Unusual root development following surgical repositioning of horizontally developing central incisor

The enhanced conservation of vital pulp and apical tissues by the application of crown rotation surgery for inversely impacted central incisors: a follow-up analysis of two patients over four years

AIM

To describe a novel surgical method (crown rotation surgery) to manage inversely impacted central incisors with immature roots.

SUMMARY

Two young patients each presented with an inversely impacted maxillary central incisor. To protect the apical tissues, the two impacted incisors were rotated downwards to a relatively normal position without extraction from their bony sockets. After crown rotation surgery, spontaneous eruption, continuous root development, and periodontal healing of the rotated incisors were observed. The pulp retained vitality and blood flow was normal. Moreover, there were no obvious signs of pulp canal obliteration (PCO), as indicated by Cone Beam Computed Tomography (CBCT) imaging.

KEY LEARNING POINTS

• By optimising protection of the vital pulp and apical tissues, crown rotation surgery represents a minimally invasive, conservative, and practical surgical technique for treating inversely impacted incisors with developing roots. • In contrast to existing surgical methods, crown rotation surgery may avoid certain complications, including PCO and abnormal or arrested root development.

[Phantom root as dental trauma complication in immature teeth (systematic literature and clinical cases review)]

The paper presents literature review and the analysis of three clinical cases of phantom root development. Phantom root is a rare complication occurring as a result of apical papilla detachment, usually after dental trauma. Some authors suggest regenerative endodontic procedure may contribute to phantom root development because of rude intervention in periapical tissues needed to induce apical bleeding required for intracanal blood clot formation. Phantom root is not an indication for endodontic treatment. The prognosis depends on initial root formation stage and root to crow length ratio at the time of trauma. In the majority of cases the teeth may be preserved, but continuous root development is not to be expected.

Development of a calcified odontogenic hamartoma following avulsion of a permanent central incisor

The avulsion of a permanent immature tooth is a serious condition and a real emergency in dentistry. The management of a traumatized avulsed tooth is always a challenge to the clinician. This case report concerns the development of a calcified odontogenic hamartoma after the avulsion of an immature central incisor in an eight-year-old female. The patient presented for the treatment four months after the avulsion. Her intraoral examination showed complete healing of the area but an atypical appearance of the alveolar area of the missing tooth was observed in the periapical radiograph. A new radiographic scan performed six months later revealed the formation of a radiopaque irregular structure at the cervical level of the alveolar ridge at the site of the missing tooth. Surgical removal was performed, and the histopathological examination revealed a hamartomatous proliferation of odontogenic tissue with calcification. After healing, the lateral incisor was orthodontically moved mesially and restored to resemble the central incisor. An orthodontic device was installed to improve function and aesthetics of the patient.

Can forces be applied directly to the root for correction of a palatally displaced central incisor with a dilacerated root?

This case report describes the interdisciplinary treatment of an ectopic horizontally placed maxillary right central incisor with severe root dilaceration. The root was distally angulated and entrapped by the root of the maxillary right lateral incisor. The initial force system was aimed at an occlusal displacement and applied to the crown. During the second phase, a button was cemented onto the apex of the impacted tooth. A force from the apex to a temporary anchorage device in the palate moved the root toward the midline. Finally, a root canal and an apectomy were performed and the central incisor could be moved to its ideal position. The treatment generated a normal height of the alveolar bone and an ideal occlusion with a healthy periodontium.