Mesiodens ile birlikte görülen bir intrüzyon olgusu: 30 aylık takip vaka sunumu

İntrüziv lüksasyon, dişin alveoler kemik içerisine gömülmesi nedeniyle dişin destek yapıları ve pulpasında hasara yol açan bir travma tipidir. Mesiodens üst çene ön bölgede bulunan süpernümerer dişlerin en sık görülen tipidir. Bu rapor, intrüze immatür orta kesici dişin ve ters pozisyondaki mesiodensin tedavisini sunmaktadır. 7 yaşındaki erkek çocuk, travmadan 1 gün sonra kliniğimize başvurmuştur. Klinik ve radyografik muayeneler sonrasında, immatür sol orta kesici dişte intrüziv lüksasyon ve orta kesici dişler arasında inverte bir mesiodens teşhis edilmiştir. Mesiodensin cerrahi olarak çıkarılması, intrüze keser dişin yeniden sürmesini engellememek için ertelenmiştir. İntrüze keser diş dikkatle izlenerek kendiliğinden sürmesine izin verilmiş, diş birkaç ay içinde yeniden sürmeye başlamıştır. Takip süresi boyunca pulpal ve/veya periapikal patoloji görülmemiş, kök gelişimi devam etmiş, pulpa canlı kalmıştır. İntrüze immatür daimi dişlerin herhangi bir cerrahi ya da ortodontik müdahaleye gerek kalmadan canlılıklarını koruyup kendiliğinden sürdükleri sonucuna varılabilir. Ancak, mesiodensin cerrahi olarak çıkarılması, ideal müdahale zamanlaması açısından-erken ya da geç müdahale-son derece tartışmalı bir konu olmaya devam etmektedir.
Anahtar Kelimeler:

intrüzyon, travma, mesiodens

A Case of Intrusion With Mesiodens: 30 Months Follow Up A Case Report

Intrusive luxation is a dental injury that causes damage to supporting structures and pulp of a tooth because of its dislocation into the alveolar bone. Mesiodens is the most common type of supernumerary tooth found in anterior maxilla. This report presents the case of a intruded immature permanent incisor and the treatment of a inverted mesiodens. A 7-year-old boy was referred to the clinic 1 day after trauma. After clinical and radiographic examinations, intrusive luxation of the immature left permanent incisor and a inverted mesiodens diagnosed between the roots of central incisors. The surgical removal of mesiodens was delayed in order not to interfere the reeruption of intruded incisor. The intrudedincisor, with careful monitoring, were allowed to spontaneously re-erupt, tooth started to re-erupt spontaneously in a few months. No periapical and/or pulpal pathology was observed during following period, root development continued, pulp remained vital. It can be concluded that intruded immature permanent teeth can spontaneously re-erupt, conserve their vitality, and continue their root development without any surgical or orthodontic management. However, with respect to surgical removal of mesiodens, ideal timing of intervention – immediate or delayed intervention – remains to be a highly controversial issue

___

  • Andreasen JO, Andreasen FM. Luxation injuries. In: Andreasen JO,Andreasen FM, Andersson L. Textbook and colour atlas of traumatic injuries to the teeth, 4th edn. Oxford:Blackwell Munksgaard; 2007, p. 428–43.
  • Andreasen JO. Luxation of permanent teeth due to trauma. A clinical and radiographic follow-up study of 189 injured teeth. Scand J Dent 1970;78:273-86.
  • Sapir S, Mamber E, Slutzky-Goldberg I, Fuks AB. A novel multidisciplinary approach for the treatment of an intruded immature permanent incisor. Pediatr Dent 2004;26:421-5.
  • Andreasen FM, Pedersen BV. Prognosis of luxated permanent teeth — the development of pulp necrosis. Endod Dent Traumatol 1985;1:207–20.
  • Shapira J, Regev L, Liebfeld H. Re- eruption of completely intruded immature permanent incisors. Endod Dent Traumatol 1986;2:113-6.
  • Güngör HC, Cengiz SB, Altay N. Immediate surgical repositioning following intrusive luxation: a case report and review of the literature. Dent Traumatol 2006; 22:340–4.
  • Alves LD, Donnely JC, Lugo A, Carter DR. Re-eruption and extrusion of a traumatically intruded immature permanent incisor: Case report. J Endod 1997;23:246-8.
  • Gallas M, Garcia A. Retention of permanent incisors by mesiodens: a family affair, Br Dent J 2000;188:63-4.
  • Giancotti A, Grazzini F, De Dominicis F, Romanini G, Arcuri C. Multidisciplinary evaluation and clinical management of mesiodens. J Clin Pediatr Dent 2002;26:233-7.
  • Zhu JF, Marcushamer M, King DL, Henry RJ. Supernumerary and congenitally absent teeth: A literature review. J Clin Pediatr Dent 1996;20:87-95.
  • Fernandez Montenegro, E. Valmaseda Castellon, L. Berini Aytes L, Gay Escoda C. Retrospective study of 145 supernumerary teeth, Med. Oral Patol. Oral Cir. Bucal 2006;11:339-44.
  • Stellzig A,. Basdra E.K, Komposch G. Mesiodentes: incidence, morphology, etiology. J.Orofac. Orthop 997;58:144-53.
  • Hattab FN, Yassin OM, Rawashedeh MA. Supernumerary teeth: Report of three cases and review of the literature. ASDC J Dent Child 1994;61:382-93.
  • Primosch RE. Anterior supernumerary teeth — assessment and surgical intervention in children. Pediatr Dent 1981; 3:204–15.
  • Atasu M, Orguneser A. Inverted impaction of a mesiodens: a case report. J Clin Pediatr Dent 1999; 23:143–5.
  • Marya CM, Kumar BR. Familial occurrence of mesiodentes with unusual Şndings: case reports, Quintesse Int 1998;29:49-51.
  • Rajab LD, Hamdan AM. Supernumerary teeth: Review of the literature and a survey of 152 cases. Int J Paediatr Dent 2002;12:244-54.
  • Altay N, Güngör HC. A retrospective study of dento alveolar injuries of children in Ankara, Turkey. Dent Traumatol 2001;17:201-4
  • Saroglu I, Sönmez H. The prevalence of traumatic injuries treated in the pedodontic clinic of Ankara University, Turkey,during 18 months. Dent Traumatol 2002;18:299-303.
  • Chan AWK, Cheung GSP, Ho MWM. Different treatment out-comes of two intruded permanent incisors: a case report. DentTraumatol 2001;17:275-80.
  • Saroglu I, Tunç Şen E, Sönmez H. Spontaneous re-eruption of intruded permanent incisors: Şve case reports. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:60- 65.
  • Taintor JF, Bonness PW, Biesterfeld RD. The intruded tooth. Dent Survey 1977;55:30-4.
  • Hyun HK, Lee SJ, Lee SH, Hahn SH, Kim JW. Clinical Characteristics and Complications Associated With Mesiodentes. J Oral Maxillofac Surg. 2009;67:2639-43.
  • Tyrologou S, Koch G, Kurol J. Location, complications and treatment of mesiodentes—A retrospective study in children. Swed Dent J 2005;29:1-9.
  • Gündüz K, Çelenk P, Zengin Z, Sü- mer P. Mesiodens: A radiographic study in children. J Oral Sci 2008;50:287-91.
  • Garvey MT, Barry HJ, Blake M. Supernumerary teeth—An overview of classiŞcation, diagnosis and management. J Can Dent Assoc 1999;65:612-6.
  • Huang WH, Tsai TP, Su HL. Mesiodens in the primary dentition stage: A radiographic study. ASDC J Dent Child 1992;59:186-9.
  • Zilberman Y, Malron M, Shteyer A: Assessment of 100 children in Jerusalem with supernumerary teeth in the premaxillary region. ASDC J Dent Child 1992;59:44-7.
  • Foster TD, Taylor GS: Characteristics of supernumerary teeth in the upper central incisor region. Dent Pract Dent Rec 1969;20:8- 12.
  • Di Biase DD: Midline supernumeraries and eruption of the maxillary central incisor. Dent Pract Dent Rec 1969;20:35-40.
  • Mitchell L, Bennett TG: Supernumerary teeth causing delayed eruption—A retrospective study. Br J Orthod 1992;19:41-6.