NSRCT maxillary anterior teeth Flashcards
A. What anatomic structure should be taken into consideration when radiographically evaluating maxillary anterior teeth?
Failure to recognize normal anatomy of the anterior maxilla may result in an incorrect diagnosis.The nasopalatine canal, also called the incisive canal or anterior palatine canal, has been described as a canal located in the middle of the palate, just posterior to the roots of central maxillary incisors (Figure 7.5).The open- ing of this canal can appear as an oval‐shaped radiolucency and must not be mistaken for a periapical radiolucency (PARL). A true PARL will be associated with tooth attachment.The radio- lucent periodontal ligament (PDL) space should be evaluated carefully for any thickening and discontinuation. A change in the width and/or shape of the PDL aids in the diagnosis of peri- apical pathosis (PAP) (Strindberg 1956).
B. How should diagnostic testing be performed in the maxillary anterior region?
Diagnostic testing for disease of endodontic origin includes thermal testing, electric pulp testing percussion, and palpation. In the maxillary anterior there are systematic approaches to performing these tests (Figures 7.6, 7.7 and 7.8). Cold testing is a valuable and reliable tool to determine pulpal nerve status of permanent teeth (Petersson et al. 1999). Electric pulp testing activates low threshold A‐delta fibers and an ionic fluid shift that elicits a positive pulpal response in healthy pulps (Närhi et al. 1979). Percussion and palpation testing will give the clinician informa- tion regarding the status of the apical periodontal ligament. A significant cause of mechanical allodynia is inflammation of vital pulp tissue.This inflammation contributes to early stages of odontogenic pain (Owatz et al. 2007).
C. What kind of initial radiographic exam is appropriate for an endodontic work up in the maxillary anterior region?
Endodontic therapy requires a radiographic exam in addition to clinical examination. Multiple periapical radiographs taken at different angulation have been shown to increase the accuracy of interpretation (Brynolf 1970).
The natural curvature of the arch may cause the roots of the teeth to become superimposed. Different angulation will change position of the teeth on the image (Figures 7.9 and 7.10).
D. What is an example of an anatomical variation associated with the maxillary anterior teeth that can affect non‐surgical endodontic therapy?
Maxillary anterior teeth typically have one root and one root canal (Vertucci 1984). However, there have been case reports of maxillary anterior teeth with two roots. Additional roots are not always visible on PA radiographs and are only discovered after endodontic access (Figure 7.11).The use of an endodontic operating microscope and/or CBCT may be useful in determining the presence of atypical anatomy (Patel et al. 2015). CBCT can also give the clinician more information on the extent of lesions. In Figure 7.12, one can appreci- ate a 3‐D view of a periapical lesion and its relation to the buccal and palatal bone.
E. What is an example of a developmental anomaly associated with the maxillary anterior teeth that can affect non‐surgical endodontic therapy?
Dens invaginatus (DI) is a developmental anomaly resulting from the folding of the enamel organ into the dental papilla prior to calcification of dental tissues (Oehlers 1957; Gound 1997).The frequency of DI is reported to be 0.04–10%; its prevalence is the greatest in permanent lateral incisors (Gound 1997). A tooth with this anomaly is susceptible to pulp necrosis.The invagination makes the disinfec- tion of these teeth very challenging and would be best handled by an endodontic specialist.
