Dilaceration: review of an endodontic challenge

By Jafarzadeh H, Abbott PV.

Date: 09/2007
Journal: JOE

Summary: 

•Purpose: to present a review of the literature and a discussion of the options for managing Dilaceration.

Dilaceration: deviation or bend in the linear relationship of a crown of a tooth to its root  (according to Tomes).

Etiology:

•2 possible causes of dilaceration:

1.mechanical trauma to the primary predecessor tooth, which results in dilaceration of the developing succedaneous permanent tooth

2.Idiopathic developmental disturbance in cases that have no clear evidence of traumatic injury

Epidemiology:

•Dilaceration can be seen in both the permanent and deciduous (less common) dentitions.

•prevalence is greater in posterior teeth and in the maxilla.

•Bilaterally occurring dilacerations might be seen in many patients, but bilateral dilaceration in both the maxilla and mandible of the same person is rarely found.

•Root dilaceration in anteriors and premolars is most common in the apical third of the roots. Dilaceration within the middle third of the root is more frequent in molars.

•Crown dilacerations are less common than root dilacerations and they usually occur in maxillary permanent incisors

Diagnosis:

•The direction of root dilacerations should be considered in 2 planes.

•If the roots bend mesially or distally, the dilaceration is clearly apparent on a periapical radiograph. However, when the dilaceration is toward the labial/buccal or palatal/lingual, the x-ray beam passes through the deflected portion of the root in an approximately parallel direction.

•Associated Syndromes:

  • Smith- Magenis syndrome,
  • Ehlers-Danlos syndrome
  • Axenfeld-Rieger syndrome
  • congenital ichthyosis

Treatment Considerations:

•Accepted basic endodontic techniques must be strictly followed.

•good preoperative and working radiographs

•unobstructed access to the root canal orifice, as direct access as possible to the apical third of the canal.

•precurvature of all files used.

•thorough irrigation

•Access Cavities:

•Direct access to the apical foramen, as much as possible, is an important benefit gained through the access cavity preparation.

•a cloverleaf appearance might evolve as the outline form. Luebke has termed this a “shamrock preparation”. A modified outline form to accommodate the instrument unrestrained in the severely curved canals

•Root Canal Filling:

•The use of warm or thermoplasticized gutta-percha techniques might be more applicable in many cases

•Intentional Replantation

Intentional replantation of dilacerated teeth is generally not recommended.

•Forced Eruption

In rare instances in which orthodontic treatment is used to extrude a dilacerated tooth, the dilaceration of the root might make this procedure quite complicated or even impossible.

•Prosthetic Treatment

Dilacerated teeth should be considered as a risk factor in abutment selection.

Splinting the dilacerated abutment tooth to an adjacent tooth to obtain a multi-rooted abutment might be an approach to consider in some cases.

•Prognosis

The prognosis of dilacerated teeth that require endodontic treatment varies according to the severity of the deformity and the practitioner’s skills .

It will also depend on many other factors such as the reason why endodontic treatment was required, how much tooth structure remains, and the prognosis for any restoration that is placed on the tooth.

•Conclusions

Dilacerated teeth are not common, but they do pose a number of diagnostic, management, and prognostic challenges to dental practitioners. The presence of a dilaceration must be identified before treatment.