Objective Maxillary canine impaction represents one of the most common eruption disturbances in orthodontics after third molars. This case report describes the management of a 9.2‐year‐old growing male patient with bilateral ectopic eruption of the maxillary permanent canines, transverse maxillary deficiency, mesiorotation of the upper first molars, and bilateral Class II molar relationship. The patient was treated according to the BIG‐C concept (Biomechanical Interceptive Guidance of Canine Eruption)—a biomechanically guided interceptive approach combining rapid maxillary expansion, sequential distalization with clear aligners, and arch‐perimeter management. Methods Radiographic changes were assessed on serial panoramic radiographs using the Ericson and Kurol criteria, including α ‐angle and sector classification at baseline (T0), after RME (T1), and after sequential distalization (T2). Clinical and radiographic follow‐up was continued until eruption and progressive alignment of both permanent canines following interceptive treatment were observed (T3). Results Both maxillary canines showed progressive radiographic improvement. The α ‐angle decreased from 44.5° to 17.7° for Tooth 1.3 and from 47.1° to 18.7° for Tooth 2.3, corresponding to total reductions of 60.2% and 60.3%, respectively. Sector relationships improved to Sector 1 for both canines, and eruption occurred without surgical exposure or direct orthodontic traction. Conclusions The combined interceptive protocol, including rapid maxillary expansion followed by sequential distalization with clear aligners, was associated with progressive α ‐angle reduction, improvement in sector relationship, and eruption of both maxillary permanent canines in this case. The contribution of the individual treatment components cannot be determined from this single observation.
Florid cemento‐osseous dysplasia (FCOD) is a benign fibro‐osseous condition, typically asymptomatic and readily diagnosed because of its characteristic radiographic features, but diagnostic difficulties may arise when it is associated with secondary lesions. This report describes a rare case of FCOD associated with multiple simple bone cysts (SBCs), with radiographic evolution retrospectively documented over 13 years. A 45‐year‐old woman presented with multifocal mandibular lesions that were initially predominantly radiolucent and showed dynamic changes over time, including qualitative changes in radiographic appearance, progression to a mixed radiolucent–radiopaque pattern, and development of multiple bilateral intraosseous cavities. Episodes of pain were reported. Cone‐beam computed tomography demonstrated multiple intraosseous cavities, and surgical exploration of the right posterior lesion revealed an empty bone cavity, supporting the diagnosis of an SBC in this region. At the 2‐month postoperative follow‐up, the patient reported symptomatic improvement, and panoramic radiography showed early evidence of bone remodeling in the surgically explored area. This case demonstrates the importance of careful evaluation of radiolucent lesions in the context of FCOD to reduce the risk of potentially inappropriate interventions when radiolucent findings are interpreted in isolation. Integration of clinical findings, pulp vitality testing, and cone‐beam computed tomography is essential for accurate diagnosis, whereas analysis of serial radiographic examinations over time remains important given the evolving nature of these lesions.
Pulp necrosis in immature permanent teeth interrupts root development and prevents physiological apical closure, making endodontic management particularly challenging. Apexification with calcium hydroxide or mineral trioxide aggregate (MTA) has long been considered the standard treatment for these teeth by promoting the formation of an apical barrier and achieving periapical healing. However, neither approach allows continued root maturation, leaving thin dentinal walls that may compromise the long‐term prognosis. Regenerative endodontic treatment, including pulp revascularization, has emerged as a biologically based alternative capable of promoting continued root development and reinforcing root structure. This report presents two clinical cases of necrotic immature permanent incisors managed at the Department of Pediatric Dentistry, CCTD Casablanca, Morocco, illustrating calcium hydroxide apexification, MTA apexification, and pulp revascularization. Both treatment approaches resulted in satisfactory clinical and radiographic healing. However, pulp revascularization demonstrated the additional benefit of continued root maturation, whereas apexification provided apical closure without further root development. These cases highlight the indications, advantages, limitations, and clinical outcomes of each therapeutic approach and support the current evidence favoring regenerative endodontic treatment whenever clinical conditions are suitable.
Background Tooth transposition is an uncommon dental anomaly involving the positional interchange of two adjacent teeth within the same quadrant. Transpositions affecting posterior teeth in the mandible, particularly a premolar and a molar, are rarely reported, and their diagnosis and management can be challenging. Case Presentation A 39‐year‐old man presented with difficulty in mastication related to multiple edentulous spaces in both arches. Clinical examination revealed poor oral hygiene, generalized gingival recession, Fordyce granules, a fissured tongue, and spacing of the maxillary anterior teeth. The mandibular right second premolar was found positioned within the first molar region, an incidental finding on intraoral examination. Periapical and panoramic radiographs confirmed the anomalous position of the premolar and demonstrated generalized alveolar bone loss. No reliable history could establish whether the first molar had previously been extracted, was congenitally absent, or had failed to erupt, and no family history of similar dental anomalies was reported. Management addressed the patient′s primary complaint through scaling and oral hygiene instruction, restoration of carious teeth, and prosthetic rehabilitation of edentulous spaces; no intervention was directed at the positional anomaly itself, as it was asymptomatic and of no functional or esthetic concern to the patient. Conclusion This case illustrates a rare mandibular premolar–molar positional anomaly discovered incidentally in an adult, a presentation most consistent with tooth transposition. It highlights the value of thorough clinical and radiographic examination in identifying atypical dental findings and the importance of longitudinal or cross‐sectional imaging in confidently distinguishing true transposition from other causes of anomalous tooth position, such as postextraction migration.
Mandibular cysts arise from various etiologies and generally exhibit benign characteristics, with favorable treatment outcomes. Nevertheless, extensive cystic lesions may involve cortical bone, leading to substantial bone loss, reduced mechanical integrity of the mandible, and an increased risk of pathological fractures. In severe cases, hemimandibulectomy may become a clinical option, potentially resulting in functional and aesthetic impairment and requiring complex mandibular reconstruction. Therefore, conservative regenerative strategies aimed at preserving mandibular continuity may provide substantial benefits for patient recovery and quality of life. In this case report, we present a successful approach in which a mandible severely affected by benign cyst-induced bone loss was preserved and extensively regenerated over a 6-year follow-up period. Following preoperative endodontic management with iodoform, the cyst was completely enucleated, and the resulting extensive bone defect was filled with lyophilized bovine bone combined with iodoform and covered with collagen membranes and a titanium mesh. Long-term radiographic follow-up demonstrated progressive increases in radiopacity and integration of the treated area, whereas computed tomography at 5.5 years revealed restoration of cortical bone continuity and extensive mandibular remodeling. At 6 years, the treated region exhibited radiopacity similar to that of the contralateral preserved mandibular region. These findings suggest that, in carefully selected extensive benign mandibular lesions, a conservative regenerative approach may preserve mandibular continuity and potentially avoid extensive mandibular resection.
