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Endodontic Treeatment of a Maxillary Lateral Incisor Presenting Dens Invaginatus and Transposition to the Region of the Canine - Case Report


JesusDjalmaPÉCORA1,2
Paulo César SAQUY1,2
José Euripedes de SOUZA2
Manoel D. SOUSA NETO2

1Faculdade de Odontologia de Ribeirdo Preto, Universidade de São Paulo
2Faculdade de Odontologia Universidade de Ribeirão Preto


Braz Dent J (1991) 2(1): 1-84 ISSN 0103-6440

| Introduction | Care report | Discussion | References |


Endodontic treatment was performed in a maxillary lateral incisor presenting two different types of anomalies: dens invaginatus and transposition to the region of the canine. The two-trausposcd teeth were subsequently mtomd with light-cumd composite, bringing dental csthetics to normal in a single session.


Key Words: dens invaginatus, dental transposition, and esthetic restoration.


Introduction

    Numerous clinical case of anatomical alteration of the maxiary anterior teeth have been reported since the end of the last century. Among these teeth (central and lateral incisors and canine) the one which presents the greatest number of developmental abnormalities (dens invaginatus, talon cusps and radicular grooves) is the lateral incisor, due to its localization in a region of great embryological risk.
    Dens invaginatus is an anomaly of development resulting from the deepening or invagination of the enamel organ into the dental papilla, beginning at the crown and often extending to the root, which occurs before the calcification of the dental tissues.
    This anomaly is also known as dens in dente, dilated composite odontoma or gestant anomaly. Type 1 and Type 2 dens invaginatus from Oehlers' classification (Oehlers, 1957) represent no problem for endodontic treatnent. The invagination of Type 3, however, poses greater difficulty to endodontic therapy, by the necessity of surgical completion.
    Another anomaly that may occur in the maxillary anterior region is the interchanging of position between teeth. The canine frequently changes its normal place, occupying the position of the lateral incisor or of the first premolar (Thoma, 1954).
    The objective of the present paper is to report a case of simultaneous occurrence of Type 2 dens invaginatus in a maxillary lateral incisor and transposition between this tooth and the canine, as well as to describe the endodontic treatment of the lateral incisor and the restoration of the patient's dental appearance.


Case report

    A twenty year old white woman was admitted to the Endodontic Clinic of the University of Ribeirfio Preto, complaining about spontaneous pain in the right maxillary lateral incisor.
    The clinical examination revealed that the lateral incisor presented a cuneiform shape and was transposed to the region of the canine (Figure 1A,B). The pain was localized and the patient was able to securely identify the causative tooth. The lateral incisor was slightly sensitive to percussion, but insensitive to touch or thermal tests.
    The roentgenographic examination disclosed the presence of Type 2 dens invaginatus of the right maxillary lateral incisor, with no alteration of the periodontal bone plate (Figure lC).
    The invaginated enamel was removed with diamond points, according to Pécora et al. (1987) and Vansan (1990), and endodontic treatment was performed by conventional methods (Figure lF).
    Once the endodontic treatment was completed, the lateral incisor was restored with light-cured composite (P50, 3M), but anatomically shaped as a canine, while the crown of the canine had its shape esthetically recomposed as a lateral incisor, by using the same resin (Figures lD, E).
    Finally, the patient's occlusal balancing was tested in protrusion as well as in lateral movement.


Discussion

    The maxillary lateral incisor is more likely to present dens invaginatus than any other tooth. Conventional endodontic treatment may be performed with no problem in the case of Type I or Type 2 dens invaginatus (Pécora, 1987), but Type 3 requires additional surgery.
    The lateral incisors presenting dens invaginatus are commonly cuneiform, producing an esthetically unpleasant aspect. In the case now reported, besides the cuneiform aspect and the presence ofddns invaginat1Js, a second abnormality was present - transposition of the canine. Thus, the appearance of the patient was doubly prejudiced and, as a consequence, the crowns of these teeth required modification.
    There were two options for doing this: 1) use prosthetic crowns, and 2) change the anatomical shape of the teeth, by using light-cured composite. This latter technique was chosen because the patient was not inclined to use a rlxed prosthesis. The technique consists basically in re-covering the buccal enamel of the tooth to be modified with esthetic material, without the necessity of excessive wearing of the healthy dental structures.
    The light-cured composite selected to restore the teeth was P50 (3M), a hybrid resin with 88% charge, whose particles vary from 1 to 5?m, which provides opacity above 35%, and high resistance to compressive and transversal strains. This resin is able to be highly polished by conventional techniques using stones and sandpaper disks. These properties make it superior to the resins generally indicated for anterior teeth (Leinfelder, 1988; Monteiro, 1988).
    Care was taken to re-establish the esthetics without offecting the periodontium, applying the resin to the tooth crown but avoiding the periodontal tissues.
    The selected option of using the light-cured composite (P50, 3M) to restore the esthetics proved to be satisfactory, inasmuch as the esthetical end results satisfied the patient as well as her friends and relatives. This case has been observed for one year and the resin is in good clinical condition.
    The case reported shows the possibility of modifying the anatomical shape of teeth of the maxillary anterior region when unesthetic anomalies are present, restoring the esthetical appearance of the patient by using light-cured composite.


References

Lcinfcldcr KF: Posterior composite resins. JADA (special issue) 117: 21E-6F, 1988

Monteiro Jr S: Resinas compostas em posteriores (seminário) RGO 36: 198-199, 1988

Oehlers FA: Dens invaginatus: variation of the invagination process and associated anterior crown forms. Oral Surg 10: 1204-1218, 1957

Pécora JD, Costa WF, Macchetti DD: Caso clínico: dens in dente. Rev Odont USP 1: 46-49, 1987

Thoma, KH: Oral pathology. CV Mosby, St. Louis, 1954

Vansan LP, Gariba Silva R. Silva Aiello JS, Pécora JD: Dens invaginatus tratamento endodôntico em uma sessão. Rev Ass Paul Cirurg Dent 44: 353-355, 1990


Correspondence: Professor Jesus Djalma Pécora, Departamento de Odontologia Restauradora, Faculdade de Odontologia de Ribeirlo Preto, USP, 14050 Ribeirão Preto, SP, Brasil.





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