Salima Bouaziz - Academia.edu (original) (raw)

Papers by Salima Bouaziz

Dental, Oral and Craniofacial Research, 2017

Dens invaginatus is an anomaly of the tooth formation, its root canal treatment is a real challen... more Dens invaginatus is an anomaly of the tooth formation, its root canal treatment is a real challenge due to the severe complex of root anatomy. This paper reports the nonsurgical endodontic management of three cases of maxillary lateral incisor with type I, II and III dens invaginatus, necrotic pulp and periapical lesion. Cone Beam Computed Tomography (CBCT) was used to get a three-dimensional observation of this area. The use of dental operating microscope and ultrasonic tips helped us to eliminate the invagination safely. Correspondence to: Hela Zekri, Resident in Restorative Dentistry and Endodontics, Dental faculty of Monastir, Tunisia, Tel: +21655085423; E-mail: Hela_Zekri@ hotmail.fr Received: July 04, 2017; Accepted: August 14, 2017; Published: August 17, 2017 Introduction Genetic disorders or environmental factors during tooth formation can cause tooth abnormalities [1]. Dens invaginatus has been defined as a defect in tooth development, characterized by invagination of the enamel organ into the dental papilla before the calcification phase [27]. Several terms have been used to define this malformation such as dens in dente, dilated composite odontoma, dens invaginatus. This is probably due to the lack of consensus on its formation, etiology and classification [4]. Its frequency is reported to be 0.04-10% by Heydari A, et al. [3]. Many classifications were proposed but the one by Oehlers (1957) is probably the most clinically relevant [5]. Type I: invagination confined inside the crown, not extending beyond the cemento-enamel junction (CEJ). Type II: invagination extends beyond the CEJ, it may or may not communicate with the pulp and not reach the periradicular tissue. Type IIIA: Invagination extends beyond the CEJ penetrating the root and communicates laterally with the periodontal ligament space through a pseudo-foramen. There is usually no communication with the pulp, which lies compressed within the root. Type IIIB: Invagination extends through the root and communicates with the periodontal ligament at the apical foramen. There is usually no communication with the pulp [2,6]. 1st Case report An 18-year-old female was referred by her general dental practitioner to the Department of Restorative Dentistry and Endodontics, University of Dental Medicine, Monastir, Tunisia. The patient dental history revealed pain related to the right maxillary lateral incisor since 5 years, and every time she consulted, her doctor prescribed antibiotics and analgesics. Then, she consulted another private dental practitioner who opened a very decayed access cavity in the tooth 12 and the 11, left the teeth open and referred her to our department. Clinical examination revealed a cone-shaped lateral right incisor (Figures 1a,b). The tooth was sensitive on palpation and percussion. Discoloration was present and the tooth did not respond to cold vitality test. Radiographic examination including panoramic and periapical films showed a dens invaginatus type II with a large periapical radiolucency (Figures 2 and 3). Our diagnosis was pulp necrosis with acute apical periodontitis in a type II dens invaginatus. Thus conventional root canal therapy was indicated. A cone-beam computed tomography (CBCT) scan was indicated to observe the three-dimensional image of this complex anatomy. As an emergency treatment, the central canal of tooth 12 was prepared with #10, #15 and #20 K-files (Dentsply Maillefer, Ballaigues, Switzerland) until possible working length and disinfected with 5.25% sodium hypochlorite (NaOCl). It was wide in the apical part of the root. The root canal of tooth 11 was also disinfected with NaOCl and instrumented with rotary Protaper (Dentsply Maillefer). Then calcium hydroxide was mixed and inserted into the teeth’s roots, and the access cavities were temporarily sealed with Cavit. The analysis of CBCT showed a very large periapical lesion, a type II dens invaginatus and a very decayed access cavity in tooth 12 (Figures 4a,b,c,d). In the next appointment after 15 days, the patient had no pain. After rubber dam isolation, microscope examination (Carl Zeiss, Oberkochen, Germany) revealed an invaginatus centered in the middle of the root canal and perfectly individualized (Figure 5a). By the use of ultrasonic tip #ET180 we eliminated the invagination. So, the canal Zekri (2017) Nonsurgical endodontic treatment of an invaginatus maxillary lateral incisor: Three case reports Dent Oral Craniofac Res, 2017 doi: 10.15761/DOCR.1000233 Volume 4(1): 2-4 became wide from the coronal part to the apical one (Figure 5b). Then, it was instrumented with Protaper rotary files (Dentsply Maillefer) and disinfected. Working lengths were determined using #20 K-files and periapical radiograph (Figure 6a). Final irrigation was done using: NaOCl 5.25%, EDTA 17% and Clorhexidine 0.2% with physiological serum between each solution to prevent interactions. In tooth 11, the canal was filled using thermoplasticized guttapercha with #25 Revo…

Dental, Oral and Craniofacial Research, 2017

Dens invaginatus is an anomaly of the tooth formation, its root canal treatment is a real challen... more Dens invaginatus is an anomaly of the tooth formation, its root canal treatment is a real challenge due to the severe complex of root anatomy. This paper reports the nonsurgical endodontic management of three cases of maxillary lateral incisor with type I, II and III dens invaginatus, necrotic pulp and periapical lesion. Cone Beam Computed Tomography (CBCT) was used to get a three-dimensional observation of this area. The use of dental operating microscope and ultrasonic tips helped us to eliminate the invagination safely. Correspondence to: Hela Zekri, Resident in Restorative Dentistry and Endodontics, Dental faculty of Monastir, Tunisia, Tel: +21655085423; E-mail: Hela_Zekri@ hotmail.fr Received: July 04, 2017; Accepted: August 14, 2017; Published: August 17, 2017 Introduction Genetic disorders or environmental factors during tooth formation can cause tooth abnormalities [1]. Dens invaginatus has been defined as a defect in tooth development, characterized by invagination of the enamel organ into the dental papilla before the calcification phase [27]. Several terms have been used to define this malformation such as dens in dente, dilated composite odontoma, dens invaginatus. This is probably due to the lack of consensus on its formation, etiology and classification [4]. Its frequency is reported to be 0.04-10% by Heydari A, et al. [3]. Many classifications were proposed but the one by Oehlers (1957) is probably the most clinically relevant [5]. Type I: invagination confined inside the crown, not extending beyond the cemento-enamel junction (CEJ). Type II: invagination extends beyond the CEJ, it may or may not communicate with the pulp and not reach the periradicular tissue. Type IIIA: Invagination extends beyond the CEJ penetrating the root and communicates laterally with the periodontal ligament space through a pseudo-foramen. There is usually no communication with the pulp, which lies compressed within the root. Type IIIB: Invagination extends through the root and communicates with the periodontal ligament at the apical foramen. There is usually no communication with the pulp [2,6]. 1st Case report An 18-year-old female was referred by her general dental practitioner to the Department of Restorative Dentistry and Endodontics, University of Dental Medicine, Monastir, Tunisia. The patient dental history revealed pain related to the right maxillary lateral incisor since 5 years, and every time she consulted, her doctor prescribed antibiotics and analgesics. Then, she consulted another private dental practitioner who opened a very decayed access cavity in the tooth 12 and the 11, left the teeth open and referred her to our department. Clinical examination revealed a cone-shaped lateral right incisor (Figures 1a,b). The tooth was sensitive on palpation and percussion. Discoloration was present and the tooth did not respond to cold vitality test. Radiographic examination including panoramic and periapical films showed a dens invaginatus type II with a large periapical radiolucency (Figures 2 and 3). Our diagnosis was pulp necrosis with acute apical periodontitis in a type II dens invaginatus. Thus conventional root canal therapy was indicated. A cone-beam computed tomography (CBCT) scan was indicated to observe the three-dimensional image of this complex anatomy. As an emergency treatment, the central canal of tooth 12 was prepared with #10, #15 and #20 K-files (Dentsply Maillefer, Ballaigues, Switzerland) until possible working length and disinfected with 5.25% sodium hypochlorite (NaOCl). It was wide in the apical part of the root. The root canal of tooth 11 was also disinfected with NaOCl and instrumented with rotary Protaper (Dentsply Maillefer). Then calcium hydroxide was mixed and inserted into the teeth’s roots, and the access cavities were temporarily sealed with Cavit. The analysis of CBCT showed a very large periapical lesion, a type II dens invaginatus and a very decayed access cavity in tooth 12 (Figures 4a,b,c,d). In the next appointment after 15 days, the patient had no pain. After rubber dam isolation, microscope examination (Carl Zeiss, Oberkochen, Germany) revealed an invaginatus centered in the middle of the root canal and perfectly individualized (Figure 5a). By the use of ultrasonic tip #ET180 we eliminated the invagination. So, the canal Zekri (2017) Nonsurgical endodontic treatment of an invaginatus maxillary lateral incisor: Three case reports Dent Oral Craniofac Res, 2017 doi: 10.15761/DOCR.1000233 Volume 4(1): 2-4 became wide from the coronal part to the apical one (Figure 5b). Then, it was instrumented with Protaper rotary files (Dentsply Maillefer) and disinfected. Working lengths were determined using #20 K-files and periapical radiograph (Figure 6a). Final irrigation was done using: NaOCl 5.25%, EDTA 17% and Clorhexidine 0.2% with physiological serum between each solution to prevent interactions. In tooth 11, the canal was filled using thermoplasticized guttapercha with #25 Revo…