Management of bulbous exophytic malformations of permanent mandibular incisors

This paper presents the diagnosis and management of a rare case of bulbous exophytic malformation of three permanent mandibular incisors. An 8-year-old Caucasian girl presented with concerns on the appearance of these teeth. Medical history was noncontributory, and there was no recall of relevant past trauma. Upon clinical examination, 3 permanent mandibular incisors exhibited hard bulbous protuberances in the crown's middle and cervical areas. Radiographic examination assisted by dental computed tomography revealed that these were continuous with the tooth structure, contained no pulpal tissue, and the teeth displayed normal root development. They were excised and the teeth were restored with a thin composite facing. They remained asymptomatic with acceptable esthetics for 4 years. Scanning electron microscopy and histology of the biopsied hard tissue revealed a nonhomogeneous structure resembling anomalously intertwined enamel with predentin and dentin. The etiology of this disturbance of dental development remains unknown.