TEETH IMPACTION: CHALLENGES AND SOLUTIONS

The aim of the study was investigation of statistics of impaction and semi-impaction in permanent dentition in the population of Georgia, revealing the correlation and feedback of expressed adentia and retention in different groups of teeth. Study was also aimed to determine any regularity in reduction of tooth number of the skeleto-dental system. To comply with this goal, 1000 panoramic images of patients, from 12 to 35 years of age 651 women and 349 men have been examined. In our study cases 1 and 3 were similar. In both situations possible cause of impaction was dental crowding and space deficiency. Similarities were found in facial features as well. Case 1 (N. J.) - NLA (nasolabial angle) was obtuse and patient had prominent chin. E-Line to lower lip was (-5) mm. Therefore tooth extraction could cause adverse esthetic outcome. Case 2 (N.G.) - patient had class I dental and skeletal malocclusion and tendency towards vertical growth (Sn-GoGn- 34°, FMA- 31°). Maxillary right canine was horizontally impacted and was located close to the nasal cavity. Technically it was very difficult to expose canine surgically and put it orthodontically into the dental arch. Deciduous canine was extracted, space was closed and missing canine was substituted with first bicuspid. We ended treatment with right side in functional class II malocclusion and left side in class I molar and canine relationship. Case 3 (N.S.) - Sn-GoGn angle was 28° and FMA -22° -patient had Low Mandibular Plane angle, square Gonial angle and tendency towards "horizontal facial growth". In both cases treatment was without tooth extraction. Spaces were created for retained teeth and facial esthetics was improved. In some cases, the restorative approach can be considered as an alternative to orthodontic treatment. Improvement of facial aesthetics, taking into consideration individual cases and approaches, can be achieved by aesthetic restoration. Despite the considerable number of cases reported in the literature, to find guideline of proper outcome of treatment therapy of abovementioned abnormalities is difficult. That's why, the aesthetic rehabilitation has been suggested, to depend upon the patient's desires, but at the same time, avoid treatment plans with aggressive management.

ANATOMO-MORPHOLOGICAL FEUTURES OF THE ROOT CANAL SYSTEM IN GEORGIAN POPULATION - CONE-BEAM COMPUTED TOMOGRAPHY STUDY

Incomplete and superficial knowledge of morphological types and anatomical variations of the root canal system will become the reason leading to the failure of endodontic treatment. cone-beam computed tomography (CBCT) - it is a technologically more sophisticated, interesting, reliable, non-invasive imaging technique with high degree of visualization, considered as a particularly important and useful tool to study complexity and variability of canal system. 2753 teeth of 228 patients have been studied by CT. Ages of the patients varied within 25-55 years. Among them 122 men and 106 women. Maxillary teeth - 1394 and mandibular - 1359, respectively. The aim of our study was investigation and evaluation of: tooth length, number of roots and canals, type of configuration, root canal curvature and degree of curvature in Georgian population. The results of the study revealed interesting data and anatomical characteristics, those replicating the racial signs and differs from the data recorded by the other researchers, became evident. In studying of dental form variations were interested anatomists (description and comparison) anthropologists, biologists, palaeontologists and stomatologists. The field of human dental anatomy has not been completely explored so, the modern human teeth still remain a matter of continual curiosity and research. The knowledge of anatomical characteristics of dental root canals will help clinicians to optimize the algorithm of endodontic treatment. Thus, statistic data are not the universal criterias, however, basing on these indicators anthropometrical data of roots and canals vary according to the geographic zones and nationalities. The study of variations in tooth form has interested anatomists (description and comparison), anthropologists, biologists, palaeontologists and dentists. The field of human dental anatomy has not been completely explored and the dentition of modern man still remains a matter of continual curiosity and research. Thus, statistic data are not the universal criterias, however, basing on these indicators anthropometrical data of roots and canals vary according to the geographic zones and nationalities. The study of variations in tooth form has interested anatomists (description and comparison), anthropologists, biologists, palaeontologists and dentists. The field of human dental anatomy has not been completely explored and the dentition of modern man still remains a matter of continual curiosity and research.

The maxillary second molar - anatomical variations (case report)

To be acquainted with dental anatomical specificity is of great importance for dental endodontic treatment algorithm. The subject of present publication is 2 clinical cases of upper second molars, detailed characterization of, which is considered very important for enrichment of anatomical knowledge about dental anatomical variations. In one case, the reason for admission to the clinic of a 38-year-old woman was complains as of esthetic character as well as functional misbalance (disturbance of chewing function due to the damage of orthopedic construction). The patient indicated to the existence of coronary defects of large size aesthetic discomforts, damage and discolouration of old orthopedic construction (denture) in maxillary right molar area. According to the data obtained after clinical and visiographical examinations, chronic periodontitis of 17 teeth was identified as a result of incomplete endodontic treatment. According to the data obtained after clinical and visiographical examinations, the diagnosis of chronic periodontitis of 17 teeth was identified, tooth 17 with 2 roots and 2 canals. In the second clinical case, the reason for admission to the clinic of a 39-year-old woman was severe pain in the upper right molar area. The patient indicated to the caries on the tooth 17. After completion of proper survey clinical and visiographical examinations, acute pulpitis (K04.00) - with three roots and 4 canals was diagnosed. In both cases after the proper examinations and agreement with the patients a treatment plan envisaging: 17 teeth endodontic treatment, filling of caries defects and their preparation on one hand for orthopedic construction (denture) and on the other hand for restoration of anatomical integrity by light-cured composite, was scheduled. The present study is designed to prevent complications of endodontic treatment of the second molar, to optimize diagnosis and treatment algorithm, once again proving reliable information indicating to the individuality of treatment tactics.

Gemination or fusion? - challenge for dental practitioners (case study)

Gemination and fusion are anomalies in size, shape and structure of teeth. Gemination more frequently affects the primary teeth, but it may occur in permanent dentitions, usually in the incisor region. Geminated teeth are typically disfigured in appearance due to irregularities of the enamel. Fused teeth can have separated pulpal space, one pulp chamber and two canals or take the form of a large bifid crown with one pulpal space. It is hard to differentiate between fusion and gemination, especially if the supernumerary tooth bud is fused with the adjacent one. Usually, fusion may be differentiated from germination by a reduced number of teeth. An exception is in the unusual case in which the fusion is between a supernumerary tooth and normal tooth. A 20-year-old male referred to us at - "UniDent" - Dental Clinic, Training and Research Center. The patient complained about the large, unusual maxillary central incisors, lip irritation and aesthetic problems. According clinical examination and radiological findings, clinical diagnose was - bilateral germination of central incisors. Several treatment methods have been described in the literature with respect to the different types and morphological variations of fused and geminated teeth, including endodontic, direct\indirect restorative, surgical, periodontal and/or orthodontic treatment. Our patient has demanded for better aesthetics and he choose the treatment option to make two separate PFM crowns. In the beginning of treatment, the length of tooth 11 was 9.5mm, after prosthodontic treatment it has become 11.5mm. For tooth 21, it was 9.9 millimeter and became - 10.8 mm, while the primary width of right central incisor appeared 13.2 millimeter and was narrowed until 10.8 mm. 12.8 mm was the - width of left central incisor, which finally became - 10.4 mm. Despite the considerable number of cases reported in the literature, the differential diagnosis between these abnormalities is very difficult, as well as, to find guideline of proper outcome of treatment therapy of abovementioned abnormalities. That's why, the aesthetic rehabilitation of doubled teeth, has been suggested, to depend upon the patient's desires, but at the same time, avoid treatment plans with aggressive management.

Peculiarities of the anatomo-morphological parameters of teeth and root canals in permanent dentition in Georgian population

One of the main reasons that cause the failure of endodontic treatment is the lack of knowledge of complex anatomy of the tooth cavity. Numerous studies over the years have established a complex structure of the tooth root system, a particular configuration of which determines the uniqueness of each tooth.Numerous researches have laid the foundation for anatomical and morphological peculiarities of root system of the tooth, their classification and nomenclature indices. The anatomical picture of the tooth, its shape, root length - the "norms" have been established in the course of years. Statistical indices do not represent universal criteria due to the fact that anthropometric data are subjected to variations in accordance with national and geographic zones. The aim of our study is to establish anatomo-morphological peculiarities of the groups of teeth, roots and canals in Georgian population and to develop statistically reliable indicators on the basis of anthropological and clinical data. The obtained data will help to improve the effective endodontic treatment and avoid complications after obturation.