25 March 2021

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Treatment of dental dilacerations. Narrative review

Authors: Andrea Fama , Davide Cavagnetto, Andrea Abate, Andrea De Filippis, Eleonora Mainardi, Luca Esposito

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The term dilacerated refers to a dental element that has an alteration of the axial inclination of the crown with respect to the root. Dilaceration can occur at the crown-root junction with deformation of the cementoenamel junction, or it can be present anywhere along the surface of the root and includes any axial modification during the process of formation of the root itself. The purpose this article is to describe a review of the literature on dental dilaceration, presenting epidemiology, etiology, diagnosis and therapeutic options.  

Materials and methods: The review was conducted through the following electronic databases: Medline database, Pubmed, Embase, Cochrane Library. Inclusion criteria: articles between 1970 and 2017 were selected. Using the “limits” option, only articles in English referring to "Humans" were considered. Articles referring to a non-dentistry topic and those published before 1970 were not considered. Articles regarding etiology, diagnosis and treatment were included. Two of the authors were responsible for the non-blind selection of the articles. Disagreements were resolved by discussion or by the involvement of another reviewer. The extracted data were collected on the following elements: magazine and year of publication, study design, therapeutic results, ethnicity and author's conclusions.

Results: The search strategy resulted in 390 articles. Two hundred and seven articles were selected from that database. Then, 156 articles were deemed to be irrelevant on the basis of the study's abstract, title and design and were excluded. Full texts of 51 articles were read to exclude further irrelevant studies. Only 31 met the inclusion criteria. 

Conclusions: The main issue is diagnosis. The first level imaging for diagnosis are periapical radiographs and orthopantomography. In case of dilacerated elements in vestibular position, an occlusal radiography can be used. As confirmed in the literature, a study conducted on maxillary dental elements, CT has a significantly greater specificity and sensitivity than conventional radiographs and therefore represents the technique of choice as a second level imaging. Advanced imaging techniques are an essential requirement for correct diagnosis and for planning surgical access and positioning of the ligature, as well as for defining the optimal and efficient path for extrusion into the oral cavity, which avoids or minimizes collateral damage by using intraoral anchorage aid such as the rapid maxillary expander or skeletal anchorage (miniplates or miniscrews). This study suggests that combined orthodontic-surgical options for dilacerated teeth is the best treatment option. There is no evidence in which way ethnicity may influence therapeutic options. 

Clinical significance: the problem of retained teeth in orthodontics has been studied for many years to try to guide clinicians in choosing the least invasive and most effective treatment possible. The methods presented are, net of the available evidence, the most suitable in the management of these problems.