• Journal of the korean academy of Pediatric Dentistry
• /
• v.43 no.2
• /
• pp.192-199
• /
• 2016

Triple tooth is rare in primary dentition; it is the abnormal fusion of three teeth. There are a few reports of double teeth, but triple teeth are rare. These multiple teeth create several clinical problems, not only esthetic problems but also a high caries susceptibility, congenital missing permanent tooth germ(s), orthodontic problems, and periodontal problems. They also make it difficult to perform pulp treatment because of the complex tooth structure. A 1-year 7-month-old male underwent a partial pulpotomy with mineral trioxide aggregate (MTA) when pulp exposure caused by deep caries occurred at a maxillary anterior triple tooth in the first case. The second case was a 1-year 9-month-old male presenting with a fracture line at a mandibular anterior triple tooth. After removing the fractured fragment, a pulpectomy was performed at the remaining primary lateral incisors. Specific complications were not observed during 24 and 6 months of follow-up, respectively.

• The Journal of the Korean dental association
• /
• v.57 no.10
• /
• pp.588-594
• /
• 2019

The fusion is an anomalous union of two or more tooth germ at some stage in the development process resulting in a decreased number of teeth in the dental arch. Fusion is common odontogenic anomaly but triplication of primary teeth is a rare phenomenon. We report a case of a 3 - year - old girl who visited our clinic for the pain on maxillary anterior tooth. The patient was diagnosed by the fusion of a the maxillary primary right central and lateral incisor with a supernumerary tooth and caries of dentine. And then, Endodontic treatment and composite resin restoration were performed on the triple teeth. After follow-up of 6 months period, there was no marked complications.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.40 no.1
• /
• pp.60-65
• /
• 2013

The term 'triple tooth' is used to describe a rare dental abnormality in which three teeth appear to be joined. The literature contains many reports of joined primary teeth; most cases have involved, however, the joining of two teeth, and only rarely three teeth. Triple tooth has clinical problems such as dental caries, esthetic problems, malocclusions, and periodontal problems. Therefore, it may require multi-disciplinary approach. The present study describes rare case of triple tooth between maxillary primary central and lateral incisors and a supernumerary tooth. An one-year, eleven-month old girl was seen for evaluation of swelling in the labial gingiva above a right maxillary triple tooth. She experienced traumatic dental injury in that area three weeks ago. Intraoral examination revealed an abscess and fistula in the region of the triple tooth. A radiographic examination showed that right lateral incisor was missing. Endodontic treatment and composite resin restoration was performed on the triple tooth. After follow-ups of 7 months period, there were no marked complications.

• Restorative Dentistry and Endodontics
• /
• v.40 no.4
• /
• pp.322-327
• /
• 2015

A recent treatment option for non-vital immature teeth in young patients is revascularization with triple antibiotic paste (TAP). However, tooth discoloration was reported with the use of conventional minocycline-containing TAP. In this case report, amoxicillin-containing TAP was used for revascularization of non-vital immature teeth to prevent tooth discoloration. At the 1 yr follow up, the teeth were asymptomatic on clinical examination and showed slight discoloration of the crown due to mineral trioxide aggregate (MTA) filling rather than amoxicillin-containing TAP. Radiographic examination revealed complete resolution of the periapical radiolucency, and closed apex with obvious periodontal ligament space. However, the root growth was limited, and the treatment outcome was more like apexification rather than revascularization. These results may be due to unstable blood clot formation which could not resist the condensation force of MTA filling, whether or not a collagen matrix was in place. These cases showed that although revascularization was not successful, apexification could be expected, resulting in the resolution of the periapical radiolucency and the closure of the apex. Therefore, it is worthwhile attempting revascularization of non-vital immature teeth in young patients.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.41 no.4
• /
• pp.335-343
• /
• 2014

Regenerative endodontic treatment has the potential to heal a necrotic pulp, which can affect root development in immature teeth. However, several drawbacks and unfavorable outcomes are associated with regenerative endodontic treatment, of which the most significant is coronal discoloration due to the presence of minocycline in triple antibiotic paste and mineral trioxide aggregate (MTA). To prevent tooth discoloration following pulp treatment, the modified triple antibiotics (ciprofloxacin, metronidazole, clindamycin) were used as canal disinfectants and Retro MTA, a $ZrO_2$-containing calcium aluminate cement, was used to seal the canal. Following access cavity acquisition, the canal was copiously irrigated with 2.5% sodium hypochlorite. A modified triple antibiotic paste was then applied to the canal. Once the tooth was asymptomatic (after between 3 and 8 weeks), Retro MTA was carefully placed over the blood clot or a collagen plug. Follow-up radiographs revealed normal periodontal ligament space and root development. In two cases, successful regenerative endodontic treatment of the infected immature tooth, without discoloration, was achieved with disinfection using modified triple antibiotics and Retro MTA sealing.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.39 no.1
• /
• pp.43-50
• /
• 2012

The concept of revascularization of necrotic pulps regained interest and became an alternative conservative treatment option for young permanent teeth with immature roots. Revascularization of immature teeth with apical periodontitis depends mainly on disinfection of the canal. Since the infection of the root canal system is considered to be polymicrobial, a combination of drugs would be needed to treat the diverse flora. A triple antibiotic mixture of metronidazole, ciprofloxacin, and minocycline was used as an intracanal medicament. However, discoloration was developed after applying the triple antibiotic mixture. It is believed that the marked discoloration is related to the use of minocycline. The aim of this article was to present cases of coronal discoloration after triple antibiotic therapy in immature tooth and was treated with bleaching technique to control coronal discoloration. In conclusion, revascularization by using triple antibiotics promotes a paradigm shift in treating endodontically involved permanent teeth. However, we should understand that triple antibiotics containing minocycline induces tooth discoloration. Further research to prevent coronal discoloration should be investigated and suggested for the safe use of triple antibiotics.

• Restorative Dentistry and Endodontics
• /
• v.37 no.2
• /
• pp.119-122
• /
• 2012

Regenerative endodontics has a potential to heal a partially necrotic pulp, which can be beneficial for the continued root development and strengthening of immature teeth. For this purpose, triple antibiotic mixture of ciprofloxacin, metronidazole, and minocycline was recommended as intracanal medicament in an attempt to disinfect the root canal system for revascularization of a tooth with a necrotic pulp. However, discoloration of the tooth was reported after applying this. This case shows the idea for preventing the tooth discoloration using a delivery syringe to avoid the contact between the clinical crown and the antibiotics.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.40 no.3
• /
• pp.216-222
• /
• 2013

Paradigm shift in management of infected immature permanent teeth has occurred. The new concept of the treatment includes minimal or no intracanal instrumentation, disinfection with triple antibiotic paste and sealing with mineral trioxide aggregate. This regenerative endodontic treatment promotes differentiation of periradicular stem cells that induce regeneration of vital tissue and continuation of root formation. Thorough disinfection and three-dimensional scaffold are important in this new concept of the treatment. Platelet-rich fibrin has been reported as 'new scaffold' instead of blood clot, which had been used in the past. Triple antibiotics can be used to disinfect the tooth but may lead to complications including discoloration. Three cases of infected immature permanent tooth caused by dens evaginatus fracture are presented. After removal of necrotic pulp and thorough intracanal irrigation, only platelet-rich fibrin was applied to the root canal in the first case. In the other cases, topical antibiotics was used for disinfection and platelet-rich fibrin for scaffold. In all the cases, the opening was sealed with mineral trioxide aggregate. All the cases showed proper healing of inrabony lesion and some lengthening of root. According to these cases, regenerating vital tissue of the infected immature permanent tooth can be achieved with disinfection and application of platelet-rich fibrin.

• Restorative Dentistry and Endodontics
• /
• v.43 no.3
• /
• pp.31.1-31.7
• /
• 2018

Despite considerable focus on the regenerative endodontic treatment of immature teeth with necrotic infected pulps and apical periodontitis, little data exist with regard to its possible implementation in necrotic permanent teeth with complete apical and radicular development. The present report describes the procedures and outcome of a regenerative endodontic treatment approach in 2 previously-traumatized incisors with closed apex with apical periodontitis. A 2-visit treatment procedure was employed. At initial visit, the root canals were copiously irrigated, followed by placement of a triple antibiotic paste containing ciprofloxacin, metronidazole, and clindamycin into the root canals. After 4 weeks, the antibiotic paste was removed, and apical bleeding was initiated with size 10 hand files beyond the apices. The root canals were coronally sealed with mineral trioxide aggregate, and the access cavities were restored with bonded resin composite. At post-operative 60 months, both teeth were remained asymptomatic, with the recall radiographs showing complete resolution of apical radiolucency and reestablishment of periradicular tissues. In both teeth, the dimensions of root space remained unchanged as verified by image analysis. The revitalization protocol utilizing root canal disinfection and induced apical bleeding in necrotic, closed-apex incisors may offer a clinically acceptable alternative to conventional root canal treatment.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.31 no.2
• /
• pp.136-143
• /
• 2004

The purpose of this study was to investigate the relationship between morphology and position of deciduous double teeth, and the occurrence of other dental anomalies in the same subject. Four morphological types were indentified according to Ailing's classification: type I, bifid crown-single root; type II, large crown-large root; type III, two fused crowns-single root; type IV, two fused crowns-two fused roots. Fifty-four double teeth were found in a total of 1,803 children, who had visited Wonkwang university hospital for dental treatment from January 1, 2003 to September 30, 2003. All of these children were examined clinically and intra-oral radiographs were taken. The results were as follows; 1. 49 children(2.7%) had more than one double teeth, 5 of these children had two double teeth on the bilateral side. And one child showed triple teeth which has three crowns and three roots. 2. Double teeth were predominantly situated in the anterior region, with a preference for the mandible. The ratio of cases involving central incisor and lateral incisor was higher than other cases. 3. There were 25 cases(46.2%) of missing successors among 54 cases of the double teeth. And, prevalence of the missing teeth was highest in the cases involving maxillary central incisor and lateral incisor. 4. In the case of type II(large crown-large root) had more missing successors.