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Table of Contents
Year : 2015  |  Volume : 5  |  Issue : 2  |  Page : 75-78

Endodontic and orthodontic interdisciplinary management of a patient with Turner's hypoplasia

1 Department of Conservative Dentistry and Endodontics, NIMS Dental College, Jaipur, Rajasthan, India
2 Department of Orthodontics and Dentofacial Orthopaedics, NIMS Dental College, Jaipur, Rajasthan, India

Date of Web Publication5-Jan-2016

Correspondence Address:
Gaurangi Lavania
Department of Conservative Dentistry and Endodontics, NIMS Dental College, Jaipur, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2229-5194.173232

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Trauma to primary dentition usually presents with problems in the permanent dentition which are difficult to treat. This case report describes the treatment of a 23-year-old adult female patient with crown dilaceration and discoloration of maxillary right central incisor. Therapeutic management of this tooth was combined with orthodontic treatment for proclination due to associated dilaceration of crown. A. sequential approach of endodontic treatment followed by orthodontic treatment was carried out. The tooth was later treated with a fiber post, and ceramic facing crown was delivered. To produce esthetic results, discoloration of maxillary left central incisor was treated with the composite restoration.

  • The article “gEndodontic and Orthodontic Interdisciplinary Management of a Patient with Turner'fs Hypoplasia”h is a case report of a young 23-year-old girl who was seeking dental help for her unesthetic upper incisors
  • The proclination due to an unusual crown angulation could not be corrected by prosthetic treatment alone and required help from an orthodontist. Once the proclination along with crowding was corrected, the esthetics could be improved
  • Also the patient had focal hypoplastic lesions with brownish discoloration and root reinforcement was required. Thus, a fiber post was luted
  • The esthetic look was, however, enhanced with a prosthetic treatment of a metal ceramic crown.

Keywords: Anterior tooth trauma, hypoplasia, turner's hypoplasia

How to cite this article:
Lavania G, Lavania A. Endodontic and orthodontic interdisciplinary management of a patient with Turner's hypoplasia. J Interdiscip Dentistry 2015;5:75-8

How to cite this URL:
Lavania G, Lavania A. Endodontic and orthodontic interdisciplinary management of a patient with Turner's hypoplasia. J Interdiscip Dentistry [serial online] 2015 [cited 2023 Mar 30];5:75-8. Available from: https://www.jidonline.com/text.asp?2015/5/2/75/173232

   Introduction Top

Hypoplasia is defined as a visual quantitative defect of enamel and is histomorphologically identified as an external defect involving the surface of the enamel associated with reduced thickness of enamel.[1] Turner's hypoplasia is a frequent pattern of enamel defects seen in permanent teeth primarily due to a periapical inflammatory disease of the overlying deciduous tooth. The altered tooth is known as a Turner's tooth.[2] The degree of hypoplasia may vary from a mild brownish discoloration of the crown in focal areas or may involve the entire crown. It is most common in permanent maxillary incisors or maxillary and mandibular premolars.[3] If Turner's hypoplasia is found on a canine or a premolar, the most likely cause is an infection that was present when the primary tooth was still in the mouth. Most likely, the primary tooth was heavily decayed, and an area of inflamed tissues around the root of the tooth affected the development of the permanent tooth. The appearance of the abnormality depends on the severity and longevity of the infection. If Turner's hypoplasia is found in the anterior area of the mouth, the most likely cause is a traumatic injury to a primary tooth. The traumatized tooth, which is usually a maxillary central incisor, is pushed into the developing tooth underneath it and consequently affects the formation of enamel. Because of the location of the permanent tooth's developing tooth bud in relation to the primary tooth, the most likely affected area on the permanent tooth is the facial surface.[4] The Turner's tooth can also be dilacerated along the crown or the root of the tooth.[2] Dilaceration (Latin: dilacero = tear up) refers to an angulation or a sharp bend or curve in the root or crown of a formed tooth. Crown dilaceration is the displacement of a portion of the developing crown at an angle to the longitudinal axis of the tooth. It constitutes 3% of total injuries to developing teeth.[3] The characteristics of clinical enamel hypoplasia include unfavorable esthetics, higher dentin sensitivity, malocclusion, and dental caries susceptibility. The treatment challenge in this type of injury is to promote a complete oral rehabilitation in both esthetics and function.[5]

   Case Report Top

A 23-year-old female patient reported to the Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital with a chief complaint of the discolored left upper front tooth from the time it erupted in the oral cavity. On clinical examination, the maxillary left central incisor showed brown discoloration [Figure 1] with the irregular facial surface. There was a history of trauma when the patient was 5 years old. There was no history of treatment carried out. Medical history was noncontributory. Also, the maxillary right central incisor showed mild focal discoloration on the disto-cervical aspect of the facial surface.
Figure 1: Preoperative photograph (lateral view)

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On clinical examination, the tooth was noncarious and nontender on percussion. Heat and cold tests were performed to determine the vitality. The response was negative. Intraoral periapical radiograph showed a periapical radiolucency measuring approximately 0.5 cm in diameter with respect to the tooth 21 [Figure 2]. A test cavity was prepared in 21 and the tooth had no response, indicating nonvitality. It was decided to perform the endodontic therapy in the teeth 21. Thus, access opening was accomplished. Working length was determined and biomechanical preparation was carried out with Hand ProTaper files (Dentsply Maillefer, Ballaigues, Switzerland) with the use of 3% sodium hypochlorite (Vensons India, Bengaluru, India) as an irrigant. Calcium hydroxide powder (Deepti Dental Products, Ratnagiri, India) mixed with distilled water was placed as an intracanal medicament for 2 weeks.
Figure 2: Preoperative intraoral periapical radiograph

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After 2 weeks, the canal was obturated up to apex with Gutta-percha points and AH Plus sealer (Dentsply Maillefer, Ballaigues, Switzerland) [Figure 3].
Figure 3: Postobturation radiograph

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After 3 months, periapical healing was observed and the patient was then referred to an orthodontist who decided to fabricate a Hawleys appliance for correction of labial proclination. This treatment continued for a period of 1 year, with activation of the appliance at monthly visits [Figure 4].
Figure 4: Hawleys appliance in place

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After 1 year, the proclination was not completely corrected, so it was decided to place a post in the tooth and fabricate a ceramic facing crown to enhance the esthetics. Post space preparation was carried out with use of drills (Glassix, Nordin, Swiss dental products of distinction) in the teeth 21 and Light Transmitting Composite Post (Glassix, Nordin, Swiss Dental Products of Distinction) was tried in the tooth. The post space was etched (SS White Dental Pvt. Ltd., India), and the bonding agent (3M ESPE Adper Single Bond 2, St. Paul, USA) was applied and cured. Dual cure cement (Variolink Low Viscosity, Ivoclar Vivadent, Liechtenstein) was used and the post was cemented and cured again [Figure 5]. A restoration was done in composite for teeth 11 and 21 (shade A 3, Ivoclar Vivadent, Liechtenstein). Crown preparation was done for 21, and metal ceramic crown was fabricated and luted using Glass Ionomer Luting Cement (GC Gold Label, GC Corporation Tokyo, Japan) [Figure 5] and [Figure 6].
Figure 5: Postplacement

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Figure 6: Postoperative smile

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   Discussion Top

In the present case, the patient has a history of trauma at 5 years of age which is possibly responsible for damage to the permanent tooth bud of the maxillary central incisors. However, one tooth (21) was more affected than the other tooth (11). Defective enamel and open dentinal tubules probably acted as a nidus for bacterial entry into the pulp space, thereby leading to pulpal necrosis, which could possibly explain the reason for 21 being nonvital.

Pulpal reaction to dental trauma varies. The most common complications are calcification and obliteration of the pulp.[6] Calcification can vary from a small denticle to the total obstruction of the pulpal canal.[7] The assessment of trauma in primary dentition seems to be very important because of sequelae in the permanent dentition. do Espírito Santo Jácomo and Campos reported from their longitudinal study of 8 years that discolorations of enamel and/or enamel hypoplasia (46.08%) were the most prevalent sequelae on permanent dentition due to traumatic injury.[8] Traumatic injuries to the primary dentition are very common, affecting from 4% to 30% of all children.[9] With regard to the malformation of the permanent tooth germ reported in this article, prior studies [6],[10],[11],[12],[13],[14],[15] support the finding that intrusion injuries are the most common cause of developmental disturbances.

Fiber posts are passively retained inside the root canals, and resin-based luting agents are the materials indicated for their retention. A wide variety and number of prefabricated posts – made of stainless steel; zirconia; or carbon, glass, or quartz fiber – are available in dentistry, in different geometries and sizes. Clinically, the necessity of placing a post arises when too little tooth structure is present to sustain a coronal restoration. One of the critical factors that can influence the survival of the restoration is the retention capacity of the post. The post must be cemented to the root canal walls in such a way that it cannot be dislodged by external forces.[16] The posts should transmit light to permit curing of the cement throughout the apical region of the tooth. The use of dual-cured or self-curing resin-based cement has been recommended to bond fiber-reinforced, resin-based composite posts to root canal walls. The long-term performance of restorations in endodontically treated teeth with intracoronal posts depends on the retention of the post.[17] Translucent and white fiber posts have increased in popularity in the last few years, mainly due to the fact that they can be used in high-demand cosmetic procedures, such as with all-ceramic restorations. Translucent posts are not visible through these types of restorations, thus yielding better esthetic results than metal and carbon fiber posts. Ceramic posts also offer good esthetics and are stronger and stiffer than fiber posts, but they are more difficult to bond to root canal walls. It is critical that the clinician considers the mechanical properties of fiber-reinforced composite posts when designing or using a post restoration in an endodontically treated tooth. For example, the quality of the support of the coronal restoration can be reflected by the stiffness of the post, being related to the loss of retention of a crown. Posts with low strength and elastic limits have an increased risk of failure due to distortion or fracture. However, posts with elastic modulus similar to that of dentin induce less stress in the root.[17]

   Conclusions Top

The case we report here stresses the importance of traumatic injuries to primary dentition because of their effects on the permanent tooth germ. Injured teeth should be followed up periodically for possible periapical infections and pulp necrosis.[18] In addition, special care may be necessary in the restoration of injured teeth because their reaction patterns may differ from those of nontraumatized teeth. Injury to the deciduous predecessor might generate root or crown dilacerations to the permanent dentition. The presence of severe dilacerations increases the risk of an accident during the endodontic procedure. Meticulous preoperatory examination and a multidisciplinary approach to treatment planning is strongly advocated.[19]

   References Top

Geetha Priya PR, John JB, Elango I. Turner's hypoplasia and non-vitality: A case report of sequelae in permanent toot. Contemp Clin Dent 2010;1:251-4.  Back to cited text no. 1
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. 2nd ed. Philadelphia: Elsevier Publications, WB Saunders Co.; 2004.  Back to cited text no. 2
Shafer WG, Hine MK, Levy WM. A Textbook of Oral Pathology. 4th ed. Philadelphia: WB Saunders Co.; 2003. p. 40.  Back to cited text no. 3
Broadbent JM, Thomson WM, Williams SM. Does caries in primary teeth predict enamel defects in permanent teeth? A longitudinal study. J Dent Res 2005;84:260-4.  Back to cited text no. 4
Kalra N. Sequelae of neglected pulpal infections of deciduous molars. Endodontology 1994;6:19-23.  Back to cited text no. 5
Holan G, Ram D, Fuks AB. The diagnostic value of lateral extraoral radiography for intruded maxillary primary incisors. Pediatr Dent 2002;24:38-42.  Back to cited text no. 6
Nikoui M, Kenny DJ, Barrett EJ. Clinical outcomes for permanent incisor luxations in a pediatric population. III. Lateral luxations. Dent Traumatol 2003;19:280-5.  Back to cited text no. 7
do Espírito Santo Jácomo DR, Campos V. Prevalence of sequelae in the permanent anterior teeth after trauma in their predecessors: A longitudinal study of 8 years. Dent Traumatol 2009;25:300-4.  Back to cited text no. 8
Sellos MC, Sab TB, de Souza Chagas M, Campos V. Circular enamel hypoplasia in permanent maxillary incisors subsequent to trauma to their predecessors: A 10-year follow-up case report. Braz J Dent Traumatol 2009;1:50-3.  Back to cited text no. 9
Flores MT. Traumatic injuries in the primary dentition. Dent Traumatol 2002;18:287-98.  Back to cited text no. 10
Diab M, elBadrawy HE. Intrusion injuries of primary incisors. Part III: Effects on the permanent successors. Quintessence Int 2000;31:377-84.  Back to cited text no. 11
Holan G, Ram D. Sequelae and prognosis of intruded primary incisors: A retrospective study. Pediatr Dent 1999;21:242-7.  Back to cited text no. 12
Sennhenn-Kirchner S, Jacobs HG. Traumatic injuries to the primary dentition and effects on the permanent successors – A clinical follow-up study. Dent Traumatol 2006;22:237-41.  Back to cited text no. 13
Ravn JJ. Sequelae of acute mechanical traumata in the primary dentition. A clinical study. ASDC J Dent Child 1968;35:281-9.  Back to cited text no. 14
Kramer PF, Zembruski C, Ferreira SH, Feldens CA. Traumatic dental injuries in Brazilian preschool children. Dent Traumatol 2003;19:299-303.  Back to cited text no. 15
Teixeira EC, Teixeira FB, Piasick JR, Thompson JY. An in vitro assessment of prefabricated fiber post systems. J Am Dent Assoc 2006;137:1006-12.  Back to cited text no. 16
Goracci C, Corciolani G, Vichi A, Ferrari M. Light-transmitting ability of marketed fiber posts. J Dent Res 2008;87:1122-6.  Back to cited text no. 17
Altun C, Esenlik E, Tözüm TF. Hypoplasia of a permanent incisor produced by primary incisor intrusion: A case report. J Can Dent Assoc 2009;75:215-8.  Back to cited text no. 18
Borges L. Clinical considerations for the endodontic treatment of dilacerated tooth: A case report. Braz J Dent Traumatol 2010;2:27-30.  Back to cited text no. 19


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


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