Extraoral examination revealed a symmetric face, a normal lower facial height, and a convex profile first (Figure 1). Intraoral examination showed a Class 1 molar relationship with congenitally missing upper lateral incisors. The permanent upper canines, which had erupted into the missing lateral incisor space, were in crossbite. The retained deciduous canines were located distal to the permanent canines. The overjet and overbite were 1 mm and 3 mm, respectively. The color and morphology of the crowns were normal. The ANB and SNGoGn angles were 2.5�� and 38��, respectively. The upper incisor to maxillary plane angle was normal, i.e., 112��. Both periapical and panoramic radiographs revealed pulp stones and several teeth with atypically shaped roots (Figure 1).

The pulp stones were located at the middle or coronal third of the roots, with the roots bulging around the pulpal calcifications. Figure 1. Pretreatment photographs and panoramic radiograph. We treated the anterior crossbite with a fixed appliance for the buccal movement of the upper permanent canines and subsequently performed esthetic restorations of the permanent and deciduous canines. Informed consent for the treatment was obtained prior to the procedure. Maxillary molar teeth were banded, and pre-adjusted fixed appliances (22-inch slot MBT prescription; American Orthodontics, Sheboygan, Winconsin, USA) were placed in the maxillary arch for leveling and alignment. A 0.014-inch NiTi arch wire (American Orthodontics, Sheboygan, Winconsin, USA) was inserted, bypassing the upper permanent canine teeth.

Four weeks later, open coils (100 gr; American Orthodontics, Sheboygan, Winconsin, USA) were placed to provide the necessary space for the permanent canines, and were removed after sufficient space was created. The upper canine teeth were bonded. A 0.014-inch NiTi arch wire was reinserted and ligatured to the upper canines. The bite was opened using the G��ray instant bite raiser (GAC International, Islandia, New York, USA). The anterior cross bite was corrected within 8 months. For final detailing, a 0.016-inch stainless steel arch wire (American Orthodontics, Sheboygan, Winconsin, USA) was used. At the end of the treatment, both panoramic and periapical radiographs showed a slight blunting of the roots of the upper deciduous and permanent canines.

The patient was referred to the department of periodontology for gingivoplasty, and to the department of operative dentistry for esthetic restorations of the anterior teeth (Figure 2). Figure 2. Posttreatment photographs and panoramic and periapical radiographs. DISCUSSION Pulp stones vary in size, ranging from microscopic particles AV-951 to larger masses that almost obliterate the pulp chamber with only the large masses being radiographically apparent.1 Many prevalence studies have identified pulp stones using radiographic criteria. Tamse et al6 examined both periapical and bitewing radiographs and showed that 20.7% of the teeth had pulp stones.