case_images: PMC9371876_01
case_images: Periapical radiograph: (a) #11 with open apex; (b) one year later found apexification material on root canal and closed apex. The impacted mesiodens shown surrounded with cyst between apical of #21 and #11.
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case_images: fig1
case_images: Periapical radiographic examination showed #11 with an open apex (Figure 1(a)), and the patient was scheduled for obturation. Radiograph examination revealed #11 with a closed apex and well-defined margin radiolucency area around mesiodens between apicals of #21 and #11 (Figure 1(b)).
case_images: Clinical features. Intraoral photography highlighting #11 with class III Ellis crown fracture classification.
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case_images: fig2
case_images: Based on clinical examination, the provisional diagnosis is pulp necrosis with class III Ellis crown fracture classification (Figure 2).
case_images: CBCT radiographic view. The mesiodens impacted tooth was seen between teeth 11 and 21 in an inverted position. Mesiodens tooth distance with the base of the nasal cavity: 3.93 mm. A mixed radiolucent-radiopaque image is seen around the crown of the mesiodens with a clear border with radiopaque edges and an oval shape. The lesion appears to cause a discontinuity of the palatal cortical bone, and the lesion is in contact with the floor of the nasal cavity.
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case_images: fig3
case_images: Panoramic radiographic view. Panoramic radiograph revealing a well-defined unilocular radiolucency around impacted mesiodens.
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case_images: fig4
case_images: Based on periapical, panoramic, and CBCT, radiographs displayed unilocular, radiolucent, and well-delineated defect related to impacted mesiodens, suggesting a dentigerous cyst (Figure 4).
case_images: Surgical procedure: (a) buccal window; (b) curettes of granulation tissue; (c) extraction of mesiodens; (d) apex resection; (e) MTA and GIC application; (f) evaluation; (g) suturing.
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case_images: fig5
case_images: A round carbide bur under constant irrigation for cooling was used to enlarge the bony defect to the buccal window to gain access to the periapical lesion and root end of the affected tooth (Figure 5(a)). Needle aspiration test showed mixed blood and cyst fluid; curettes were then used to remove the soft granulation tissue (Figure 5(b)), which further aided inadequate visualization of mesiodens to ensure complete extraction and no remaining dental follicle. The apical end of 2 mm was resected in faciolingual direction to the long axis of the tooth with a tapered fissured bur in a low-speed handpiece under constant irrigation (Figure 5(d)). The resected root surface was inspected, prepared, and then filled with mineral trioxide aggregate and glass ionomer cement on the periapical area (Figure 5(e)). Spongostan was then applied to the defect area, then sutured with silk Vicryl 4.0 (Figure 5(g)).
case_images: Specimen postoperative: (a) the cystic specimen after enucleation; (b) mesiodens; (c) tooth bud post germinectomy.
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case_images: fig6
case_images: Postoperative intraoral view: (a) one day postoperative; (b) composite restoration on #21 and #11.
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case_images: fig7
case_images: On intraoral examination, the postoperative wounds on #12, #11, #21, #22, #18, #28, #38, and #48 were well sewn and hyperaemic, and minimal debris was seen at the edges of the sutures (Figure 7).
case_images: Radiographic examination 3 months postoperative.
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case_images: fig8
case_images: There are no signs of recurrence (Figures 8 and 9).
case_images: 6 months postoperative recall: (a) intraoral view; (b) radiographic examination.
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case_images: fig9
case_images: There are no signs of recurrence (Figures 8 and 9).