Bicuspidization of Mandibular first Molar

   

   Bicuspidization of Mandibular Molar;A Clinical Review;Case Report

1.                          Dr.Vivik Periodontics                                                                               Dr.Mudit Uppal Endodontics 

                                      Dr. Sumona Kumar Periodontics                                         Dr. Gurleen Arora Prosthodontics   

                                                                                                                       Dr. Maryam Jameel Dental Intern                                

 Abstract

 Bicuspidization is a surgical procedure performed on the mandibular molars for the separation of the mesial and distal roots with their respective crown portions; this separation eliminates the existence of a furcation and facilitates effective oral hygiene practice. This case report aims at highlighting the conservative management of a grade III furcation-involved molar by bicuspidisation procedure and use of   the treated tooth as an abutment for fixed prosthesis 

A 20-year-old female patient reported with the chief complaint of pain and food lodgement in right mandibular first molar. On examination, the tooth was sensitive to percussion. On radiographic examination, bone loss was evident in the intra- radicular area. Root canal treatment was done followed by bicuspidization of tooth

Introduction

 A mandibular molar is bisected into two parts post root canal treatment to form two units of single bicuspid molars which makes it easy for the patient to maintain the area. 1,2 Bicuspidization procedure is indicated in cases of extensive grade III periodontal defects particularly of mandibular molar where tunnelling procedure is required for oral hygiene maintenance

Indications for bicuspidization are following

 Root fracture Severe bone loss affecting one or more roots untreatable with regenerative procedures 

 Class II or III furcation invasions or involvements

Inability to successfully treat and fill a canal 

 Severe root proximity inadequate for a proper embrasure space

 Root trunk fracture or decay with invasion of the biological width

Contraindications include

 Poor oral hygiene 

 

 Fused roots

 

 Unfavourable tissue architecture

 

 Retained roots endodontically untreatable This case report describes a multidisciplinary treatment procedure for mandibular molar with grade III furcation involvement that includes intentional root canal therapy,orthodontics,surgical periodontal therapy with Bicuspidization and prosthetic rehabilitation

Discussion 

Management of grade III furcation involvement always presents a challenge to the periodontist. Nonsurgical management alone leads to failure due to inaccessibility of the furcation region, leading to incomplete removal of the plaque and plaque retentive factors. The clinician splits the mandibular molar vertically through the furcation, without removing either half, leaving two separate roots that then are treated as bicuspids (a procedure termed "bicuspidization"). Farshchian and Kaiser have reported the success of a molar bisection with subsequent bicuspidization . They stated that the success of bicuspidization depends on three factors: 1. Stability of, and adequate bone support for, the individual tooth sections 2. Absence of severe root fluting of the distal aspect of the mesial root or mesial aspect of the distal root 3. Adequate separation of the mesial and distal roots, to enable the creation of an acceptable embrasure for effective oral hygiene.

Fig1

Pre-Operative Radograph 

Fig 2

RCT done for 46 ,47

Fig 3

Photograph showing division of molar into two separatedCrowns

Fig 4

After 6 week 

Fig 5

After crown prepration 

Fig 6 

metal try in

Fig 7 

PFM CROWN 

 

Fig 8 

Photograph showing the two separate crown restored with PFM

Conclusion

 Bicuspidization may be a suitable alternative to extraction and implant therapy especially for FPM in young children and should be discussed with patients during consideration of treatment options. With recent refinements in endodontics, periodontics and restorative dentistry, root separation and resection have received acceptance as a conservative and dependable dental treatment and teeth so treated have endured the demands of function

Tooth fusion in primary anterior teeth

 Dental fusion In 7 year  in primary teeth

Abstract

Tooth fusion is defined as the developmental dental anomaly in which two different tooth buds are fused into one during the development stage. 

Introduction

In the deciduous dentition, as well as in the permanent dentition, anomalies in color, shape, size or number may occur .

Fusion is one of the many different types of developmental anomalies. It is defined as the union of two normally separated tooth germs . This anomaly leads to alterations of number, as the union results in one tooth less than normal if the affected tooth is counted as one; size, since the tooth will be much larger as it is the union of two tooth buds, and shape.

Clinically, it may be difficult to differentiate a tooth fusion from another developmental anomaly, such as gemination. Gemination is the attempt of division of a single tooth germ by invagination, resulting in the incomplete formation of two teeth This particular anomaly does not affect the normal number of teeth, as the affected tooth is counted as one.

Tooth fusion may occur within the dentin, the enamel, or both. Radiographically, these teeth are observed to have one or more root canals and one or two pulp chambers On the other hand, geminated teeth present one single root and one root canal .

This anomaly has a prevalence of 0.1-2.5% in deciduous dentition, and 0.1-0.2% in permanent dentition . There is an equal distribution between females and males, and there are no significant differences in its location, affecting either maxillary or mandibular arches

Case Report

A 7-year-old boy come to  dental clinic with the  

  chief complaint of dental caries on the

 primary maxillary right central incisor  and the maxillary  right lateral incisor 

The patient’s medical history was unexceptional, and there was no family history of dental abnormalities and no parental consanguinity. No history of trauma was recorded. The patient reported an occasional hypersensitivity to thermal stimulation (cold and heat) and to sweet in the two anterior carious teeth

. General and extraoral examinations appeared to be noncontributory. The patient had complete primary dentition. Intraoral examination revealed the presence of a large upper right central incisor with slightly deep and decayed buccal and lingual grooves and the presence of extensive caries on the distal, lingual, and incisal surfaces of the right lateral incisor (Figures 1(a) and 1(b))

Figure 1: Intraoral photographs. Carious large crown of tooth 51 associated with dental caries of tooth 52.

Figure 2

 Periapical radiograph

Radiographic examination revealed fusion of the maxillary right primary central incisor with lateral incisor . According to the radiographs, the fused tooth had two distinct roots, with no connection between the pulp chambers and canals. No periapical radiolucency associated with these teeth was detected

Figure 3 After Extraction 

Conclusions

The presence of dental anomaly and correct diagnosis is always a challenge for the dentist. Early observation of the anomaly followed by clinical and radiographic evaluation

Dental abnormalities can cause functional and endodontic problems, but problems are mostly aesthetic if located in the upper anterior region. They represent a challenge for clinicians 

Many treatment options to solve cases of dental fusion. The best treatment plan depends on the nature of the anomaly, its location, the morphology of the pulp chamber and root canal system, the subgingival extent of the separation line, and the patient compliance. Following an analysis of radiographical and clinical data, it was possible to solve our patient’s dental anomaly with a multidisciplinary approach

Buccal Fibroma

 Buccal Fibroma

Dr. Ghada Amin (Professor Of Oral and Maxillofacial)

Maryam Jameel Dental Intern 

Ghadah Alwahbi Dental Intern 

Abstract

 The fibroma, also referred to as irritation fibroma, is by far the most common of the oral fibrous tumorlike growths. While the terminology implies a benign neoplasm, most if not all fibromas represent reactive focal fibrous hyperplasia due to trauma or local irritation. Although the term focal fibrous hyperplasia more accurately describes the clinical appearance and pathogenesis of this entity, it is not commonly used. We present a case report of oral fibroma in the left side of the buccal mucosa in 35 years old 

Introduction

Fibromas are benign tumors of fibrous connective tissue Their size is usually small and their diameter is rarely larger than 1.5 centimeter . Generally, fibromas are solitary, asymptomatic, sessile lesions, affecting patients between third and sixth decade of life. They are found in 1.2% of adults and they have a 66% female predominance The association between fibromas and trauma is well established. Most of the fibromas of the oral cavity are reactive hyperplasia in response to local irritation or trauma They are common on gingiva, tongue and buccal mucosa . However, although fibromas are common in the oral cavity, their incidence on the hard palate is rare, mainly because of fewer chances of trauma or irritation

Figure 1 & 2. Intraoral examination revealed a soft nodule in the premolar left side

The intraoral examination revealed a soft nodule in the left side which was covered by normal mucosa.

 Intra orally on palpation, it was ovoid and firm in terms of consistency and is located in the premolar-molar region (Figure 1 & 2). 

Case Presentation

A 35 years old female had reported to dental clinic , with the chief complaint of growth in the left check mucosa region since 4 months. She had no relevant medical or dental history as evidenced with a comprehensive case history reported. It started initially as a small lesion four months ago which steadily increased to the current size. Chewing and normal oral function have been hampered by growth. Intraoral inspection showed a single, painless, sessile, well circumscribed mass with smooth surface. On palpation, it was firm in consistency, and lobulated swelling measuring approximately 3*3 cm 

Figure 3 & 4 &5. Surgical resection and suturing

Figure 6 Formalin solution 

Postoperative Follow-up

The patient presented for the 1-week postoperative appointment and indicated she had experienced no pain following the surgical excision of the mass

Figure 7 After 1week

Figure 7 Follow up After 4 months

Discussion

 Fibroma is the most common connective tissue tumour in oral cavity. It is also described with a term “inflammatory hyperplasia” representing inflamed fibrous and granulation tissue. These proliferative benign connective tissue tumour size varies from small to large depending on the degree to which one or more of the components of the inflammatory reaction and healing response are exaggerated in the particular lesion. If a similar lesion is present on gingiva it is been referred as “epulis”. Fibroma is also known as irritational fibroma, focal fibrous hyperplasia or fibromatous fibroma. Fibroma occurs more frequently in females than in males between third, fourth and fifth decade of life. In this case report fibroma occurred in 35 years old female 

Conclusion 

Fibroma clinically resembles as traumatic fibroma, pyogenic granuloma, peripheral ossifying fibroma, irritational fibroma, peripheral giant cell granuloma so clinical, radiographical and histological examination is very important for accurate diagnosis and treatment

Using 3M Composite Restoration For Post Trumatic Incisor Edge Fracture

• Using 3M Composite Restoration
•  For Post Trumatic Incisor Edge Fracture

DR.HazimRizk Pedodontics 

DR.Mudit Uppal Endodontics 

 Maryam Jameel Dental Intern 

Introduction 

Dental traumas considered an increasing public health problem, unlike dental caries that have been declining over the last decades. The majority of dental injuries occur in the anterior region, affecting mainly the maxillary central incisors1 that can have significantly negative functional, esthetic and psychological impact. Prosthetic rehabilitation of traumatized anterior teeth would alter the entire appearance of the patient by providing them with a beautiful smile .

Oral trauma frequently occurs during the life of a young child and adolescent. Often, the consequences of this trauma are minor and may even go unnoticed .

The trauma may affect the hard tissue (alveolar bone, enamel, dentin, and cementum) and adjacent soft tissues.

The dental changes resulting from this clinical occurrence, in general, lead to a reduced quality of life of patients. This occurs because of the sensitivity and also because of the aesthetic conditions, reducing the quality of social life because of reduced self-esteem The aesthetic factor is even more critical considering the standards of beauty socially imposed, where minimal changes in shape, color and/or 

 positioning have become highly valued.

patient along with preoprative photograph was taken (figure 2)

intraoral examination revealed has generalized calculus and that right central incisor was fracture in middle third of the crown

involving enamle and dentin without pulp exposure ,left central incisor was fracture in meso angle .

oral prophylaxisis was done (figure 3) and dental hygine maintenace instruction were given .

Figure 1

radiographs (IOPA)

figure 2

initial case : generalized calculus and stain 

 right central incisor was fracture and left central incisor was fracture mesio angle

figure 3

After full ultrasonic scaling and polishing

Figure 4

After 1 week preoprative frontal images .

Figure 5

postoperative frontal images showing 

the esthetics result of composite placement ,finishing .

conclusion

In order to achieve and maintain efficient treatment outcomes, the case of a traumatically fractured single central incisor is very challenging for the practitioner. Esthetic and functional results must

be considered when determining the proper treatment plan.