Page 41 - MDJ Volume 47 Number 2 ( Jul-Dec 2024)
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Mustafa, et al.: Management of the Impacted Tooth with Dilacerated Roots – A Surgical Challenge
            spot, which represents the apical foramen and is a part of   latest imaging modalities and careful, delicate handling
            the root canal as well. This radiographic image is known   during surgery. With good planning and good technique,
            as a bull’s eye or a target.                        successful surgery by experienced clinicians is possible.

            Conventional radiography can only take images of the
            teeth in two dimensions, but this shortcoming can be   Acknowledgements
            overcome using CBCT. Its use leads to more accurate   We would like to thank the Dean, Faculty of Dentistry,
            identification of the location, direction and the degree of   MAHSA University, for permission to publish this case
            the dilacerations. [13,14]                          series.
                                                                Financial support and sponsorship
            Management                                          Nil.
            Dilaceration of permanent teeth poses diagnostic,
            prognostic and management challenges. In symptomatic
            cases or when orthodontics is contemplated, these teeth   Conflicts of interest
            may require extraction as they may block tooth movement.  There are no conflicts of interest.
            In a patient with dilacerated lower third molar roots, there   references
            is a possibility of damage to the inferior dental nerve or
            displacement of part or all of the tooth into the lingual   1. Tomes J. A Course of Lectures on Dental Physiology and Surgery
                                                                   Delivered at the Middlesex Hospital School. London: John W
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            path of tooth delivery must be carefully chosen. Bone must   2. Andreasen JO, Sundström B, Ravn JJ. The effect of traumatic
            be removed distal to the tooth to create space and allow   injuries to primary teeth on their permanent successors. I. A clinical
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                                                                   Res 1971;79:219-83.
            backwards rotation following the curvature of the root   3. Chadwick SM, Millett D. Dilaceration of a permanent mandibular
            will facilitate delivery without root fracture occurring.  incisor. A case report. Br J Orthod 1995;22:279-81.
                                                                4. White SC, Pharoah MJ. Oral Radiology: Principles and
            In the case of the lingually positioned, supplemental   Interpretation. 6th ed. St Louis: Mosby; 2009. p. 303-4.
            premolar bone is removed from the concave aspect to allow   5. Chohayeb AA. Dilaceration of permanent upper lateral incisors:
            elevation and rotation towards the lingual, which allows the   Frequency, direction, and endodontic treatment implications. Oral
                                                                   Surg Oral Med Oral Pathol 1983;55:519-20.
            removal of the tooth without the risk of root fracture.  6. Hamasha AA, Al-Khateeb T, Darwazeh A. Prevalence of
                                                                   dilaceration in Jordanian adults. Int Endod J 2002;35:910-2.
            In the third patient whose impacted dilacerated tooth was   7. Schneider SW . A comparison of canal preparations in straight
            in very close proximity to the sinus floor, the possibility   and curved root canals. Oral Surg Oral Med Oral Pathol 1971;32:
            of creating an oro-antral communication or complete    271-5.
            displacement of the tooth into the maxillary sinus has to   8. Miloglu O, Cakici F, Caglayan F, Yilmaz AB, Demirkaya F. The
            be kept in mind.                                       prevalence of root dilacerations in a Turkish population. Med Oral
                                                                   Patol Oral Cir Bucal 2010;15:e441-4.
            Although the overall complication rate related to this   9. Colak H, Bayraktar Y, Hamidi MM, Tan E, Colak T. Prevalence of
                                                                   root dilacerations in central Anatolian Turkish dental patients. West
            procedure is low, during  or after dental extraction,   Indian Med J 2012;61:635-9.
            oro-antral communications are among the possible    10. Ledesma-Montes C, Hernández-Guerrero JC, Jiménez-Farfán MD.
            complications that surgeons must take into account prior   Frequency of dilaceration in a Mexican school-based population. J
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            the surgery.  Accidental displacement of tooth fragments   11. Qutieshat A, Al Harthy N, Javanmardi S, Singh G, Chopra V,
                     [15]
            or of complete teeth towards adjacent anatomical spaces,   Aouididi R, et al. Prevalence of mesio-distal dilaceration in patients
            for example, maxillary sinus is a rare event that requires   presenting for initial orthodontic care: A retrospective study. J
            a specific treatment. Among the different aetiologies   Orthod Sci 2023;12:13.
            described in the literature, iatrogenic cases resulting from   12. Malcić A, Jukić S, Brzović V, Miletić I, Pelivan I, Anić I. Prevalence
                                                                   of root dilaceration in adult dental patients in Croatia. Oral Surg
            dental treatment are the most common cause of foreign   Oral Med Oral Pathol Oral Radiol Endod 2006;102:104-9.
            bodies displaced towards this cavity. [16]          13. Walia PS, Rohilla AK, Choudhary S, Kaur R. Review of dilaceration
                                                                   of maxillary central incisor: A mutidisciplinary challenge. Int J Clin
            In our case 3, to facilitate extraction of the tooth, bone   Pediatr Dent 2016;9:90-8.
            palatal to the tooth was removed. To minimise the   14. Asheghi B, Sahebi S, Zangooei Booshehri M, Sheybanifard F.
            possibility of displacement into the antrum, mesial bone   Evaluation of root dilaceration by cone beam computed tomography
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            the sinus floor by the use of Coupland’s elevators.  15.  Toledano-Serrabona  J,  Cascos-Romero  J,  Gay-Escoda  C.
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                                                                16. Hara Y, Shiratsuchi H, Tamagawa T, Koshi R, Miya C, Nagasaki M,
            Surgical management of the impacted tooth with dilacerated   et al. A large-scale study of treatment methods for foreign bodies in
            roots requires careful pre-operative assessment using the   the maxillary sinus. J Oral Sci 2018;60:321-8.


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