Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2006  |  Volume : 24  |  Issue : 3  |  Page : 152--154

Dilacerated unerupted central incisor: A case report


A Agnihotri, N Marwah, S Dutta 
 Department of Pedodontics and Preventive Dentistry, Govt. Dental College, Rohtak, Haryana, India

Correspondence Address:
N Marwah
20/849, D.L.F colony, Rohtak, Haryana
India

Abstract

Dilaceration of permanent successors is one of the most common complications of trauma to the deciduous teeth. It is advisable to keep these patients under observation post-trauma and to consult an orthodontist at an early stage to prevent unfavorable sequelae. Presented here is a typical case of dilaceration.



How to cite this article:
Agnihotri A, Marwah N, Dutta S. Dilacerated unerupted central incisor: A case report.J Indian Soc Pedod Prev Dent 2006;24:152-154


How to cite this URL:
Agnihotri A, Marwah N, Dutta S. Dilacerated unerupted central incisor: A case report. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2019 Nov 20 ];24:152-154
Available from: http://www.jisppd.com/text.asp?2006/24/3/152/27897


Full Text

 Introduction



Eruption of a tooth as such describes the changes in position from the earliest time of development through successive stages to the emergence into the oral cavity.[1] The position or shape of the tooth may be altered even before it erupts into the oral cavity and sometimes it may remain unerupted. The factors responsible for failure of eruption remain unknown except in those cases in which the teeth are obviously impacted.[2] One of the reasons known for the noneruption of teeth is dilaceration. The term 'dilaceration' refers to an angulation or a sharp bend or curve, in the root or crown of a formed tooth (Latin: dilacero = tear up).[3] The term was first used by Tomes and referred to as the 'forcible separation of the cap of the developed dentine from the pulp in which the development of dentine is still progressing.'[4] The condition is thought to be due to trauma during the period in which the tooth is forming, with the result that the position of the calcified portion of the tooth is changed and the remainder of the tooth is formed at an angulation. The curve or bend can be anywhere along the length of the tooth, sometimes at the cervical portion, at other times midway along the root or even just at the apex of the root, depending on the extent of root formed at the time of injury. It has been emphasized by Van Gool that such an injury to a permanent tooth, resulting in dilaceration, often follows traumatic injury to the deciduous predecessor in which that tooth is driven apically into the jaw.[5] Other authors have also given an extensive description of this anomaly.[6],[7] Presented here is a typical case of dilaceration.

 Case Report



Reported here is a case of an 11-year-old girl child who reported with a complaint of proclined anteriors. Patient gave a history of trauma at the age of 3 years due to fall, which resulted in intrusion and impaction of deciduous maxillary central incisors. The intruded teeth were extracted. Intraoral examination revealed Class II div 1 malocclusion with missing right maxillary central incisor [Figure 1]. No bulge was palpable in the maxillary vestibular area. An intraoral periapical radiograph was taken to ascertain the presence and position of the central incisor. The tooth was found to be impacted with dilaceration at the cementoenamel junction [Figure 2]. The occlusal radiograph of maxilla revealed that the crown was directed labially and embedded deep in the bone [Figure 3]. The diagnostic findings were also confirmed by CT scan, which helped determine the exact position and angulation of the dilacerated tooth [Figure 4][Figure 5]. The angle was such that the orthodontic eruption was not possible after gaining the space; so it was decided to extract the tooth. Presurgical investigations were carried out and surgery was done under local anesthesia. An incision was made to include two teeth on either sides and a buccal flap was raised. The incisal edge of the tooth was visible through a small window in the labial cortical plate [Figure 6]. Bone cutting was done to expose the crown completely. The tooth was extracted with great care so as to remove it in toto [Figure 7]. The follicle of the tooth was enucleated and curettage was done followed by copious irrigation and a clean cavity was visible thereafter [Figure 8][Figure 9]. Sutures were placed at the end of surgery to promote healing [Figure 10]. The healing was uneventful and sutures were removed after 1 week. The patient is presently on twin-block therapy for treatment of malocclusion, which will be followed by orthodontic therapy for proper alignment and space regaining for prosthetic replacement of the missing tooth.

 Discussion



Trauma to the deciduous teeth may have various implications such as enamel hypoplasias and dilacerations, the latter found to be far more common, with maxilla being more frequently involved than mandible.[8],[9],[10],[11] The actual mechanism of injury is usually the intrusion of the deciduous teeth. The prognosis of these teeth is not favorable; usually all the teeth remain unerupted. So, it is advisable to keep these patients under observation after trauma and to consult an orthodontist at an early stage in case of non-eruption of teeth. The reason for this is that early extraction and orthodontic closure of the diastema may be preferred to ligation and movement. As in the present case, the tooth remained unerupted and thus space loss occurred. Surgical exposure followed by orthodontic traction and repositioning was not possible because of the acute bend of the root, hence extraction was preferred to prevent unfavorable sequelae of unerupted tooth. Therefore, early consultation with an orthodontist is necessary in order to make a choice of either ligation and orthodontic treatment or removal and orthodontic closure of diastema or prosthetic replacement.

References

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