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Labial fenestration of a ‘dilacerated’ maxillary central incisor apex: an orthodontic complication Robert AC Chate Denis T Falconer Dental Update 2024 5:4, 707-709.
A case is presented of a ‘dilacerated’ central incisor whose apex perforated the labial alveolus following orthodontic traction subsequent to its surgical exposure, which then necessitated endodontic treatment and an apicoectomy. The literature is reviewed regarding the aetiology and terminology of this complication and the implications for informed consent in such cases are discussed.
Clinical Relevance: This article will clearly differentiate between the two types of incisor root deflections that may occur during development. That is, those with true incisor palatal root dilacerations and those with pseudo-dilacerations which are actually incisors with vestibular root angulations.
The surgical and orthodontic recovery of an unerupted central incisor with a vestibular root angulation is outlined, in particular the management of the manifestation of one of the risks associated with this procedure, namely that of inducing an alveolar fenestration with the apex of the tooth during the process.
Article
Dilaceration is the presence of an angulation between the crown and the root of a maxillary incisor tooth. It only applies to an incisor that has had its crown deflected palatal to the long axis of the tooth during development. In contrast, the term vestibular root angulation describes a case where the incisor crown has been deflected labially.1
True dilacerations have been estimated to occur in 3% of all forms of incisor injuries.2 The root of the deciduous predecessor, during an intrusive luxation or avulsion, can cause a palatal rotation of the permanent incisor crown around the vascular dental papilla. As Hertwig's sheath remains in position, root formation of the permanent incisor continues along the original long-axis, thus creating the angulation between crown and root. At about the age of two years,3 and for only a relatively short period of time,4,5,6 the developing permanent central incisor is palatal to the roots of its deciduous predecessor, during which time this type of injury can occur.
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