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.
Cementoblastoma is a rare benign odontogenic neoplasm defined by its fusion to the root of a tooth and characterized by radiating cementoid deposition with peripheral active cementoblasts. Although recurrence is uncommon following complete excision, when it occurs, it typically arises at the original site. We report an unusual recurrent cementoblastoma associated with a primary mandibular molar in a pediatric patient. Review of records from the initial presentation documented a radiopaque mandibular lesion fused to the roots of the lower right primary first molar with cortical expansion, which was treated by extraction of the involved tooth and removal of the associated lesion. Eighteen months later, the patient presented with recurrence as multiple discrete, noncoalescent masses involving the alveolar crest, lingual cortical bone, and buccal gingival soft tissue. All recurrent lesions, including the soft tissue lesion, showed histologic features consistent with developing cementoblastoma. Each lesion demonstrated a radial growth pattern forming a well‐circumscribed spherical mass. This case documents recurrence after apparently conservative initial removal of a cementoblastoma arising in the primary dentition, and supports the concept that neither persistent root attachment nor an osseous environment is required for lesion development or for maintaining the characteristic radial growth pattern. The findings highlight the importance of complete excision at initial presentation to reduce the risk of recurrence.
Fragment reattachment is the most conservative treatment approach for uncomplicated crown fractures, which enables the restoration of the original tooth structure and the preservation of the remaining tooth structure. A 15-year-old patient reported with an uncomplicated crown fracture of the maxillary left central incisor involving enamel and dentin. Pulp sensibility testing had a normal response and radiographic examination revealed no periapical pathology. The retrieved fractured fragment had good marginal adaptation. Following rehydration, fragment reattachment was performed under rubber dam isolation using an etch-and-rinse protocol, a two-coat adhesive application and nanohybrid flowable composite. At the second appointment, a V-shaped retentive groove of 0.7-mm depth was placed in both the labial and palatal aspects, extending 2 mm on either side of the fracture line, followed by composite restoration. The patient was reviewed at 6 weeks, 1 year and 2 years in accordance with the International Association of Dental Traumatology (IADT) guidelines. Throughout the follow-up period, the reattached fragment remained clinically intact with no evidence of debonding, marginal discolouration or fracture recurrence. Pulp sensibility testing remained normal, and radiographic examination revealed no periapical changes at all follow-up intervals, demonstrating sustained aesthetic and functional stability over a 2-year follow-up period.
Introduction Long‐term split‐mouth comparisons between autogenous connective tissue grafts and acellular dermal matrices using the tunnel technique remain limited in the literature. Gingival recession may lead to root exposure, hypersensitivity, and esthetic concerns. Connective tissue grafts are widely considered the gold standard for root coverage; however, palatal harvesting is associated with postoperative morbidity when multiple sites are treated. Acellular dermal matrix has been proposed as a donor‐site‐free alternative. Case Presentation A 55‐year‐old female patient presented with multiple RT1 gingival recessions and dentin hypersensitivity. A split‐mouth design was performed. On the right maxilla, a tunnel technique combined with an autogenous connective tissue graft was used, whereas on the left maxilla, the same technique was combined with acellular dermal matrix. Clinical measurements and photographic documentation were obtained up to 10 years. Results During the first 2 years, mean root coverage was 100% on the CTG‐treated side and 95% on the ADM‐treated side. At Year 6, mean root coverage remained 100% on the CTG‐treated side and decreased to 67% on the ADM‐treated side. Complete root coverage was maintained in 75% and 40% of sites, respectively. Relapse occurred primarily in acellular dermal matrix–treated teeth after Year 6, whereas the soft‐tissue phenotype remained clinically stable on both sides. The patient reported high satisfaction and complete resolution of hypersensitivity. Conclusion In this single case, the CTG‐treated side showed greater observed stability at 10 years, whereas ADM provided satisfactory clinical outcomes with lower donor‐site morbidity. These observations are descriptive and should not be interpreted as evidence of comparative effectiveness or generalized beyond this patient.
