Autotransplantation of teeth in orthodontic treatment.
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Bicuspid↗
Biomedical subjects
H U Paulsen
Publications and source records attributed to H U Paulsen.
Eruption pattern of autotransplanted premolars visualized by radiographic color-coding.
Eruption patterns and root growth were visualized with the use of a new technique, radiographic color-coding, for comparison of the development of autotransplanted premolars with contralateral control teeth. Rates of eruption and root growth were studied. The eruption pattern and rate was assessed relative to the first molar. Maximum rates were found to occur between 30 and 60 days after transplantation. There were no significant differences between transplants and their contralaterals. Two distinct categories of eruption patterns were demonstrated. One group showed a tendency toward an initial rate of transplant eruption that was somewhat faster than that of the contralaterals. The other group showed initially retarded eruption. Possible explanations were discussed. Because no significant differences between the transplants and the contralaterals were observed, it was concluded that autotransplantation is a sound treatment option for substitution of missing teeth, at least from a tooth development point of view.
Bicuspid↗
Computer tomographic and radiographic changes in the temporomandibular joints of two young adults with occlusal asymmetry, treated with the Herbst appliance.
Two young patients, one female and one male, with asymmetric occlusal deviation and extreme Angle Class II division 1 malocclusions were treated with the Herbst appliance after cessation of endochondral growth (union of the radius epiphysis). During treatment, computer tomographic (CT) scanning and orthopantomograms of the temporomandibular joints (TMJs) revealed, as a result of bone modelling, asymmetrical new bone formation as a double contour on the distocranial part of the condyles. The treatment results were followed for more than 2 years and the new bone was found to be stable.
Adult↗
Orthodontic application of color image addition to visualize differences between sequential radiographs.
A new technique was developed making it possible to visualize changes that take place after premolar transplantation. Three sequential radiographs from a series of standardized control examinations were digitized and registered to the first radiograph in the series using subtraction technique. The digitized radiographs were then transformed into monochromatic images: red, blue, and green. After correction of gray level and contrast, the three radiographs were superimposed. All details that were common in the radiographs were then displayed in black-and-white. Details that were different appeared in color. Red and blue combines into magenta, blue and green into cyan, and green and red into yellow. A procedure was developed to create color-coded radiographs according to the above. The procedure was applied to cases that had been treated by premolar transplantation. The color coding offers the possibility to identify any radiographic changes that take place over time, eg, growth, apposition or resorption of bone, and progression or regression of pathological processes.
Bicuspid↗
A histomorphometric and scanning electron microscopy study of human condylar cartilage and bone tissue changes in relation to age.
OBJECTIVES: To determine the possibility for adaptive growth in human condyles, quantifying the thickness of fibrocartilage and the constitution of cells with potential activity, the trabecular bone volume, and the structural parameter: marrow space star volume in a larger sample of human autopsy condyles. EXPERIMENTAL SETTING AND DESIGN: A histomorphometric and scanning electron microscopic analysis of cartilage characteristics and bone remodelling activity. The Departments of Orthodontics and Cell Biology at Aarhus University, Denmark. An autopsy sample of condyles from 20 individuals, 18-31 years of age. Correlation analyses between ages and all parameters were conducted. RESULTS: There was a statistically significant correlation between age and the fibrocartilage thickness (r = -0.48, p < 0.05) and age and the trabecular bone volume (r = -0.52, p < 0.05). There was a statistically significant correlation between age and the hypertrophic chondrocytes (r = -0.50, p < 0.05) and age and the hypertrophic chondrocytes in bone (r = -0.48, p < 0.05). There was no significant correlation between age and the two other zones in the fibrocartilage. No statistical analyses were carried out concerning gender differences, as the sample consisted of very few females. Individual morphological description was performed, and is described in the article. Only slight age-related differences were found concerning the quantitative measurements for the fibrocartilage and the underlying bone tissue. CONCLUSIONS: Quantitative and qualitative investigations of the turnover activity in the fibrocartilage and the bone tissue, describing activity of hypertrophic chondrocytes and the trabecular bone tissue, indicated condylar growth potential in the age group until 30 years of age. The growth activity seemed to decline with age.
Adaptation, Physiological↗
Eruption of premolars subsequent to autotransplantation. A longitudinal radiographic study.
One-hundred-and-eighteen premolars transplanted at a stage with 3/4 to 4/4 root development with an open apical foramen were followed using a standardized clinical and radiographic technique for signs of periodontal ligament healing, root development, and tooth eruption. Root growth was unimpeded in 26 per cent, impaired in 55 per cent, and arrested in 19 per cent. Eruption of transplants occurred at the time of periodontal and alveolar healing, and before any significant root growth. Furthermore, autotransplanted premolars created growth of the alveolar process along with the eruption process.
Adolescent↗
Bone scintigraphy of human temporomandibular joints during Herbst treatment: a case report.
Bone scintigraphy results were compared with changes shown on orthopantomographic radiographs in a patient with facial asymmetry, before, during, and after Herbst treatment, and followed up with control of growth activity in the temporomandibular joints (TMJs) after long-term retention. The present study showed that new bone formation (modelling) was initiated asymmetrically in TMJs during treatment. The results indicate that late development of right/left asymmetry in the occlusion can be corrected and normalized using the Herbst appliance therapy, stimulating a differentiated 'catch up' growth (modelling) in the TMJ with condyles. After treatment, original growth with asymmetric activity in the TMJ was re-established. This growth activity may re-establish the asymmetry in the sagittal occlusion and the face of the patient. It is therefore recommended that the occlusion should be maintained with an appliance which stabilizes the occlusion until cessation of the primary, endochondral growth.
Adolescent↗
Morphological changes of the TMJ condyles of 100 patients treated with the Herbst appliance in the period of puberty to adulthood: a long-term radiographic study.
One hundred consecutive patients were treated with the Herbst appliance in the period of puberty to adulthood. The orthopaedic effects on the morphology of the condyles were described from orthopantomographic and transpharyngeal radiographs. The orthopaedic treatment effect was, in most cases, visible as a change in morphology of the condyle, a double contour in the distocranial part of the condyle and sometimes also at the distal surface of the ramus. In patients at the peak of puberty, the double contour was distinct for a short time. In patients in late puberty, the double contour could be seen several months after treatment. At adulthood, males showed, in most cases, double contours, while females showed in most cases nearly unchanged condyles. When double contours were seen, these persisted for a few months to several years after Herbst treatment. The newly formed bone was stable and no TMJ problems were observed. The change in morphology and the double contour of the condyle can be interpreted as bone modelling. The newly formed bone on the posterior part of the condyle can be explained as a response to hypertropic chondrocytes, and that on the posterior part of the ramus as a response of resting osteoblasts to mechanically induced changes in the condyle (adaptive bone growth). In two cases, remodelling resorption was found in the anterior part of the condyle after Herbst treatment, again as a sign of adaptation to changed mechanical influence. In both cases, later refilling with bone was registered during the remodelling process. The biomechanical effect of Herbst treatment on the mandible is also analogous with an impeded matrix rotation combined with relocation of the mandible.
Adaptation, Physiological↗
Pulp and periodontal healing, root development and root resorption subsequent to transplantation and orthodontic rotation: a long-term study of autotransplanted premolars.
One hundred and eighteen premolars transplanted at a stage with 3/4 to 4/4 root development with a wide open apical foramen were followed with standardized clinical and radiographic techniques for signs of pulpal and periodontal ligament healing and root development. Pulp healing, evaluated first by radiographic presence of pulp canal obliteration, appeared to be an earlier sign of pulp healing than the detection of pulp vitality with an electrometric test. Continued root growth of premolars was seen in some cases. Complete arrest of root development was usually followed by development of the missing root structure at the donor site, indicating a separation of the Hertwig's epithelial root sheath. Orthodontic rotation performed on 11 premolars induced slight surface resorption and a significant shortening of tooth length (mean 1.2 mm), compared with nontreated but transplanted control teeth. However, the extent of the apical root resorption is of minor clinical importance, and is equivalent to what has been found in previous investigations of orthodontic treatment of nontransplanted premolars. Late pulp necrosis occurred in 2 of the 11 treated cases 6 years after transplantation and 5 years after orthodontic rotation. To prevent late pulp necrosis, orthodontic rotation is recommended after periodontal healing and before total pulp canal obliteration has taken place, i.e., 3 to 9 months after transplantation.
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CT-scanning and radiographic analysis of temporomandibular joints and cephalometric analysis in a case of Herbst treatment in late puberty.
From a consecutive sample of 100 patients treated with the Herbst appliance after the peak of puberal growth, a boy was chosen to show the total effect of the Herbst treatment. Changes in the dentofacial morphology and the structure of the temporomandibular joints (TMJ) were followed by radiologic examinations and the function of the craniomandibular system was studied by clinical examinations, and electromyographic and bite-force recordings. Treatment resulted in marked dentoalveolar changes, an increase of mandibular length, ramus height, and gonion angle. Three months after insertion of the appliance CT-scanning and orthopantomograms of the TMJ revealed new bone formation as a double contour in the fossa articularis and on the posterior part of the condylar process as a result of adaptive bone remodelling. Function was affected by treatment, but was markedly restored at control.
Adolescent↗
A long-term study of 370 autotransplanted premolars. Part II. Tooth survival and pulp healing subsequent to transplantation.
The purpose of the present investigation was to determine the long-term prognosis of autotransplanted premolars with respect to tooth survival and pulpal healing. The material consisted of 195 patients aged 7 to 35 years, with a total of 370 autotransplanted premolars with observation period ranged from 1 to 13 years. Teeth transplanted with incomplete and complete root formation showed 95 per cent and 98 per cent long-term survival respectively: Pulp healing as evaluated by sensibility testing and radiographic signs of partial pulp canal obliteration was usually verified 6 months after transplantation. The frequency of pulpal healing (versus pulp necrosis), appeared to be closely related to stage of root development at time of transplantation. Teeth transplanted with incomplete and complete root formation showed 96 per cent and 15 per cent pulp healing respectively. Another and associated factor which could equally well predict pulpal healing was the diameter of the apical foramen of the graft. Finally, in teeth with completed root formation, the use of bursa with internal cooling and no extra-alveolar storage prior to transplantation seemed to increase the chance for pulpal healing. The present study indicates, that the size of the apical foramen and possibly the avoidance of bacterial contamination during the surgical procedure are explanatory factors for pulpal healing.
Adolescent↗
A long-term study of 370 autotransplanted premolars. Part III. Periodontal healing subsequent to transplantation.
The purpose of the present investigation was to determine the long-term prognosis of autotransplanted premolars with respect to periodontal healing. The subjects consisted of 195 patients aged 7 to 35 years, with a total of 370 autotransplanted all operated and followed with a standard technique. The observation period ranged from 1 to 13 years. Periodontal healing as demonstrated radiographically was complete in most cases after 8 weeks. Root resorption occurring after transplantation was divided into surface-, inflammatory- and replacement resorption (ankylosis). Root resorption occurred in 52 of the transplanted teeth and was usually diagnosed within 6 months. Root resorption was found to be significantly related to increasing stage of root development and the stage of eruption at the time of transplantation. Subsequent orthodontic movement of teeth with completed root formation at the time of transplantation resulted in a slight increase in the frequency of both surface and inflammatory resorption. The present study indicates that trauma to the PDL of the transplant is the explanatory factor for the development of root resorption.
Adolescent↗
A long-term study of 370 autotransplanted premolars. Part I. Surgical procedures and standardized techniques for monitoring healing.
Tooth autotransplantation has recently become a method of treating certain orthodontic problems. Over a 13-year period 370 premolar transplants were monitored by electrometric pulp sensibility testing and radiographic examination for pulp and periodontal ligament healing as well as root growth. This article describes the surgical technique as well as the precision of sensibility testing and radiographic examination for evaluating transplant healing. The sensibility response was found markedly related to the stage of tooth development but not to the type of premolar. The precision of sensibility testing (i.e. deviation of two consecutive measurements at a few weeks' interval) was found to range from 15-36 per cent for the different stages. Film holders were used to standardize the intraoral radiographic exposures. The precision percentage for the measuring technique of tooth length and crown width based on a single radiograph read twice (reading error) ranged from 1.1 to 1.8 with only small variations among the different types of premolar. The precision percentage of the radiographic exposure technique evaluated from two consecutive radiographs (measuring plus exposure error) was found to range from 1.2 to 4.2, again with small variations among the different premolars. The accuracy of the radiographic technique (i.e. deviation of radiographically determined tooth dimensions from the true values) was found to range from 2.0 to 2.9 with only small variation between the various types of premolar. In conclusion the evaluation of electrometric sensibility testing should take into account the stage of root formation of premolars.
Adolescent↗
A long-term study of 370 autotransplanted premolars. Part IV. Root development subsequent to transplantation.
The purpose of the present study was to analyse the extent of root development subsequent to transplantation in a material of 370 transplanted premolars. Before transplantation, the grafts were classified according to stage of root development (i.e. quarters of root length and constriction of the apical foramen) and length of tooth development (measured in mm from the cusp tip to the apical foramen). At radiographic controls the extent of root formation was registered. These figures were compared to the final tooth length of 288 non-transplanted premolars from the present material as well as to tooth length determinations of 534 premolars extracted for orthodontic purposes. Furthermore, intra-individual and inter-individual differences in tooth length were examined in a skull material with 40 pairs of premolars. These method studies indicated that root growth was probably determined genetically with great right-left accuracy and variation related to location of premolar (maxilla or mandible) and sex. A statistical analysis of the transplant material revealed that stage as well as length of tooth development assessed prior to transplantation were significantly related to final tooth length after transplantation. In most cases of transplantation performed at early stages of root development, a reduction in the final root length was seen. When a qualitative analysis of root development was performed in teeth with incomplete root formation at the time of transplantation, and where a homologous non-transplanted premolar was present, it was found that 14 per cent showed total arrest of root formation, 65 per cent partial arrest whereas 21 per cent showed no arrest (i.e. normal root formation). Premolars in ectopic position in the mandible before transplantation showed a significantly reduced root growth compared to matched pairs with normal position of the tooth graft. The present study indicated that no, partial or total damage to the Hertwig's epithelial root sheath was probably the explanatory factor for variations in root growth.
Adolescent↗
[Herbst apparatus and Jasper jumper].
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[Treatment of anterior tooth loss by autotransplantation of premolars].
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Bicuspid↗
[Autotransplantation of premolars in treatment of tooth loss in the anterior maxilla].
The value of autotransplantation of premolars to the anterior region is demonstrated in three cases where respectively one, two and four maxillary incisors were lost due to trauma. It is stressed that a careful analysis should precede this treatment approach.
Bicuspid↗
Herbst treatment in late adolescence: clinical, electromyographic, kinesiographic, and radiographic analysis of one case.
In an almost full-grown male of 17 years, functional and morphological changes were followed during Herbst treatment and subsequent control. Retrognathism of the mandible was overcorrected, and then normalized by reverse headgear to the maxilla. Partial relapse due to insufficient cooperation during retention necessitated retreatment. Treatment resulted in marked dentoalveolar changes, increase in mandibular length and ramus height, apposition and remodelling of condylar heads and flattening of the temporal joint surface. After treatment masseter strength was 40 per cent reduced, probably due to prolonged hypofunction.
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