Apicoectomy what is the right statement:
1- Incisor with an adequate RCT and 9mm lesion.
2- Lateral incisor with good condensing RCT but swelling and pain 14 day after the treatment, the tooth a symptom before the obturation.***
3- First upper premolar with lesion on the buccal root...
Dental agenesis, and particularly that of the maxillary lateral incisors (ILS), is a relatively common dental anomaly. In this paper we present the various treatment options for this type of agenesis that has a high aesthetic and functional impact. Orthodontic treatment is in most cases the ideal treatment; however, the use of tooth-implant or implant-supported prosthetic rehabilitation is often the solution to these missing teeth. In the clinical case presented the agenesis of tooth 22 was treated using crowns on teeth 11, 21, 23 and 24, since the patient refused orthodontic treatment to reposition tooth 23 in its usual location and subsequent prosthetic rehabilitation. , using a dental implant. Treatment of ILS agenesis is almost always multidisciplinary requiring careful planning providing a good and highly predictable long-term aesthetic end result.
Dental agenesis, particularly agenesis of the maxillary lateral incisors, is a relatively common dental anomaly. The authors present different treatment options for this type of agenesis which has a high aesthetic and functional impact. Orthodontic treatment is most of the times the ideal treatment option however dental or implant-supported prosthetic rehabilitation is often the solution to these dental absences. In the case presented agenesis of tooth 22 was treated with crowns on teeth 11, 21, 23 and 24, since the patient refused orthodontic treatment to reposition tooth 23 in its usual place and subsequently prosthetic rehabilitation of the space with a dental implant. Treatment is often multidisciplinary requiring careful planning in order to achieve a good aesthetic outcome and high predictability in the long term.
Introduction:
Dental anomaly is defined as a deviation from normality, usually associated with the embryonic development of the teeth, which may result in the absence, excess or change of shape.
Dental agenesis is a dental anomaly in number and is considered to be in the presence of one whenever at least one tooth, after completing a detailed clinical history for dental extraction, is absent. Congenital absence of teeth may be associated with a genetic syndrome or arise as an isolated phenomenon.
Agenesias are relatively frequent anomalies in the permanent dentition with a prevalence ranging from 0.3 to 36.5%, and for the Portuguese population the values described range from 5.6 to 6.5%, excluding the third molars. It occurs most often in females, although gender distribution varies according to the geographic location of the populations under study.
Although some differences can be found in the literature, most studies report that the most frequently missing tooth is the 2nd mandibular premolar (PMI), followed by the maxillary lateral incisor (ILS). 2nd premolar (PMS) and lower central incisor (ICI). Agenesis of the 1st and 2nd molars, lower canine (IC) and maxillary central incisor (ICS) are relatively rare.
Pinho et al. studied the frequency of ILS agenesis in a Portuguese population and concluded that 1.3% of the individuals under study had this anomaly, and females were the most affected.
In deciduous dentition, although this condition is not very frequent (incidence below 0.9%), when present, it mainly affects the ILS, ICI and lower lateral incisor (ILI).
Johannsdottir et al. states that when there is agenesis of any deciduous tooth, in almost 100% of cases, there is agenesis of the corresponding replacement tooth.
The absence of only one lateral incisor is often accompanied by malformation of the contralateral lateral incisor, with microdontics being the most common dental anomaly. This phenomenon suggests the influence of genetic factors on these dental anomalies.
The impact, aesthetically and functionally, that the agenesis of these teeth has is enormous, being a concern not only for patients with the anomaly, but also for health professionals who see their treatment planning a major challenge.
1- Incisor with an adequate RCT and 9mm lesion.
2- Lateral incisor with good condensing RCT but swelling and pain 14 day after the treatment, the tooth a symptom before the obturation.***
3- First upper premolar with lesion on the buccal root...
Dental agenesis, and particularly that of the maxillary lateral incisors (ILS), is a relatively common dental anomaly. In this paper we present the various treatment options for this type of agenesis that has a high aesthetic and functional impact. Orthodontic treatment is in most cases the ideal treatment; however, the use of tooth-implant or implant-supported prosthetic rehabilitation is often the solution to these missing teeth. In the clinical case presented the agenesis of tooth 22 was treated using crowns on teeth 11, 21, 23 and 24, since the patient refused orthodontic treatment to reposition tooth 23 in its usual location and subsequent prosthetic rehabilitation. , using a dental implant. Treatment of ILS agenesis is almost always multidisciplinary requiring careful planning providing a good and highly predictable long-term aesthetic end result.
Dental agenesis, particularly agenesis of the maxillary lateral incisors, is a relatively common dental anomaly. The authors present different treatment options for this type of agenesis which has a high aesthetic and functional impact. Orthodontic treatment is most of the times the ideal treatment option however dental or implant-supported prosthetic rehabilitation is often the solution to these dental absences. In the case presented agenesis of tooth 22 was treated with crowns on teeth 11, 21, 23 and 24, since the patient refused orthodontic treatment to reposition tooth 23 in its usual place and subsequently prosthetic rehabilitation of the space with a dental implant. Treatment is often multidisciplinary requiring careful planning in order to achieve a good aesthetic outcome and high predictability in the long term.
Introduction:
Dental anomaly is defined as a deviation from normality, usually associated with the embryonic development of the teeth, which may result in the absence, excess or change of shape.
Dental agenesis is a dental anomaly in number and is considered to be in the presence of one whenever at least one tooth, after completing a detailed clinical history for dental extraction, is absent. Congenital absence of teeth may be associated with a genetic syndrome or arise as an isolated phenomenon.
Agenesias are relatively frequent anomalies in the permanent dentition with a prevalence ranging from 0.3 to 36.5%, and for the Portuguese population the values described range from 5.6 to 6.5%, excluding the third molars. It occurs most often in females, although gender distribution varies according to the geographic location of the populations under study.
Although some differences can be found in the literature, most studies report that the most frequently missing tooth is the 2nd mandibular premolar (PMI), followed by the maxillary lateral incisor (ILS). 2nd premolar (PMS) and lower central incisor (ICI). Agenesis of the 1st and 2nd molars, lower canine (IC) and maxillary central incisor (ICS) are relatively rare.
Pinho et al. studied the frequency of ILS agenesis in a Portuguese population and concluded that 1.3% of the individuals under study had this anomaly, and females were the most affected.
In deciduous dentition, although this condition is not very frequent (incidence below 0.9%), when present, it mainly affects the ILS, ICI and lower lateral incisor (ILI).
Johannsdottir et al. states that when there is agenesis of any deciduous tooth, in almost 100% of cases, there is agenesis of the corresponding replacement tooth.
The absence of only one lateral incisor is often accompanied by malformation of the contralateral lateral incisor, with microdontics being the most common dental anomaly. This phenomenon suggests the influence of genetic factors on these dental anomalies.
The impact, aesthetically and functionally, that the agenesis of these teeth has is enormous, being a concern not only for patients with the anomaly, but also for health professionals who see their treatment planning a major challenge.
Clinical case:
Patient M.A.G., 36 years old, Caucasian female, attended the Dentistry consultation to improve the aesthetics of the anterior teeth. After clinical and radiographic examination, the patient was found to have agenesis of teeth 22 and 25. The midline was offset to the 2nd quadrant about 4mm and tooth 23 was in a mesialized position in relation to its position. which resulted in a decrease in the arch space between teeth 21 and 23, and the appearance of a space of about 4 mm between teeth 23 and 24. The latter was in contact with the mesial surface of tooth 26 The occlusal plane was inclined with greater proximity to the bipupillary line in the 2nd quadrant.
After evaluating the case, the patient was proposed to perform an orthodontic correction, approaching tooth 23 and tooth 24, thus creating space for subsequent rehabilitation of the space corresponding to tooth 22, using an endoosseous dental implant. correction of midline position and occlusal plane inclination. The patient refused to undergo orthodontic treatment as she aimed for rapid treatment without having to resort to braces. Thus, a second treatment plan was proposed which consisted of crowns on teeth 11, 21, 23 and 24, with the crowns of teeth 23 and 24 being ferulized presenting an intermediate pontic for replacement of missing tooth 22. For the patient to have an image of the expected final aesthetic result, a diagnostic waxing was performed. After visualization, the patient opted for this second treatment plan.
In the first consultation, teeth 11, 21, 23 and 24 were prepared and the temporary bridge, previously made in the laboratory from the diagnostic waxing, was reshaped in the mouth. The teeth were kept vitally. This bridge was cemented with a Life brand temporary cement (Kerr, Orange, USA).
At the next consultation, and once the gum health allowed, the definitive silicone mold was made using the double mixing technique. An alginate mold of the antagonist arch and a silicone bite registration were also performed. The color was selected using the VITA (VITA Zahnfabrik, Bad SäcKingen, Germany) ceramic scale based on the adjacent teeth.
After making the alumina / ceramic crowns in the laboratory, the test was performed in the mouth to evaluate the adjustment and color agreement. The permanent cementation was performed using Relix brand glass ionomer cement (3M ESPE, St. Paul, USA). The patient was very pleased with the final aesthetic result.
Discussion and conclusion:
According to the existing literature, the clinical resolution of dental agenesis is varied and constitutes, in most cases, a multidisciplinary treatment. Given the resulting amount of space due to the absence of one or more teeth and the patient's profile, orthodontic treatment can be used to close or open spaces leading to dental alignment. In the case of opening the space, it is then necessary to proceed to the prosthetic rehabilitation of the edentulous zone. There are several therapeutic options, fixed or removable, and their selection depends on several factors such as: age and economic capacity of the patient, bone availability, integrity and aesthetics of adjacent teeth and the size of the toothless space. .
It is currently agreed that implants are the most conservative prosthetic solution for the treatment of these anomalies, however, such treatment cannot always be implemented. Some factors such as the age of the patient, bone quantity and quality, and available space may limit implant placement. Where conditions are not favorable, the use of a fixed prosthesis may be a good solution. Conventional bridges have the disadvantage that they require wear of adjacent teeth, which are often intact. For this reason, in the early 1980s, the use of adhesive bridges, such as Maryland bridges, was very popular as it was a more conservative therapeutic solution. However, several follow-up studies have shown that this type of bridging was very subject to setbacks.
This type of rehabilitation can be a good temporary solution in situations where bone growth has not yet ended, making implant placement temporarily unviable. It is particularly interesting in cases where the waiting time until the end of bone growth is large to avoid the gingival inflammation inherent in the use of a removable prosthesis, since according to Garnett et al., Adhesive bridges have a long survival. average of 59 months.
Any permanent removable prosthetic solution is always less interesting and should be avoided.
In cases where occlusion and aesthetics of the canine in the IL position are acceptable, arch space closure with canine mesialization may be the alternative treatment of choice. This solution, according to Robertsson's study is better accepted by patients from the aesthetic point of view and confers better periodontal health.
In the clinical case described, the patient refused orthodontics. As the space available in the arch was not sufficient for an implant to be placed, a conventional fixed bridge between teeth 23 and 24 was used. The patient's decision has to be taken into consideration and in this case the The treatment, although less conservative, allowed to achieve a final aesthetic result according to the initial expectations of the patient. Crowns 11 and 21 were made in order to improve the final aesthetics of the treatment; however, facets on these 2 teeth could also have been performed.
In conclusion, the most important thing in these clinical cases is to establish a careful and realistic treatment plan, always taking into consideration the patient's goals and expectations. The time factor is often a determining factor for treatment plan selection, as some patients want to solve their problem in the shortest possible time.
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