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endo tribune Dental Tribune Middle East & Africa Edition | November-December 2015 About the Author About the Author < Page 1B Fig. 1 Fig. 5 Fig. 9 Fig. 13 Fig. 17 Fig. 2 Fig. 6 Fig. 10 Fig. 14 Fig. 18 Fig. 3 Fig. 7 Fig. 11 Fig. 15 Fig. 19 Fig. 4 Fig. 8 Fig. 12 Fig. 16 Fig. 20 was compressed by the erupt- ing follicle of the supernumer- ary tooth and caused a lack of blood supply to the pulp of the left central incisor can be ob- served in the image, held by a haemostat (Fig. 14). Afterwards, preparation for retrograde root filling was performed using a Satelec ul- trasonic system and the ap- propriate handpiece for this surgery. Retrograde root filling was performed with SuperEBA (Bosworth), thereby achieving sealing of the canal at apical level (Figs. 15 &16). The flap was closed with three silk su- tures (Fig. 17), which were re- moved after seven days. Supernumerary tooth after ex- traction can be observed in the picture (Fig. 18). Two months after the inter- vention, internal whitening was performed to improve the colour of the incisor. The last two images show the clinical appearance (Fig. 19) and a ra- diograph (Fig. 20) three years posttreatment. Discussion CT scans, which have been widely used in endodontic di- agnostics for fractures and fissures, for example, and in implantology, are not yet com- monly used in surgical plan- ning to obtain diagnostic and anatomical data. The relevant and detailed information that this imaging technique pro- vides, especially regarding the position of supernumerary teeth, is proof that it should form part of the protocol during surgical planning. The second point of discussion is the pathway used to approach the supernumerary tooth. We could have used a palatal path- way, but the CT scan revealed that the vestibular pathway was less risky, provided greater vis- ibility and better respected the important anatomical struc- tures, such as the adjacent teeth, without injuring them by accident and risking an iatro- genic injury. Another important point to be observed is the pathophysiolog- ical mechanism that resulted in pulp necrosis. We suspected an apical or periapical resorp- tion of tooth #21 because of the expansion of the erupting fol- licle and secondary osteolysis, which cannot be excluded. In order to eliminate the greatest number of cells involved in the resorptive-destructive process, an apicectomy was performed. Nevertheless, pulp congestion suggested that the most proba- ble pathophysiological mecha- nism involved was venous sta- sis of the vascular plexus that enters the incisor, just before apex. The last point of discussion is when these supernumerary teethshouldberemoved.Ifpos- sible, the best time for removal is before any pathology signs appear. This requires consid- eration of the individual case of each patient, and perform- ing clinical and radiographic follow-up of the case in order to determine the right time. Conclusion The presence of supernumer- ary teeth in the permanent dentition has a frequency of between 0.1% and 3.8%. Necro- sis of the adjacent teeth is one of the possible complications of this phenomenon; therefore, clinicians must consider the possibility of a supernumerary tooth during diagnosis, espe- cially in patients with pulp ne- crosis without previous trau- matic dental pathology. Editorialnote: This article was published in cone Beam - in- ternational magazine of cone beam dentistry No. 01/2015 Dr. Sebastiana Arroyo Boté Graduated in medicine in 1983 from the University of Barcelo- na. She specialized in dentistry in 1985. She has been Associate Professor of Conservative Den- tistry and Endodontics at the University of Barcelona since 1992. She maintains a special- ist private practice for conser- vative dentistry and endodontic treatment in Barcelona. She has authored a number of publications, and lectures on current topics in endodontics and conservative aesthetic den- tistry. She is a member of the Asociación Española de Endod- oncia and Sociedad Española de Odontología Conservadora (Spanish societies for end- odontics and conservative den- tistry). She can be contacted at 20506sab@comb.cat. Dr Javier Martínez Osorio Graduated in medicine in 1981 from the University of Barce- lona in Spain. He specialized in dentistry in 1983 and in plastic surgery in 1987. He has been As- sociate Professor of Conserva- tive Dentistry and Endodontics at the Faculty of Dentistry at the University of Barcelona since 1996. He maintains a specialist private practice for implant and endodontic treatment in Barce- lona. He is the author of numer- ous publications, and lectures around the world on current is- sues in endo dontics and implan- tology. He is a member of the So- ciedad Española de Implantes, Asociación Española de Endod- oncia, Sociedad Española de Odontología Conservadora and Sociedad Española de Cirugía Oral y Maxilofacial (Spanish associations for oral implantol- ogy, endodontics, conservative dentistry, and maxillofacial sur- gery).He is also president of the Societat Catalana d’Odontologia i Estomatologia (Catalonia soci- ety of dentistry). He can be con- tacted at 16486jmo@comb.cat.