Multidisciplinary management of a fused maxillary central incisor moved through the midpalatal suture: A case report

Fusion of a Tooth with a Supernumerary Tooth: A Case Report and Literature Review of 35 Cases

Tooth fusion is a dental anomaly with a prevalence of 0.1% in permanent dentition. The aim of this paper is to present the occurrence, region of fusion, and prognosis of fused tooth which is a very rare case in the literature. The authors present a very rare case with a maxillary right lateral incisor fused to a supernumerary tooth on the palatal side. The eruption was delayed, but eruption occurred naturally at 9 years and 6 months. However, cone-beam computed tomography at 11 years and 6 months revealed it was diagnosed as a fused tooth. The authors undertook a literature review over the past 10 years and found 30 articles about fused teeth between permanent teeth and supernumerary teeth. It was more common in males than females and there were no differences depending on the occurrence. Mesiodistal fusion was more common in the incisor region, while labiopalatal fusion was more common in the molar region. Most cases required dental treatment with a surgical approach, root canal treatment, or orthodontic treatment. The present study highlights the importance of long-term follow-up and suggests the region of fusion and prognosis of the fused tooth may vary depending on the occurrence.

Microesthetics in orthodontics: A systematic review and meta-analysis

BACKGROUND

Microesthetics in orthodontics, which focuses on subtly and precisely enhancing a patient's smile's esthetics, has seen a rise in popularity in recent years. The objective of this systematic study was to assess our present understanding of orthodontic microesthetics.

METHODS

A thorough search was done using the terms "microesthetics in orthodontics," "aesthetic orthodontics," "orthodontic aesthetics," and "orthodontic smile design" across different databases. Articles published between 2011 and 2022 were considered for selection in this review.

RESULTS

Five studies were selected for the review. The meta-analysis found a statistically significant and clinically relevant improvement in microesthetic parameters due to orthodontic treatment. The odds ratio estimate was 0.32 (95% confidence interval (95% CI): 0.28 to 0.37), suggesting a noticeable effect of orthodontic treatment on microesthetic parameters. The forest plot also showed an overall risk ratio of 0.57 (95% CI: 0.53 to 0.61) and a risk difference of -0.28 (95% CI: -0.31 to -0.24) for noticeable versus negligible effects of orthodontic treatment on microesthetic parameter in patients. The heterogeneity was significant among the studies, with a Chi-square value of 15.34 (P = 0.004) and 14.79 (P = 0.005) for the odds ratio and risk difference, respectively, indicating a moderate level of heterogeneity.

CONCLUSION

The results of this study's review and meta-analysis point to a statistically significant and clinically meaningful difference in the microesthetic parameters between individuals who received orthodontic treatment and those who did not. The heterogeneity statistics, however, indicates significant variation between research studies.

REGISTRATION

This review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42022397219).

Prevalence, classification and dental treatment requirements of dens invaginatus by cone-beam computed tomography

Background

This study aimed the evaluation of the prevalence, characteristics, types of dens invaginatus (DI) and co-observed dental anomalies to understand dental treatment requirements in anterior teeth that are susceptible to developmental anomalies by using cone-beam computed tomography (CBCT).

Methods

In this retrospective study, the anterior teeth of 958 patients were evaluated by using CBCT for the presence of DI. The demographic features, types of DI and treatment requirements were also recorded. The association between sex and the presence of DI was evaluated using chi-squared test.

Results

Seventy-three DI anomalies were detected in the anterior teeth of 49 patients (18 females, 31 males). The frequency of DI was 5.11% and the most frequently involved teeth were lateral (57.53%). Forty-six teeth were classified as Type I (63.01%), 24 as Type II (32.87%), and three as Type III (4.10%). Apical pathosis was found to be 20.54% in all DIs detected and accounted for all Type III and one-third of Type II.

Conclusions

CBCT imaging can be effective in the detection of dental anomalies such as DI and planning for root canal therapy and surgical treatments. Prophylactic interventions might be possible to prevent apical pathosis with the data obtained from CBCT images.

Post-trauma complex orthodontic approach: the impact of psychological issues of bullying on treatment decision

Objective:

This article aims to discuss the multidisciplinary approach required in the treatment of cases of impaction and ankylosis of permanent teeth, associated with a history of trauma, considering the psychological state of the child and family when faced with a traumatic case of bullying, by reporting the complex treatment of a central incisor needing to be orthodontically moved across the midline.

Conclusion:

This clinical case was a major challenge, which included complex multidisciplinary procedures. Results and stability after 26 months of retention indicated successful orthodontic space closure of two maxillary teeth, without the use of implants or prostheses, in an adolescent patient who had a history of dental trauma, alveolar bone loss, and an uncertain initial prognosis.

Opportune management of a patient with a macrodont and supernumerary tooth

Macrodontia is a relatively uncommon dental anomaly and has often been reported to occur in association with other dental anomalies. Significant orthodontic and restorative challenges may arise in the management of patients with macrodont teeth. This case report demonstrates the opportune and carefully considered management of a patient presenting with both a macrodont and a supernumerary incisor tooth.

A rare case of bilateral double incisors; Early orthodontic management

A safe and suitable approach in the treatment of unusual malformed anterior maxillary teeth would be to accept a birooted fused incisor as two central teeth by moving it across the midpalatal suture and improve the frontal esthetics.