Short Cases Nov

SHORT CASES NOV-DEC 2015
3-11-15
DR A
1- What material is better to make copings/post/core for the front tooth?
2- Grossly carious molars/timing for extraction
3- EARLY LOSS OF PRIMARY TEETH---PS PEDO PG 111
4- Delayed exfoliation of primary teeth

5- RETAINED PRIMARY SECOND MOLARS PS PEDO PG 37
6- External resorption
Communicating ex tint root resorption
A 28-year-old female patient reported to the
Department of Conservative Dentistry and Endodontics with complaint of
pus discharge since last 6 months and broken front tooth. Patient had
trauma some 3-4 years back. Clinical examination revealed a discoloured 11
(FDI system) and fractured 21 with sinus openings in the apical area of both
teeth [Table/Fig-1]. Both teeth were tender on percussion and 11 was
grade 2 mobile. On probing pockets were noted on 11(10 mm buccal, 5mm
mesial, 7mm distal) and 21(5mm mesial and distal) [Table/Fig-2]. Overall
patient had poor oral hygiene. Radiographic examination [Table/Fig-3]
revealed widened periodontal ligament and periapical radiolucency w.r.t.
both 11 and 21. Internal and external resorption was present w.r.t. 11.
Based on clinical and radiographic examination it was tentatively diagnosed
as a After proper isolation, access opening was done, working length was
taken and cleaning and shaping of the root canal was done w.r.t no. 11 &
21. Calcium hydroxide as intracanal medicament was placed in the canal.
After 1 week surgery was performed. On flap elevation a large J-shaped
bony defect [Table/Fig-4] was found w.r.t. 11 with buccal plate completely
denuded. Trichloroacetic (TCA) acid was applied topically (with a small
cotton pellet with slowly increasing pressure) on the resorptive defect to
control the haemorrhage. Afterthorough curettage of the granulation tissue
from the resorptive defect and apical part, retrograde filling of root canal
was done. External resorptive defect was filled with MTA (Pro Root MTA-
Dentsply Tulsa Dental) [Table/Fig-5]. An artificial bone graft (Ossifi, Equinox
medical technologies, Holland) was placed to cover the bony defect
[Table/Fig-6] and suturing of flap was done [Table/Fig-7]. After one week
sutures were removed. Temporary crown was placed on 21 and teeth were
splinted with Ribbond for 3 weeks
7- Internal resorption
8- macrodontia Figure 1 Intraoral photographs from

four patients. Unilateral macrodontia of the permanent maxillary central incisor with (a) and
without (b) notch on the incisor edge and bilateral macrodontia of the permanent maxillary
central incisors with minor notches (c) and more profound notches (d) on the incisor edge.
Hypoplasia of the enamel (attributed to tuberculosis). (B) Hypoplasia due to trauma of
the deciduous predecessor leading to its intrusion.
Hypocalcification presents as localised abnormalities in tooth colour, called opacities, which may be:
9- Diffuse, non-demarcated chalky-white spots
10- Well-demarcated spots, often white (Figure 3.4), and otherwise cream, yellow or brow
ncisor-Molar-Hypomineralisation (IMH; “Cheese

Molars”)
This condition occurs when one or more first permanent molars show occlusal or larger areas of
demarcated yellow to brown hypocalcified enamel. In the past they were called cheese molars because
their colour and consistency resemble aged Dutch cheese. Post-eruptively, the enamel wears rapidly. The
more yellow-brown the colour, the more porous is the enamel. 426 The anomaly is named molar-incisor-
hypomineralisation960 because the permanent incisors may be involved, the maxillary incisors more often
than the mandibular incisors (Figure 3.5). IMH is, however, also observed in deciduous second molars,
permanent second molars and the canines.958 A disturbance in enamel maturation is suspected,957 and
the enamel is hypersensitive to cold stimuli.
Figure 3.5 (A–C) Incisors in molar-incisor-hypomineralisation (A), molars in molar-incisor-
hypomineralisation (B) and molars (of another patient) in molar-incisor-
hypomineralisation (C).
(Courtesy of K. Weerheim.)
No change in the function of the more cervically located ameloblasts indicates a temporary insult. 426 The
causes of hypocalcification include many well-known systemic health problems that occur around and up
to 3 years after birth,911 1033 such as high fever, digestive tract disorders910 and problems related to birth
(oxygen deficiency), and respiratory diseases427 911 such as asthma and bronchitis446 (the latter has been
found to occur in regions with drinking water containing higher levels of fluoride). 856 Other causes include:
renal insufficiency, hypoparathyroidism, dioxins, diarrhoea and malabsorption.446 IMH in two siblings was
ascribed to dehydration due to an intolerance of cow milk. Duration of breast-feeding might be associated
with IMH,427 but birthweight and length at birth, problems around and during birth do not seem to be
associated.92 426 IMH is seen in about 5 to >10% of children. 220 428 446 470 959 A more extreme range has also
been reported: from 3.5% to 25%.956 957
Small affected areas can be treated with fissure sealants. Somewhat larger areas may be restored with
glass ionomer cement. Composite resins seem better, 272 but the restoration fails frequently,1033 although
crowns with two sound surfaces on follow up after 4 years were still satisfactorily restored (one-third
remaining hypersensitive for 1 week and a few teeth for 1 year). 539 The hypomineralised enamel shows
unusual etching patterns, either because the defective enamel is not uniformly removed, 547 or because of
deviations in the prism boundaries857 or because the tissue underneath the sound enamel may be
hypocalcified.426 428 Larger affected areas require onlays, stainless steel crowns,272 or adhesive
copings.1023 To avoid a repeated cycle of restorations, extraction of a severely affected first molar should
be considered,985 ideally at age 8–9 years, when radiographs show complete calcification of the crown of
the second molar or when its bifurcation is visible, which minimises the need for orthodontics. Following
late extraction of the first molar, the second molar will show less forward movement, with mesial tipping
and lingual rolling.986 If the first molar is extracted too early, the second premolar will drift distally. To
prevent a centre line shift, a non-compromised contralateral molar may be removed too.986
11-Screwdriver teeth in congenital syphilis. Note the characteristic central notches in

the lower incisors.
12- (Courtesy of Department of Oral Surgery, University of Groningen.)
13-
14- The rounded permanent first molars with a large number of small occlusal cusps, with pigmented
areas in between, resemble a mulberry (“mulberry molars”, “Moon’s molars” after Henry Moon).
Parts of the enamel may break away.391 Hutchinson’s triad is fully present in 1% of the patients:
about 30% have screwdriver teeth and mulberry molars. 122 283 391 706 For unknown reasons the
incisors are not always bilaterally anomalous. The deciduous dentition is free from defects: the
spirochaete does not penetrate the tooth germs before the fourth (or fifth) month in utero, when
the placental Langerhans layer disappears,941 but crown growth might be disrupted after birth
(unlikely) rather than before.391
15-
16- Lad
17-
When determining a prognostic for a tooth with internal root resorption, endodontically
treated, the need for radiographic control every six months for at least two years should be
considered. Such fact is due to the possibility of the area involved by the resorption to present a
lateral canal, which would allow the continuity of the resorption process and compromise the
treatment
18- Invasive cervical resorption versus internal resorption
19- Recession by trarma tooth brushing vs early chronic periodontitis vs tipped molar vs bio width
invade
20- Internal and external resorption together
21- Non odontogenic radiolucent lesions
22- Dentoalveolar fracture
23- All guidelines of dental trauma 2010
24- Dental caries class5 and incipient
25- Maxillary incisors treated
26- Periodontal abcess versus endo
27-
28- REPAIR OR REPLACE RESTORATIONS
29- FERRULE VS NO FERRULE
30- ENDOCROWN VS POST AND CORE
The endocrown is described as a monolithic (one-piece) ceramic bonded construction 14-18 characterized by a supra-
cervical19butt joint, retaining maximum enamel to improve adhesion. The endocrown invades the pulpal chamber, but
not the root canals. It is milled using computer-aided techniques 16,18 or by molding ceramic materials under pressure2
Indications and Contraindications
The endocrown is suitable for all molars, particularly those with clinically
low crowns, calcified root canals or very slender roots. The endocrown is
contraindicated if adhesion cannot be assured, if the pulpal chamber is
less than 3 mm deep or if the cervical margin is less than 2 mm wide for
most of its circumference.
The endocrown is a restorative option for endodontically treated teeth. It

consists of a circular butt-joint margin and a central retention cavity inside the
pulp chamber and lacks intraradicular anchorage
31- NON SURGICAL ENDO DONTIC RETREATMENT

32- SURGICAL RETREATMENT
33- ENDO CROWN CAST POST AND CORE
34- CALCIFIC METAMORPHOSIS
35- FRACTURED INCISORS OPEN APEX
36- COMPLICATED FRACTURE INCISOR
37- MOLARS VRF ROLE OF ANTIBIOTICS
38- INADEQUATE POST
39- CONTRAINDICATION OF DENTAL IMPLANT
40- BRIDGE CASES
41- MISSING TEETH SCEANARIOS GRP FUNCTION
42- CANINE GUIDED CASES
43- DRIFTED TEETH
44- 2ND MOLAR EARLY LOSS CASES
45- RATAINED ES
46- DISTEMA SINGLE
47- DIASTEMA MULTIPLE
48- PERI IMPLANTITIS
49- CH ENAMEL HYPOPLASIA
50- EXTERNAL RESORTPTION
51- INTERNAL
52- REPLACEMENT
53- Hypercemetosis
54-
55-
56- ICR
57- EXTRUSIVE INCISOR
58-
59- RECESSION AROUND TEETH

60-
61-
62- RECESSIKON AROUND BRIDGE

63- RECESSION AROUND IMPLANT
64- PAPILLA
65- GROOVE LABIAL INSISOR
66- Pulp stone
67-
Pulp stones are discrete calcified masses found in the dental pulp, exist freely in the pulp tissue or become
attached to or embedded into the dentine. Structurally, pulp stones can be classified as true or false, the former
being made of dentine and lined by odontoblasts, whereas false pulp stones are formed from degenerating cells
of the pulp that gets mineralized. [1] Etiological factors that have been implicated in stone formation include pulp
degeneration, inductive interactions between epithelium and pulp tissue, age, circulatory disturbances in pulp,
orthodontic tooth movement, idiopathic factors and genetic predisposition, [2] i.e., dentine dysplasia,
dentinogenesis imperfecta and in certain syndromes such as Van der woude syndrome. In spite of higher
occurrence of pulp stones in adult population, the presence of generalized pulp stone in young children is rare.
The present case report depicts generalized pulp stone presence in a 13-year-old young girl, without any
metabolic disturbances and syndrome, which may be suggestive of its idiopathic origin.
68- PG GROOVE
69- SPLINTING CASES
70- BRIDGE CONTRAINDICATIONS
71- OPEN BITE CASES BRIDGES
72- LABIAL SULCUS UPPER INCISORS SWELLING
73- MISSING INCISOR BOTH
74- AGGRESSIVE PERIODONTITIS GENERILIZED AND LOCALIZED
75- OPG GORLIN GOLDZ SYNDROME
76- FUSION BS
77- GEMINATION
78- DILACERATION
79- CONCRESENCE
80- PEG
81-
THICK BIOTYPE
82- GINGIVAL HYPERPLASIA SYSTEMIC CONDITION
83- IMBRICATED INCISORS
84- SPACED INCISORS
85- MISSING CANINES
86- MISSING LATERALS
87- MISSING CENTRAL
88- AVULSION PRIMARY
89- AVULSION PERMANENT
90- PULPOTOMY
91- PULP CAPPING
92- ECC
93- CLEIDOCRANIAL
94- ECTODERMAL
95- GARNERS SYNDROME
96- EHLARS
97- DOWNS
98- PAPILLION LEFEVER
99- NUTROPENIA
100- SCURVY
101- RADIATION CARIES
102- ROOT FRACTUR
103- CROWN DILACERATION VS MALALIGNED
104- CM
105- SEPERATED INSTRUMENT
106- HYPODONTIA
107- DISCOLOURED TEETH
108- DISCOLOURED COMPOSITE
109- LUDWIGS
110- FACIAL SPACE INFECTIONS
111- METABOLIC DISEASES DISCOLOURED TEETH
112- INTRUSION
113- OSTEOMYLLITIS
114- DENTINE DYS
115- CYST
116- ABCESSES
117- METH CARIES
118- LEONG
119- CRACKED TOOTH
120- BLACK TRIANGLES
121- VEENER CHIP
122- ANTERIOR TSL
123- AI
124- DI
125- FLUOROSIS
126- Perikymata
127- fluorosis
128- High grade temperature enamel hypoplasia
A six-year-old boy was reported with chief complaint of large tooth in the lower jaw. His medical
and family history was noncontributory. Intraoral examination revealed unusual presence of large
used triple teeth at incisor region on right side and erupted permanent central and lateral incisors
n left side of mandible (Figures 1 and 2). There was deep vertical groove at the union without ca
ries or any other dental abnormalities. Intraoral periapical radiograph shows fusion of two prima
ry incisors with supernumerary tooth (triple teeth), with separate pulp chamber and root canal
s, erupting succedaneous lateral incisor and canine but absence of central incisor on right side as
ts position and mesiodistal dimension resemble erupted lateral incisor on left side (Figure
3). It was diagnosed as an unusual case of triple teeth in deciduous anterior region which is of
incomplete fusion. Since the fused teeth were asymptomatic, recall examination was planned
until exfoliation of triple teeth

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SHORT CASES NOV-DEC 2015

1- What material is better to make copings/post/core for the front tooth?

2- Grossly carious molars/timing for extraction

3- EARLY LOSS OF PRIMARY TEETH---PS PEDO PG 111

4- Delayed exfoliation of primary teeth

8- macrodontia Figure 1 Intraoral photographs from

ncisor-Molar-Hypomineralisation (IMH; “Cheese

11-Screwdriver teeth in congenital syphilis. Note the characteristic central notches in

The endocrown is a restorative option for endodontically treated teeth. It

31- NON SURGICAL ENDO DONTIC RETREATMENT

59- RECESSION AROUND TEETH

62- RECESSIKON AROUND BRIDGE

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