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A palatogingival groove of the maxillary lateral incisor is an anatomic malformation, which always predisposes the tooth to pulpal and periodontal disease. The diagnosis and treatment planning become complicated, with uncertain prognosis. Herein, we present an effective interdisciplinary management of a case of combined periodontal-endodontic lesions caused by palatogingival grooves. A series of treatment modalities were undertaken to preserve the two teeth, including root canal treatment, periodontal initial therapy, splinting the mobile teeth, occlusal adjustment, apical microsurgery, grinding and sealing grooves, and guided tissue regeneration. An apparent healing of the lesions was visible after 12 months. Therefore, interdisciplinary management of combined periodontal-endodontic lesions with palatogingival grooves of the maxillary lateral incisors is necessary for a favourable long-term outcome., (© 2023. The Author(s), under exclusive licence to the British Dental Association.)

This article summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the management of unerupted maxillary incisor teeth in children. The maxillary incisor teeth usually erupt in the early mixed dentition but eruption disturbances can occur and are often attributable to local factors. A failure of eruption will affect the developing occlusion and potentially influence psychological development of the child. The general principles of management for delayed eruption or impaction of these teeth is to ensure that adequate space exists in the dental arch and to remove any obstruction to eruption. Consideration should also be given to further promoting eruption through surgical exposure of the incisor, with or without subsequent orthodontic traction. A number of factors influence the decision-making process, including patient age, medical history, potential compliance, aetiology and position of the unerupted incisor. Treatment planning should be complemented by careful clinical assessment and the use of appropriate special investigations. To optimise the treatment outcome a multidisciplinary specialist approach is recommended.

Background and Aim: The conventional nasopalatine nerve block is commonly used to obtain anaesthesia in the anterior portion of the palate. The painful nature of this approach, however, has led investigators to seek alternative methods to obtain anaesthesia. Labial infiltration of the maxillary central incisors can be considered an effective anaesthetic approach for the anterior palate. Our study aimed to assess the anaesthetic effect of a modified labial infiltration method on the nasopalatine nerve., Materials and Method: A case-control clinical trial was done on 60 patients referring for extraction of maxillary incisors (mean age 44 years). The patients were divided into two groups of 30 people. For the first group, a primary conventional infiltration was given to each patient from a point between the maxillary canine and the lateral to obtain preliminary anaesthesia for the maxillary anterior labial area. The second or the control group was anaesthetised by conventional injection into incisive papilla. Two to three minutes afterwards, a labial infiltration approach was done and the amount of pain determined by OPS (objective pain score) was assessed. After five to six minutes the level of anaesthesia in the anterior palate was assessed in both groups by an explorer and recorded as pain-free, mild pain or severe pain. The sign test was used to statistically analyse the data (p <0.001)., Results: Total, moderate and no anaesthesia were observed in 76.7%, 13.3%, and 10% of the patients receiving anesthetic injection at the labial side. For the control group, these results were 83%, 17% and 0% respectively., Conclusion: This method of labial infiltration may be an effective alternative to the painful conventional palatine nerve block to obtain efficient anaesthesia of the anterior palate (p <0.001).

Ritual dental extraction among Sub-Saharan African populations has been practised for centuries, yet little is known about the removal process for any ethnic group. Dinka and Nuer refugees to the US requested replacements for missing anterior teeth removed during childhood. Among 36 Sudanese refugees, 238 individual extractions had been performed. Three retained canine/incisor root fragments; their cases are presented, including memories of the tooth-extraction ritual.

A rare case of an erupted compound odontoma associated with a malformed and dilacerated maxillary left lateral incisor is reported. The patient, a 15-year-old immigrant Sudanese boy, had a malformed right lateral maxillary incisor and missing centrals. His guardian reported he had undergone traditional extraction of his primary teeth as a child whilst in Africa. Treatment and possible mechanisms for development of the condition are discussed. The number of refugees and migrants from Africa to developed countries has increased in the past 20 years. Australia in particular with its large population of recent migrants from areas in Africa where tooth mutilation is practised will likely see more patients with dental abnormalities in the respective populations.

The replantation of avulsed primary incisors is contra-indicated. This case describes an 8-year-old child who six years previously had avulsed and had replanted a primary central incisor. At presentation, this tooth was retained, the permanent successor had failed to erupt and appearance of the adjacent lateral incisor was notably delayed. Investigation revealed a radicular cyst in relation to the replanted deciduous incisor together with severe displacement of the permanent tooth, which could not be saved.

Extractions in orthodontics remains a relatively controversial area. It is not possible to treat all malocclusions without taking out any teeth. The factors which affect the decision to extract include the patient's medical history, the attitude to treatment, oral hygiene, caries rates and the quality of teeth. Extractions of specific teeth are required in the various presentations of malocclusion. In some situations careful timing of extractions may result in spontaneous correction of the malocclusion.

Objective: To examine variations in the presentation and treatment of reimplanted incisors in children and to determine the effect of these on the prevalence of external root resorption., Setting: Departments of Paediatric Dentistry, Belfast and Newcastle upon Tyne., Design: Recording of the timing of the injury and the storage mediums (including air) and of reimplantation, the stage of root development, the degree of contamination and the time of commencement of root treatment. Cases were reviewed clinically and radiographically at intervals of 3 months. Root resorption was classified as present or absent. Logistic regression and cross-tabulations were produced with the presence of resorption set as the outcome., Results: 128 reimplanted permanent incisor teeth, their median dry time prior to reimplantation being 15 minutes (range 4-52 mins), the median time in a liquid medium being 45 minutes (range 0-650 mins), with a median splinting time of 15 days (range 4-52 days) and a median pulp extirpation time of 15 days (range 0-612 days). There was a lower prevalence of resorption when the period of dryness was less than or equal to 5 minutes (p = 0.025). The prevalence of resorption in teeth with no visible contamination was 57.1%, for those with contamination which were washed clean it was 75%, in those rubbed clean it was 87.5%, and it was 100% for those reimplanted with visible contamination still present (p = 0.014). The corrected odds ratio for contamination was 2.99 and for an extension of 10 minutes of dryness it was 1.29., Conclusion: The degree of contamination and the period of dryness were the major risk factors for resorption in this study of reimplanted teeth in children.

This case report highlights two important aspects of root canal treatment, knowledge of root canal anatomy and inappropriate use of surgery to correct failure of conventional treatment. Initially, two mandibular incisors were root treated conventionally but only one of the two canals present in both teeth was prepared and filled in each case. Symptoms persisted and a surgical approach was adopted but, again, only one of the root canals in each tooth was located and sealed with a root-end filling. Surgery was performed on a second occasion but again failed to resolve the patient's problems. On referral, the presence of the additional root canals was confirmed and further conventional non-surgical treatment resulted in the immediate cessation of symptoms. This case highlights the need for a thorough understanding of root canal morphology, and the need to expose an angled radiograph when performing root canal therapy on teeth with a high incidence of multiple canals. It emphasises that surgery should not be the first option when conventional treatment fails.

Not many people would willingly have their teeth drastically filed, ground, chipped away, or even extracted without the use of an anaesthetic. Even fewer would consent to the treatment if the teeth to be involved were the upper incisors and were entirely healthy. The practice of tooth mutilation or ablation has, however, been carried out worldwide since prehistoric times.

The methods of treatment of talon cusps are reviewed. A case is reported in which a calcium hydroxide pulpotomy was carried out on an upper central incisor with a talon cusp. This was necessary to enable (a) complete reduction of the cusp within a feasible time span, and (b) maintenance of pulpal vitality in order to allow apical development of the immature root.