Endo Tribune Middle East & Africa Edition

ENDO tribuneDental Tribune Middle East & Africa Edition | November-December 2015 1B ENDO TRIBUNE TheWorld’sEndodonticNewspaper MiddleEast&AfricaEdition FKG Dentaire SA www.fkg.ch We love endo ! Pre-Op Post-Op Tooth 38 Dx :Acute pulpitis Tx : Root canaltreatment Final preparation : 30/.04 Case completedwith ScoutRace Scouting iRace, iRace plus Shaping XP-endo Finisher Finishing TotalFill Obturation Dr Ahmed Abdel Rahman Hashem, Egypt «The superb flexibility of ScoutRace enabled me to reach predictably to the working length in this extremely curved lower third molar. The excellent spacing between files and the 4% taper of iRaCe made it easy for me to prepare this case with confidence and ease to the end of the root canal.» > Page 2B Supernumerary teeth: Diagnosis and treatment By Drs Javier Martínez Oso- rio & Sebastiana Arroyo Boté, Spain A bstract We report the case of a 17-year-old patient who came into the clinic be- cause she had noticed a colour change to the maxillary left central incisor (tooth #21) of 48-hour duration. During clini- cal examination, tooth #21 ap- peared darker than the rest of the teeth. After performing a complete exploration and obtaining no response to vitality tests, a pulp necrosis of tooth #21 was diag- nosed. Differential diagnosis began with the completion of the medical record. The patient had received orthodontic treat- ment and a supernumerary tooth in the anterior region of the maxilla had been extracted. The patient did not recall hav- ing suffered injuries or trauma in the incisal region. A den- tal panoramic tomogram was obtained, and a high-density area was observed at the apical level in the area of tooth #21. A 3-D computed tomography (CT) scan was then obtained, and it showed the presence of a supernumerary tooth in the periapical region of tooth #21, palatally located and oriented upwards. Necrosis by compression of the neurovascular pedicle of tooth #21 due to the expansion of the erupting follicle of the supernumerary tooth was di- agnosed. Pulpectomy and sur- gical removal of the supernu- merary tooth were performed. During surgical removal of the supernumerary tooth, the neu- rovascular pedicle appeared oedematous and congested and was the cause of the tooth pulp necrosis. Case report A 17-year-old patient who had undergone orthodontic treat- ment four years before came into the clinic because she had noticed a colour change to her maxillary left central incisor lasting for 48 hours. The pa- tient presented with a tooth dis- coloration (Fig. 1) with slight pain that ceased with a non- steroidal antiinflammatory drug. During the initial visit to her general dentist, vital- ity tests were performed and a slight response to the tests was detected. After that, the patient was referred to a specialist. When she presented to the en- dodontist, the tooth had dark- ened to a grey-brown colour. In addition to that, the tooth no longer responded to pulp vitali- ty tests. During the visit, the en- dodontist performed periapical radiographs of the area (Fig. 2), and based on this the existence of a supernumerary tooth at the apical level of the incisor grow- ing towards the floor of the na- sal cavity was confirmed. The endodontist requested a CT scan to study the position and assess the possibility of surgical extraction. The CT scan showed the position of the supernumerary tooth rela- tive to the roots of the adjacent teeth, confirming growth to- wards the periapical region of tooth #21, that is, a 180-degree deviation from the correct ori- entation for eruption in the dental arch. Reconstruction in 3-D showed this phenomenon clearly (Figs. 3–6). Endodontic treatment of tooth #21 was performed, during which the congested pulp was removed and some bleeding was observed. The length of the guttapercha obturation was deliberately longer than required in order to facilitate surgery (Figs. 7–9). Surgicaltreatmentwasplanned and consisted of raising a semi- lunar flap on the periapical re- gion of tooth #21 and perform- ing a minimum root resection of 2 mm approximately without a bevel, using a size 0.23 round bur with a straight handpiece, to expose the supernumerary tooth’s crown. The crown was sectioned at the coronal middle third and the incisal portion was removed (Fig. 11). A hole was made in what would be the middle and cervical thirds of the supernumerary tooth to force it up (Fig. 12) and make the extraction through the osteotomy created for apicec- tomy, thereby achieving a com- plete extraction (Fig. 13) with minimal trauma to bone and the roots of the incisors. The oedematous pedicle that

Endo Tribune Middle East & Africa Edition

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