Article

Dilaceration: review of an endodontic challenge.

Department of Endodontics, Faculty of Dentistry and Dental Research Center, Mashhad University of Medical Sciences, Vakilabad Boulevard, Mashhad, Iran.
Journal of Endodontics (Impact Factor: 2.79). 10/2007; 33(9):1025-30. DOI: 10.1016/j.joen.2007.04.013
Source: PubMed

ABSTRACT Dilaceration is the result of a developmental anomaly in which there has been an abrupt change in the axial inclination between the crown and the root of a tooth, but the criteria in the literature for recognizing root dilaceration vary. Two possible causes of dilaceration are trauma and developmental disturbances, and it has also been proposed that it might be associated with some developmental syndromes. Dilaceration can be seen in both the permanent and deciduous dentitions, and it is more commonly found in posterior teeth and in the maxilla. Periapical radiographs are the most appropriate way to diagnose the presence of root dilacerations. Diagnosis, endodontic access cavity preparation, root canal preparation and filling, and other related treatments might be complicated by the presence of a dilaceration. A review of the literature and a discussion of the options for managing this condition are presented.

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    ABSTRACT: Endodontic treatment of tooth formation anomalies is a challenge to clinicians and as such requires a complete understanding of the aberrant root canal anatomy followed by careful root canal disinfection and obturation. Here, we report the use of a 3-dimensional (3D) printed physical tooth model including internal root canal structures for the endodontic treatment of a challenging tooth anomaly. A 12-year-old boy was referred for endodontic treatment of tooth #8. The tooth showed class II mobility with swelling and a sinus tract in the buccal mucosa and periapical radiolucency. The tooth presented a very narrow structure between the crown and root by distal concavity and a severely dilacerated root. Moreover, a perforation site with bleeding and another ditching site were identified around the cervical area in the access cavity. A translucent physical tooth model carrying the information on internal root canal structures was built through a 3-step process: data acquisition by cone-beam computed tomographic scanning, virtual modeling by image processing, and manufacturing by 3D printing. A custom-made guide jig was then fabricated to achieve a safe and precise working path to the root canal. Endodontic procedures including access cavity preparation were performed using the physical tooth model and the guide jig. At the 7-month follow-up, the endodontically treated tooth showed complete periapical healing with no clinical signs and symptoms. This case report describes a novel method of endodontic treatment of an anomalous maxillary central incisor with the aid of a physical tooth model and a custom-made guide jig via 3D printing technique. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
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    ABSTRACT: Objectives We aimed to determine the prevalence and distribution of root dilaceration by tooth type and to investigate the relationship between trauma history and teeth with dilaceration in a large population of adult dental patients in Turkey. Methods Periapical radiographs of 9,406 permanent teeth from 5,504 patients were examined. Teeth were recognized as having mesial or distal root dilaceration if there was deviation of 90° or more from the normal long axis of the tooth. The patients’ biographic data, dilacerated and non-dilacerated teeth, and accidental trauma history were recorded. The Pearson Chi-square test was used to evaluate differences by sex and the Mann–Whitney U test was used to determine whether significant differences existed in the occurrence of dilaceration by age and side. Results In the 5,504 subjects (2,877 males and 2,627 females), 9,406 teeth (5,029 in males and 4,377 in females) were examined. The Mann–Whitney U test revealed no significant differences in root dilacerations by age (P = 0.6) The teeth most frequently observed with root dilaceration were mandibular third molars (10.7 %), followed by maxillary first molars (5.8 %), mandibular second molars (5.2 %), maxillary third molars (5.0 %), maxillary second molars (4.9 %), and mandibular third molars (4.9 %). Overall, there were 161 right and 156 left root dilacerations. In all patients, the root dilacerations were unilateral. Trauma occurred in 1 % (n = 59) of the population, and all cases were in the maxillary arch. Trauma involved 0.6 % of all teeth examined, and was most common in maxillary third molars (2.6 %), followed by maxillary first molars (1.9 %), maxillary second molars (1.3 %), and maxillary lateral incisors (1.3 %) (P > 0.05). In 252 of 317 dilacerated teeth (79 %), the dilaceration was observed in the apical third region. Conclusions Clinicians should consider the possibility of root dilaceration in teeth with trauma history. When other treatment (such as extraction, orthodontics) is required, identification of a dilaceration is important to ensure appropriate management. Periapical radiographs are the most appropriate way to diagnose the presence of root dilacerations.
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    ABSTRACT: Radicular dilaceration is a dental anomaly in which the longitudinal axis of the dental root shows a sudden deviation forming a 90o angle or greater. When this aberration is located in the apical portion of the root and it is not detected until the application of orthodontic movements, it may lead to fenestration of the buccal cortical bone, as well as generation of aesthetic, eruption and dental pulp problems. The treatment of these cases is very complex and usually involves surgical removal of the affected tooth. Case presentation, this article presents the surgical and non-surgical endodontic management of a maxillary central incisor with radicular dilaceration of the apical portion that fenestrated the buccal cortical bone. Additionally, it presents three and a half years of clinical and radiographic follow-up of the case. Discussion, radicular dilaceration is a rare finding that must be detected in order to prevent undesirable surgical mishaps. However, when this anomaly fenestrates the buccal cortical bone like we report in this work, an alternative treatment is the application of both surgical and non-surgical endodontic management on the affected tooth. The purpose of this is to avoid a more invasive and noxious intervention such as a dental extraction.

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May 31, 2014