular surgery resulted in a resolution of periapical inflammation and no progression of root resorption after a two-year follow-up (Bi et al, 2020).…”

“…It is also unclear pertaining to the ability of teeth that have undergone periradicular surgery to move successfully following orthodontic treatment. The reported data on the combined treatment modalities of periradicular surgery and orthodontics was published by limited numbers of researchers (Pedullà et al, 2015;Singh et al, 2018;Bi et al, 2020). In a case report with interdisciplinary patient management, the orthodontic-surgical extrusion of the impacted maxillary canine and periaradicular surgery of the deviated root of an adjacent premolar showed successful treatment outcomes (Pedullà et al, 2015).…”

“…Complicated crown-root fractures are considered challenging because 46% of general dentists find themselves unable to treat the cases and require referral to orthodontic and periodontal specialists (De Castro et al, 2010). In certain clinical cases, orthodontic tooth movement is a feasible approach to align the affected tooth/teeth prior to endodontic treatment as highlighted in the previous case reports (Singh et al, 2018;Bi et al, 2020;Sonoda et al, 2018). Leaving dental pulp untreated after severe dental trauma can lead to complications such as pulp necrosis, apical periodontitis, and root resorption (Scholtes et al, 2018).…”

Erfolgreiche kieferorthopädische Einstellung eines dilazerierten oberen mittleren Inzisivus – ein Fallbericht

“…Im vorliegenden Fallbericht beschreiben wir eine erfolgreiche kieferorthopädische Einstellung eines verlagerten dilazerierten oberen mittleren Inzisivus unter Erhaltung der Vitalität des betreffenden Zahnes. Frühere Berichte über eine erfolgreiche kieferorthopädische Einstellung von dilazerierten Schneidezähnen weisen dabei mit wenigen Ausnahmen nicht auf die Problematik der Verankerungsqualität hin [2,[11][12][13][14][15][20][21][22][23][24]. Diese ist während der gesamten Behandlungszeit von höchster Wichtigkeit, um unerwünschte Nebeneffekte wie eine Intrusion oder Kippung von Nachbarzähnen zu vermeiden.…”

“…Diese ist während der gesamten Behandlungszeit von höchster Wichtigkeit, um unerwünschte Nebeneffekte wie eine Intrusion oder Kippung von Nachbarzähnen zu vermeiden. Stehen bei einem späteren Behandlungsbeginn [15] in der zweiten Wechselgebissphase genügend bleibende Zähne zur Verfügung, können diese in ihrer Gesamtheit in Verbindung mit einem rigiden Stahlbogen als Verankerung ausreichen. Soll aber die Behandlung früher begonnen werden, müssen entsprechende zusätzliche Hilfsmittel angewendet werden.…”