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Tissue-supported implant overdentures.

Overdenture techniques can be modified for use with implants. Generally the implants, which replace the tooth roots, can be placed in a position to permit optimum retention and stability as well as enhancing esthetics. Bony undercuts, which at times are present with the retention of tooth roots, are not a problem when using implants. Various retentive schemes are available to retain the prosthesis and can be matched to the individual needs of patients in regard to retention, stability, and the ability to insert and remove prostheses. Two implants can adequately support an overdenture. The superstructure must be designed to enable the patient to maintain a healthy oral environment. The patient must understand and be able to perform required oral hygiene procedures. The use of overdentures over implants affords the dentist another option in meeting the needs of the patients.

Dental Clasps↗

Overdentures with magnetic attachments.

Magnets were used only occasionally for dental purposes several decades ago. Since the advent of rare earth magnet alloys, however, intraoral magnets are shaping the course of aesthetics and retention for both complete and removable partial overdentures. Their benefits include simplicity, low cost, self-adjustment, inherent stress breaking, automatic reseating after denture displacement, comparative freedom of lateral denture movement, a low potential for trauma to the retained roots, and elimination of the need for adjustment in service. The clinical procedures involved in their application do not require any special skills, and the options offered by the various manufacturers give the dentist a wide variety of choices in selecting an appropriate treatment plan. Clinical experience has shown that magnetic retention offers an economical alternative for teeth that would otherwise require expensive or extensive restorative treatment, and can be used as an effective and often superior replacement for failed bridgework. Finally, it is clear that overdenture treatment per se is a valuable option for the dentist, and the use of magnets expands this option to the retention of tooth roots that might otherwise be scheduled for extraction. The natural tooth root, even if periodontally involved, can serve as a useful aid in denture support and retention, and should be regarded as at least as good as, and in most cases superior to, an implant. It is also much less expensive.

Adolescent↗

Morphology of Malassez's epithelial rest-like cells in the cementum: transmission electron microscopy, immunohistochemical, and TdT-mediated dUTP-biotin nick end labeling studies.

BACKGROUND AND OBJECTIVE: It is known that epithelial islands are embedded in the cementum during tooth root formation, but details of this process remain unknown. The purpose of this study was to investigate the dynamic characteristics of Malassez's epithelial rest cells in the cementum during tooth root formation in pigs in vivo. MATERIAL AND METHODS: The first molars of 6-mo-old pigs were used in this study. Specimens were decalcified before being embedded in paraffin. Paraffin sections were investigated using TdT-mediated dUTP-biotin nick end labeling (TUNEL), immunohistochemical, and ultrastructural techniques. RESULTS: Malassez's epithelial rest cells were located close to the root surface at the apical one-third of the periodontal ligament, and epithelial clusters surrounded by distinct lamina cementia were sometimes observed in the cementum. TUNEL-positive cells were detected only in the cementum. Malassez's epithelial rest cells in the periodontal ligament were completely surrounded by basement membranes, but epithelial clusters in the cementum were only intermittently surrounded by such membranes. Cytokeratin-positive cells in the superstratum of the cementum were directly connected by cementocytes and by desmosome-like structures. However, organelles were scarce in the cytokeratin-positive cells in the substratum of the cementum, and the matrix of the cementum was deposited in the cells. CONCLUSION: These results suggest that the majority of the fragmented Hertwig's root sheath remains in the periodontal ligament and that some cells, which are connected to cementoblasts, are embedded in the cementum and progress to apoptosis.

Animals↗

[Elimination of isolated gingival atrophy by laterally positioned flap and free mucogingival autografts in combination with coronally positioned flap].

Mucogingival surgical procedures such as laterally (horizontally) positioned flap, double papillae positioned flap and free mucogingival autografts have been recommended for the prevention and treatment of isolated gingival atrophy. These procedures can bi performed either independently or in combination with coronally positioned flap. In our study, for covering of exposed tooth roots, we applied laterally positioned flap and free mucogingival autografts in combination with coronally positioned flap. The obtained therapeutic results showed that six months after the surgery the exposure of tooth necks in patients treated by laterally positioned flap, decreased by 2.54 mm. Somewhat better results were obtained in the group of patients treated by fre mucogingival autografts in combination with coronally positioned flap. Within the same time interval, the total surface area of exposed tooth roots decreased by 59.76% in the group of patients treated by laterally positioned flap, i.e. by 62.25% in the group of patients treated by free mucogingival autografts in combination with coronally positioned flap.

Gingiva↗

Localization and expression of osteopontin in mineralized and nonmineralized tissues of the periodontium.

To summarize results from various studies focusing on determining the expression/localization of BSP and OPN during tooth root development, there is general agreement that OPN is expressed/localized to the root surface during cementogenesis and is also seen throughout the PDL region. The expression/localization of OPN to odontoblasts and its role in dentinogenesis is less apparent. Recent studies directed at establishing odontoblast cell lines should help to resolve this conflict. Studies on BSP expression during tooth root formation indicate a very precise expression and localization of this molecule during cementogenesis indicating that this molecule may play an important role in the formation of this mineralized tissue. However, as with OPN, the expression of BSP and its role in dentin formation is not clearly defined.

Animals↗

Functional structure of the skull in hominoidea.

Finite elements stress analysis (FESA) was used to investigate the flow of compressive forces which occur if a homogenous, three-dimensional body representing the skull is loaded by simulated bite forces against the tooth row. Model 1 represents the snout alone. Bite forces are applied simultaneously, but increase rearward. Stresses in the model concentrate along the anterior contour and the lower surface of the model, leaving unstressed a nasal opening and a wide naso-oral connection. Model 2 represents the facial region, as far as the temporomandibular joint. The orbits and the nasal cavity are assumed to be present a priori. Model 3 applies reactions to the bite forces in the temporal fossa, corresponding to the origins of the masticatory muscles. Regions of the model under compressive stress correspond closely to the arrangement of bony material in a hominoid skull. If only the stress-bearing finite elements on each section are combined, and the stress-free parts neglected, the resulting three-dimensional shape is surprisingly similar to a hominoid skull. If bite forces are applied to parts of the tooth row only, the stress patterns are lower, asymmetrical and do not spread into all regions that are stress-bearing in simultaneous biting on all teeth. In model 2, the highest stresses occur at the tooth roots and along the forehead on top of the nasal roof. There are no marked stress concentrations on top of the orbits. The resulting shape resembles that of an orang-utan. In model 3, the highest stresses also occur at the tooth roots, but the circles of force mostly close below the brain case, so that the stress concentration in the forehead region remains much less marked. In this model, however, the stress concentrations are very similar to hollow brow ridges. The entire resulting shape resembles that of gorilla or chimpanzee skulls. A typical gracile australopithecine skull (STS-5) also shows clear similarities to the patterns of stress flow in our models. Compared to our earlier study of the modern human skull, differences relate to: the relative length and width of the dental arcade, the relative size of the brain case and the position of the arcade relative to the brain case. It seems that these traits are the points of attack of selective pressures, while all other morphological details are simply consequences of stress flow.

Animals↗

Mandibular fractures following third molar extraction. A retrospective clinical and radiological study.

Twelve patients with 13 mandibular fractures following third molar extraction were treated in our Department between 1980 and 1995. Clinical and radiographic data relating to these patients were analysed retrospectively to determine complication characteristics. Only one fracture occurred during surgery. The first week after the operation was found to be most critical for fracture occurrence. A "cracking" sound from the jaw while eating frequently indicated that a fracture had occurred, but repeated radiographic examination may be necessary for definitive diagnosis. Most teeth removed belonged to Groups II/III according to PELL & GREGORY's classification, indicating partial or total impaction of the tooth and a narrow space in the retromolar triangle. In all cases, tooth roots were superimposed on or adjacent to the inferior alveolar canal. Clinically, the age of the patient seemed to be a common predisposing factor, and patients older than 30 to 40 years were considered to be a risk group. Regardless of the degree of impaction and tooth position, the fracture type seen was uniform, i.e. preangular location and a typical course of the fracture line. After adequate fracture treatment, no further complications were noted.

Adult↗

A quantitative study on the myelinated fiber innervation of the periodontal ligament of cat canine teeth.

The periodontal ligament is richly innervated with mechanosensitive afferent nerve fibers, and the location of the mechanoreceptive terminals within the ligament is of functional significance. In this study, we have obtained quantitative information on mechanoreceptor distribution in the lower canine teeth of the cat. Using light microscopy, we quantified the number of myelinated axons in the periodontal ligament at 1 mm, 3 mm, and 5 mm from the tooth root apex. Grouped axons and axons which were isolated in the cemental half of the ligament (and therefore putative mechanoreceptors) were identified. The mean total number of axons was 1290 (n = 20) at 1 mm from the apex, 1290 at 3 mm, and 814 at 5 mm. The distribution of axons around the tooth root circumference was found to be non-uniform. Near the root apex, the highest numbers of grouped axons were located distally and mesially, and in the middle region of the root, the highest numbers were found mesially. The highest numbers of isolated axons at the apical levels were located distally, and in the mid-root region, mesially. At all levels, the lingual region was the most sparsely innervated by both groups. There was a positive correlation between the number of grouped axons and the width of the ligament in the same region, but this correlation was much weaker for isolated axons, suggesting that their distribution does not result only from the volume of tissue. Variations in the number of axons and, to a lesser extent, the dimensions of the periodontal ligament were considerable.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

Levator nasolabialis muscle transposition to prevent an orosinus fistula after tooth extraction in horses.

The ventral part of the levator nasolabialis muscle was transposed to the alveolar defect after sinusotomy and tooth extraction in five normal horses and six horses with a tooth root abscess and sinusitis. In the normal horses at weeks 6, 10, 14 and 18, the transposed muscles remained viable and were incorporated into the recipient sites, and orosinus fistulae did not form. Histologically, there was a progressive transition from muscle to fibrous tissue. There was no facial deformity or loss of nasal function at the donor site. A localized abscess was associated with incomplete removal of tooth root fragments in one horse. After 1 year or more, five horses treated for dental disease had complete resolution of clinical signs. One horse continued to have intermittent mild nasal discharge.

Animals↗

A stent fabricated on a selectively colored stereolithographic model for placement of orthodontic mini-implants.

The purpose of this report is to present a new method for placing orthodontic mini-implants using a stent fabricated on a selectively colored stereolithographic model. A stent was fabricated that incorporated a guide groove drilled in accordance with the planned direction of the mini-implant. Tooth crowns, gingiva, tooth roots, and the maxillary sinuses were clearly identified in the stereolithographic model. As a result, the stent could be fabricated while taking into account the anatomic characteristics of both the bone interior and the dental surface. A stent fabricated on the selectively colored stereolithographic model is suggested to be a promising device for guiding placement of orthodontic mini-implants adjacent to the tooth roots and the maxillary sinuses.

Color↗

Long-term occlusal guidance of a severely intoxicated patient with yusho (PCB poisoning): a case report.

The peculiar dentoorofacial characteristics and 12 years of interdisciplinary management of a patient who was severely intoxicated with the man-made chemical polychlorinated biphenyls (PCBs) are described in this case report. Cephalometric measurements showed that the SNA and SNB angles were reduced but that the developments in height and skeletal maturity were in normal ranges. Gingival hyperpigmentation that was caused by high blood PCB concentration was extremely slow to fade. A cystic mass, diffused trabeculae, and irregular calcification, which were shown on the radiograph and which were caused by high blood levels of PCB, changed gradually. However, the patient had periodontal disease because of horizontal alveolar bone resorption and a deep periodontal pocket, despite good plaque control. After the PCB poisoning the tooth roots were hypoplastic and dilacerated. One root was extracted because of chronic periodontitis. Some teeth were impacted, malposed, or ankylosed.

Adolescent↗

Light microscopic study of periapical lesions associated with asymptomatic apical periodontitis.

The purpose of the study has been to evaluate the degree of chronic inflammation in tissues surrounding the apex of the tooth root in patients with apical periodontitis in the remission phase. The material included 37 apical granulomas and radicular cysts obtained as a result of apiectomy, and 20 teeth which were removed together with the focus of the periapical inflammation. Routine histological techniques, as well as the immunofluorescent and immuno-chemical methods were used to examine the material. Despite the absence of clinical symptoms in 23 of 57 cases, the morphological signs of chronic inflammation were observed in the apical area of the tooth root. Morphological signs of viral invasion of epithelial and stromal cells in the radicular cyst wall were revealed in six cases. The presence of the virus of Herpes simplex I in epithelial cells (five cases) and adenoviral invasion (one case) was confirmed by immuno-fluorescent and immuno-chemical methods. Histological examination often reveals morphological signs of an active inflammatory process in the periapical tissues of patients treated during clinical remission. In our opinion, the presence of viruses in the epithelial cells of the radicular cyst may contribute to the persistence of the active stage of the inflammatory process.

Adult↗

Role of two mineral-associated adhesion molecules, osteopontin and bone sialoprotein, during cementogenesis.

Adhesion molecules and their cell membrane receptors are known to play important regulatory roles in cell differentiation. Consequently, the following experiments were conducted to determine the role of two adhesion molecules, bone sialoprotein (BSP) and osteopontin (OPN) in tooth root formation. Developing murine molar tooth germs at sequential stages of development (developmental days 21-42) were analyzed using immunohistochemical and in situ hybridization techniques. While BSP was localized to alveolar bone and odontoblasts early in development, BSP was distinctly localized to the cemental root surface at latter periods coincident with the initiation of root formation and cementogenesis. Conversely, OPN was distributed in a nonspecific fashion throughout the PDL and the eruption pathway of the forming tooth. In situ hybridization confirmed that cells lining the root surface express BSP. The fact that BSP is specifically localized to the cemental surface suggests that this protein is involved in cementoblast differentiation and/or early mineralization of the cementum matrix. Localization of OPN to non-mineralized tissues further suggests that OPN functions as an inhibitor of mineralization during periodontal ligament formation. These findings collectively suggest that BSP and OPN are intimately involved in the sequence of cellular and molecular events accompanying cementogenesis.

Alveolar Process↗

Expression of cathepsin K mRNA and protein in odontoclasts after experimental tooth movement in the mouse maxilla by in situ hybridization and immunoelectron microscopy.

This study demonstrated the simultaneous expression of cathepsin K (CK) mRNA by in situ hybridization and CK protein by immunoelectron microscopy in odontoclasts in mouse maxillae after experimental tooth movement. On the pressure side (the area under pressure during tooth movement), CK mRNA was detected in odontoclasts in resorption lacunae in the tooth root, in osteoclasts in bone resorption lacuane, and in fibroblasts in the periodontal ligament. Using electron microscopy, CK protein was detected at the apex of odontoclasts, intracellularly in vesicles and granules, and extracellularly in irregularly shaped vacuoles (extracellular spaces), on the plasma membrane of the ruffled border, and on and between typical striated type I collagen fibrils in the lacunae. These vesicles and granules appeared to fuse with irregular vacuoles containing CK-positive fragmented fibril-like structures close to the ruffled border. In the basolateral portion of odontoclasts, small amounts of CK-positive rough endoplasmic reticulum (ER) were found. CK-positive intracellular vacuoles (not extracellular spaces) also appeared to fuse with the vesicles and granules. However, these fused organelles rarely contained fragmented fibril-like structures. They are probably endolysosomes. The distribution of CK in odontoclasts was similar to that previously seen in osteoclasts. Furthermore, CK-positive fibril-like structures were found in the vacuoles of fibroblasts. These results indicated that during tooth movement CK is synthesized in odontoclasts on the pressure side and secreted into the tooth resorption lacunae. Therefore, CK may take part in the degradation of the dentin matrix (type I collagen fibrils and non-collagenous protein) of the tooth root, and in the subsequent intracellular degradation of endocytosed fragmented fibril-like structures in endolysosomes.

Animals↗

[Effects of post length on the dislocation of post and core crown].

OBJECTIVE: To evaluate the effects of the length of post on the dislocation of cast post and core crown. METHODS: Forty simulated tooth roots made of polymethyl methacrylate were divided into five groups according to different length of post. These cast post and core were bonded with zinc phosphate cement. Then these specimens were strectched on the INSTRON-4302 by the speed of 10 mm/min. The maximum of load was recorded. RESULTS: The loads of 7 mm, 7.5 mm, 8 mm, 8.5 mm, 9 mm were (203.25 +/- 57.19) N, (213.63 +/- 45.06) N, (234.44 +/- 59.27) N, (317.75 +/- 60.94) N, (334.25 +/- 58.00) N respectively. Linear regression analysis revealed the linear relationship of post length with dislocation, bonding, and mechanical interlocking; the values of r being 0.676, 1.000, 0.949; the regression equations being D = 73.225L - 325.776, B = 0.442L + 9.951, M = 72. 676L-334. 338. CONCLUSION: Mechanical interlocking is the main factor in dislocation of post and core crown. The length of post should be increased from 2/3 to 3/4 of the length of tooth root when prepared in clinic.

Crowns↗

The influence of chemically-induced modifications of root surfaces on cell migration, attachment, and orientation.

Surface demineralization of tooth root surfaces has been shown to improve re-attachment of cells and to promote tissue reconstruction following periodontal surgery. Exposure of collagen fibers has been thought to facilitate migration, attachment, and orientation of fibroblasts on the root surface. However, using an in vitro assay, we have found that both attachment and orientation of human gingival fibroblasts on demineralized dentin surfaces are further improved following digestion of the exposed collagen with bacterial collagenase. In contrast, pronase and trypsin digestion of the surface collagen had no significant effect, whereas heat denaturation had an inhibitory effect. Dissociative extraction of the demineralized dentin slices with 4 mol/L guanidine hydrochloride (GuHCl) also improved attachment and orientation, and when undemineralized dentin was subjected to dissociative extraction, cell attachment was comparable and orientation superior to that on demineralized surfaces. These studies indicate that demineralization is not a prerequisite for facilitating attachment, and that enhanced attachment and orientation of cells are not dependent upon a collagenous substratum.

Animals↗

Developmental properties of the Hertwig's epithelial root sheath in mice.

Hertwig's epithelial root sheath (HERS) plays an important role in tooth root formation. In this study, we examined root formation of the first molar in mice, focusing on cell proliferation, cell death, cell migration, and the expression patterns of the signaling molecules, including glycoproteins and proteoglycans between PN8 and PN26. The number of HERS cells decreased during root formation, although HERS retained total length until PN15. The migration of HERS cells did not occur during root formation. Moreover, the immunopositive reaction of laminin beta-3 and syndecan-1 in HERS indicates that both cell adhesion and cell proliferation are essential for HERS development. Bmp-2, Bmp-4, and Msx-2 were expressed in HERS cells during root formation. We also developed an in vitro culture system for investigating the periodontium and suggest that this system provides an excellent vehicle for full exploration, and hence improved understanding, of the development and regeneration of the periodontium. Together, our results provide a comprehensive model describing the morphogenesis of early root development in vertebrates.

Animals↗