Dilaceration

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Dilaceration
Specialty Dentistry

Dilaceration is a developmental disturbance in shape of teeth. It refers to an angulation, or a sharp bend or curve, in the root or crown of a formed tooth. This disturbance is more likely to affect the maxillary incisors and occurs in permanent dentition. [1] Although this may seem more of an aesthetics issue, an impacted maxillary incisor will cause issues related to occlusion, phonetics, mastication, and psychology on young patients. [2]

Contents

Description

The condition is thought to be due to trauma or possibly a delay in tooth eruption relative to bone remodeling gradients during the period in which tooth is forming. [3] The result is that the position of the calcified portion of the tooth is changed and the remainder of the tooth is formed at an angle.

The curve or bend may occur 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 upon the amount of root formed when the injury occurred.

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.

Signs and Symptoms

This image can be used as a reference point for dilaceration. As can be seen in this panorex image of a cleft palate, among the mixed dentition, all of the teeth remain to have straighter roots. Slight curves are common among the molars, however, there are no extreme curves or bends along the length of the teeth. Dilaceration would appear far more obviously in a radiograph Cleft palate alveolus panorex xray.jpg
This image can be used as a reference point for dilaceration. As can be seen in this panorex image of a cleft palate, among the mixed dentition, all of the teeth remain to have straighter roots. Slight curves are common among the molars, however, there are no extreme curves or bends along the length of the teeth. Dilaceration would appear far more obviously in a radiograph

Pressure or pain in the jaw area can be associated with dilaceration. Checking in with a general dentist and an endodontist should be done if a patient feels these symptoms. [4] Signs in radiographic imaging will indicate an bend in the tooth's root as opposed to a straight growth. [1] Dilaceration of the crown, the top part of the teeth that we see when we smile, can be visually seen for diagnosis. Crown dilaceration will present itself as a tooth that is angled to face outward or inward. It will be a non axial displacement and more of a longitudinal displacement. [5]

Cause

This image is used to orient on the formation of primary and permanent teeth. Focusing on the lower teeth in this xray, you may notice it seems that some small teeth are floating on top of larger more developed teeth. These floating teeth are primary teeth while the teeth with longer more developed roots are the permanent teeth. Cleft palate alveolus panorex xray.jpg
This image is used to orient on the formation of primary and permanent teeth. Focusing on the lower teeth in this xray, you may notice it seems that some small teeth are floating on top of larger more developed teeth. These floating teeth are primary teeth while the teeth with longer more developed roots are the permanent teeth.

The etiology of dilaceration is not very commonly known. However, it is thought to be related to:

Mechanism/ Pathophysiology

During the developmental stages, the permanent tooth germ, specifically of the maxillary incisor lies superior to the apex of the primary incisor. [5] If there is damage to the primary incisor, this will cause an impact on the permanent incisor as well as there is only about a 3mm space of thickness between the primary and permanent teeth. [5] In the human mouth, once the permanent teeth begin to develop, they remain underneath the primary teeth. Once they are ready to erupt they push upward eventually causing the primary teeth to fall out. There is essentially a small space between the permanent and primary teeth, roughly less than 3mm of spacing. [5] If a young child is to experience trauma to the mouth, this can cause developmental disorders to the permanent tooth that is still developing and lying direction underneath it. The impact from the primary tooth will be transferred to the permanent tooth that may have its roots formed, thus causing a bend or curvature of the permanent tooth root. [5] It is noted that rather than the force of the impact, the direction in which the impact occurs has a more significant effect on dilaceration formation. [5] [7] Cysts or tumors can cause dilaceration as well. As a tumor or cyst forms it may cause impaction on the growth and development of the permanent teeth as well. This may cause crown or root dilaceration as the tooth tries to grow around the cysts or tumor causing dramatic angulation. [8] Similarly, patients present with supernumerary teeth, may have impacted the growth of underlying permanent teeth causing the abnormal root curvature growth. [1] An ankylosed deciduous tooth will not allow for proper growth the permanent tooth. Thus, the tooth may look for another path to erupt. This may cause dilaceration of root or may potentially impact neighboring teeth causing dilaceration to those teeth. [1]

Diagnosis

Dilaceration can be diagnosed with a simple radiograph of the affected teeth. However, if the bends are more lingual or facially present, [1] more advance imaging techniques may be necessary. In some cases a cone-bean CT scan may be useful to create a three dimensional view. [9]

Prevention/ Treatment

This radiograph shows a root canal treatment with no crown completed. This is a possible course of treatment for dilacerated teeth. The slight curves shown on these molar teeth are normal curves. Extreme curvature of roots are known to be dilaceration. Root canal treatment.jpg
This radiograph shows a root canal treatment with no crown completed. This is a possible course of treatment for dilacerated teeth. The slight curves shown on these molar teeth are normal curves. Extreme curvature of roots are known to be dilaceration.

There are currently no preventative measures to be taken for dilaceration as the etiology is not well known. However, there are some treatment options that may serve to be of use. A surgical method which involves the exposing the impacted tooth to meet with normal occlusion with the help of orthodontic traction. [2] Although this surgical method has proven to be of use in the past, it may not be the case for every patient with dilacerated teeth. Thus the degree of dilaceration is dependent on what kind of treatment can take place. In young children many cases of dilaceration occur due to some kind of trauma to the tooth, commonly causing dislocation of the tooth affecting its direction and growth. [10] Once a trauma has occurred dilaceration can be prevented by yearly visits to the dentist and maintaining radiographic images to note any changes that may occur. If changes do occur, treatment can be done through orthodontic treatment or the tooth may be completely extracted by a dentist to prevent impaction on permanent teeth. [10] Prevention for young children also includes avoiding injury to the mouth, especially during sporting activities, proper headgear and protective measures should be taken prior to engaging in recreational activities for the overall safety of the child. [4] Patients with supernumerary teeth may also be candidates for teeth extraction followed by orthodontic treatment to prevent dilaceration. [1] In some cases and Endodontist, a tooth root specialist, may be involved in treatment of dilaceration. Using radiographs to determine the extent of dilaceration, the endodontist may recommend a root canal treatment, [4] which is essentially cleaning out the nerve of the tooth and placing material inside the tooth to help maintain its structure. Since at this point the tooth with no nerve is essentially dead, further treatment from a general dentist to crown the tooth will be necessary. Crowning the tooth will prevent breakage of the tooth while still allowing functionality of the tooth. In order to achieve the best possible results, treatment should begin as soon as possible. [5]

Prognosis

The prognosis will vary from each patients case to case. In less severe cases, patients may face minor issues with aesthetics which orthodontic treatment can resolve. In more severe cases which are not as easily treatable patients may face more severe issues with occlusions and phonetics. In some cases young children may face psychological issues. [1] Patients may face some difficulties as time progresses and if they are left untreated. Other teeth may become impacted and cause pain and soreness. [2]

Epidemiology

Most commonly affects patients in their permanent dentition. [9] [1] It may also appear in primary teeth however, its incidence rate is significantly lower. Some studies indicate that dilaceration is not more common in any gender however, other studies indicate that incidence rate is more common in females than males with a ratio of 1:6. [5] There are reports of a 0.53% for this to occur on the two front teeth of the upper jaw. In a study conducted on the adult population in Croatia, the most common teeth to experience dilaceration were the lower jaw's 3rd molars with a whopping 24.1%. [11] Next was the upper jaw's first, second and third molars at 15.3%,11.4% and 8.1% incidence rate respectively. [11]

Research Directions

Although this disease is rare there has been a significant amount of research done on this.

See also

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Wisdom tooth</span> Large tooth at the back of the human mouth

The third molar, commonly called wisdom tooth, is the most posterior of the three molars in each quadrant of the human dentition. The age at which wisdom teeth come through (erupt) is variable, but this generally occurs between late teens and early twenties. Most adults have four wisdom teeth, one in each of the four quadrants, but it is possible to have none, fewer, or more, in which case the extras are called supernumerary teeth. Wisdom teeth may become stuck (impacted) against other teeth if there is not enough space for them to come through normally. Impacted wisdom teeth are still sometimes removed for orthodontic treatment, believing that they move the other teeth and cause crowding, though this is not held anymore as true.

Hypodontia is defined as the developmental absence of one or more teeth excluding the third molars. It is one of the most common dental anomalies, and can have a negative impact on function, and also appearance. It rarely occurs in primary teeth and the most commonly affected are the adult second premolars and the upper lateral incisors. It usually occurs as part of a syndrome that involves other abnormalities and requires multidisciplinary treatment.

<span class="mw-page-title-main">Human tooth development</span> Process by which teeth form

Tooth development or odontogenesis is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. For human teeth to have a healthy oral environment, all parts of the tooth must develop during appropriate stages of fetal development. Primary (baby) teeth start to form between the sixth and eighth week of prenatal development, and permanent teeth begin to form in the twentieth week. If teeth do not start to develop at or near these times, they will not develop at all, resulting in hypodontia or anodontia.

<span class="mw-page-title-main">Malocclusion</span> Medical condition

In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855-1930), the "father of modern orthodontics", popularised it. The word "malocclusion" derives from occlusion, and refers to the manner in which opposing teeth meet.

<span class="mw-page-title-main">Dental extraction</span> Operation to remove a tooth

A dental extraction is the removal of teeth from the dental alveolus (socket) in the alveolar bone. Extractions are performed for a wide variety of reasons, but most commonly to remove teeth which have become unrestorable through tooth decay, periodontal disease, or dental trauma, especially when they are associated with toothache. Sometimes impacted wisdom teeth cause recurrent infections of the gum (pericoronitis), and may be removed when other conservative treatments have failed. In orthodontics, if the teeth are crowded, healthy teeth may be extracted to create space so the rest of the teeth can be straightened.

A dental emergency is an issue involving the teeth and supporting tissues that are of high importance to be treated by the relevant professional. Dental emergencies do not always involve pain, although this is a common signal that something needs to be looked at. Pain can originate from the tooth, surrounding tissues or can have the sensation of originating in the teeth but be caused by an independent source. Depending on the type of pain experienced an experienced clinician can determine the likely cause and can treat the issue as each tissue type gives different messages in a dental emergency.

<span class="mw-page-title-main">Dentigerous cyst</span> Medical condition

A dentigerous cyst, also known as a follicular cyst, is an epithelial-lined developmental cyst formed by accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth. It is formed when there is an alteration in the reduced enamel epithelium and encloses the crown of an unerupted tooth at the cemento-enamel junction. Fluid is accumulated between reduced enamel epithelium and the crown of an unerupted tooth.

Tooth gemination is a dental phenomenon that appears to be two teeth developed from one. There is one main crown with a cleft in it that, within the incisal third of the crown, looks like two teeth, though it is not two teeth. The number of the teeth in the arch will be normal.

<span class="mw-page-title-main">Talon cusp</span> Rare dental anomaly resulting in teeth having more than one cusp

Talon cusp is a rare dental anomaly resulting in an extra cusp or cusp-like projection on an anterior tooth, located on the inside surface of the affected tooth. Sometimes it can also be found on the facial surface of the anterior tooth.

Dental anatomy is a field of anatomy dedicated to the study of human tooth structures. The development, appearance, and classification of teeth fall within its purview. Tooth formation begins before birth, and the teeth's eventual morphology is dictated during this time. Dental anatomy is also a taxonomical science: it is concerned with the naming of teeth and the structures of which they are made, this information serving a practical purpose in dental treatment.

Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

<span class="mw-page-title-main">Enamel hypoplasia</span> Medical condition

Enamel hypoplasia is a defect of the teeth in which the enamel is deficient in quantity, caused by defective enamel matrix formation during enamel development, as a result of inherited and acquired systemic condition(s). It can be identified as missing tooth structure and may manifest as pits or grooves in the crown of the affected teeth, and in extreme cases, some portions of the crown of the tooth may have no enamel, exposing the dentin. It may be generalized across the dentition or localized to a few teeth. Defects are categorized by shape or location. Common categories are pit-form, plane-form, linear-form, and localised enamel hypoplasia. Hypoplastic lesions are found in areas of the teeth where the enamel was being actively formed during a systemic or local disturbance. Since the formation of enamel extends over a long period of time, defects may be confined to one well-defined area of the affected teeth. Knowledge of chronological development of deciduous and permanent teeth makes it possible to determine the approximate time at which the developmental disturbance occurred. Enamel hypoplasia varies substantially among populations and can be used to infer health and behavioural impacts from the past. Defects have also been found in a variety of non-human animals.

<span class="mw-page-title-main">Dental trauma</span> Medical condition

Dental trauma refers to trauma (injury) to the teeth and/or periodontium, and nearby soft tissues such as the lips, tongue, etc. The study of dental trauma is called dental traumatology.

<span class="mw-page-title-main">Dental avulsion</span> Medical condition

Dental avulsion is the complete displacement of a tooth from its socket in alveolar bone owing to trauma. Normally, a tooth is connected to the socket by the periodontal ligament. When a tooth is knocked out, the ligament is torn.

<span class="mw-page-title-main">Tooth mobility</span> Medical condition

Tooth mobility is the horizontal or vertical displacement of a tooth beyond its normal physiological boundaries around the gingival area, i.e. the medical term for a loose tooth.

Tooth ankylosis refers to a fusion between a tooth and underlying bony support tissues. In some species, this is a normal process that occurs during the formation or maintenance of the dentition. By contrast, in humans tooth ankylosis is pathological, whereby a fusion between alveolar bone and the cementum of a tooth occurs.

An ectopic maxillary canine is a canine which is following abnormal path of eruption in the maxilla. An impacted tooth is one which is blocked from erupting by a physical barrier in the path of eruption. Ectopic eruption may lead to impaction. Previously, it was assumed that 85% of ectopic canines are displaced palatally, however a recent study suggests the true occurrence is closer to 50%. While maxillary canines can also be displaced buccally, it is thought this arises as a result of a lack of space. Most of these cases resolve themselves with the permanent canine erupting without intervention.

<span class="mw-page-title-main">Ectopic tooth</span> Medical condition

An ectopic tooth, also known as an impacted tooth, is a tooth that develops in an abnormal position and fails to erupt into its normal location in the oral cavity. Ectopic teeth can cause a variety of symptoms, such as pain, swelling, and infection, and they can lead to more serious complications if left untreated.

References

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