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PubMed2001

Otodental syndrome: a case report and genetic considerations.

A 5-year-old boy presented with otodental syndrome. His maxillary and mandibular incisors were within normal limits. The premolar/molar areas in all quadrants were occupied by markedly macrodontic teeth showing globular shape. The canines had a similar rounded shape. Two canines and 1 of the other abnormal teeth demonstrated areas of yellow hypoplastic enamel. Radiographs revealed that some of the abnormal teeth had bifurcated pulp chambers and pulp stones. Premolar tooth germs were absent. Audiometry demonstrated that the child had a marked bilateral sensorineural hearing loss for frequencies above 1000 Hz. No other members of the immediate family were clinically affected. The parents of the child were not aware of any similarly affected relatives. Suggestions with respect to possible genetic mechanisms and gene participation in the etiology of this syndrome are offered.

Bicuspid↗
PubMed2002

Effect of magnification on locating the MB2 canal in maxillary molars.

The purpose of this study was to determine if the surgical operating microscope and/or dental loupes could enhance the practitioner's ability to locate the second mesiobuccal canal (MB2) canal of maxillary molars in an in vivo, clinical setting. The participating endodontists documented 312 cases of root canal therapy on maxillary first and second molars. Participants that used the microscope or dental loupes located the MB2 canal with a frequency of 57.4% and 55.3%, respectively. Those using no magnification located the MB2 canal with a frequency of 18.2%. When no magnification was used, significantly fewer MB2 canals were located based by Chi-square analysis at p < 0.01. There was no significant difference between the use of the microscope and dental loupes in the frequency of locating the MB2 canal. When the maxillary first molars were considered separately, the frequency of MB2 canal detection for the microscope, dental loupes, and no magnification groups was 71.1%, 62.5%, and 17.2%, respectively. The results of this study show that the use of magnification in combined groups leads to a MB2 detection rate approximately three times that of the nonmagnification group and that the use of no magnification results in the location of significantly fewer MB2 canals. Based on these results, more emphasis should be placed on the importance of using magnification for locating the MB2 canal.

Adolescent↗
PubMed1992

Pulp responses to two strains of bacteria isolated from human carious dentine (L. plantarum) (NCTC 1406) and S. mutans (NCTC 10919).

A series of studies has been conducted in which monoinfected gnotobiotic rats were used to study the responses of the dental pulp to micro-organisms isolated from carious lesions in dentine. In this study pulp responses to L. plantarum (formerly odontolyticus) (NCTC 1406) in pure culture and in combination with S. mutans (NCTC 10919) are reported. The incidence of inflammation/necrosis/dentine bridge formation observed in animals monoinfected with L. plantarum was similar to that reported in previous germ-free studies. There was a greater incidence of dentine bridge formation in rats monoinfected with L. plantarum compared with those monoinfected with S. mutans. When the two organisms were combined, periapical inflammation was observed in 14% of the teeth examined after 28 days, but there was no significant difference in the incidence of dentine bridge formation. Considerable variation in the density of staining of the two microorganisms in histological sections was observed.

Animals↗
PubMed1992

Root fractures in permanent teeth: a clinical review.

A retrospective study of 22 root fractures in 21 patients was performed. Ten patients were less than 11 years of age, and boys were involved more often than girls. Ten patients had more than one injured tooth, but there was no case of alveolar fracture. Twenty-one of the teeth were upper central incisors. Only 11 teeth were seen within the first week, so that not all teeth were splinted and not all displaced teeth were repositioned. Long-term clinical and radiographic review showed that loss of vitality of the coronal pulp could not be reliably detected for at least 1 year. No tooth became abscessed or developed a sinus tract, and resorption of bone at the fracture line was observed in only one out of five non-vital teeth. Lack of displacement and placing of a splint increased the chances of the pulp remaining vital and healing of the fracture occurring with hard tissue. Sclerosis of the coronal pulp occurred mainly when healing was by connective tissue. The apical pulp always remained vital, and there was sclerosis of the apical pulp in almost every case.

Adolescent↗
PubMed1996

The use of a modelling technique to investigate the root canal morphology of mandibular incisors.

The prime objective of this study was to develop and test a method of modelling the dental root canal system using a vinyl resin, type UCAR-VYHD. It also aimed to verify if the resin models allow a three-dimensional evaluation of those features of the pulpal morphology of human permanent mandibular incisor teeth, which might be associated with periodontal disease. One hundred and eleven freshly extracted teeth were studied. Pre-extraction clinical records and periapical radiographs were used to deduce the presence or absence of periodontal disease. Each extracted tooth was radiographed in two perpendicular planes before being opened by conventional orthograde endodontic technique, and photographed in a scanning electron microscope. The patent pulp space was then obturated with the vinyl resin. Scanning electron photomicrographs of the resin replicas and of the teeth were compared with the earlier radiographic images to correlate the morphological findings. The numbers of root canals and apical foramina were recorded. This study showed that in mandibular incisors with periodontal disease there was a relatively low incidence of lateral canals (7.2%). The modelling technique was found to be reliable, reproducible, and provided sufficient detail to allow three-dimensional analysis of root canal morphology.

Adult↗
PubMed1975

Repair characteristics of root fractures in permanent anterior teeth.

A follow-up study was made of repaired root fractures in 51 permanent anterior teeth, with a mean observation period of 6 years. The material was subdivided into three repair types (Figs. 1-3): Type 1 - invisible or hardly discernible fracture line (15 teeth), Type 2 - fragments separated by a narrow radiolucent line and peripheral rounding of the fracture edges (33 teeth), and Type 3 - fragments separated by a distinct bony bridge (3 teeth). The majority of repaired teeth gave a normal or slightly decreased response to electric pulp tests and the mobility was physiologic or slightly increased. Reduced transparency or slight yellowish discoloration was observed in 14 teeth. The most conspicuous radiographic finding was pulp obliteration which occurred in 86%. Two different patterns were observed: (1) partial obliteration located in the apical fragments and the fracture area, and extending 0.5-4 mm into the coronal fragment, and (2) progressive obliteration of the entire pulp cavity ending with almost total obliteration. Pulp necrosis did not develop as a sequel to progressive obliteration in any case. Several different characteristics of the fracture influenced the repair pattern, the most important being the degree of fragment dislocation and mobility, stage of root development and localization of the fracture. Correlation between type of repair and various treatment procedures was observed only with regard to reduction.

Adolescent↗
PubMed1995

Replantation of 400 avulsed permanent incisors. 2. Factors related to pulpal healing.

Four hundred avulsed and replanted permanent teeth were examined for pulpal healing. In 110 teeth, the apical foramen was either open or half-open. In 16 teeth, the pulps were extirpated prophylactically. Thus, pulpal revascularization was considered possible in 94 teeth. Revascularization occurred in 32 teeth (34%). Pulp necrosis could usually be demonstrated after 3 weeks. Positive pulpal sensibility and radiographis signs of pulp canal obliteration were usually observed after 6 months. The effect of various clinical factors was examined, such as sex, age, type of tooth replanted, stage of root formation, type and length of extra-alveolar storage, clinical contamination of the root surface, type of cleansing procedure of the root surface, type and length of splinting and the use of antibiotics. Finally, the width of the apical foramen and the length of the root canal were measured on radiographs taken at the time of injury. A multivariate statistical analysis revealed that pulpal revascularization was more frequent in teeth with shorter distances from the apical foramen to the pulp horns. Furthermore, that wet storage (saliva and/or saline) for more than 5 min decreased the chance of pulpal revascularization; whereas dry extraalveolar storage had a monotonous effect on pulpal revascularization, i.e. decreasing chance of revasculatization with increasing length of the extraalveolar dry storage. Based on these findings, immediate replantation after brief cleansing in either tap water or saline is recommended.

Age Factors↗
PubMed1996

Prognosis of root-fractured permanent incisors.

The prognosis of 56 root-fractured permanent incisors was evaluated clinically and radiographically for 2 to 31 years. Information about initial case histories, examination and treatment of root-fractured teeth were recorded retrospectively from patient cards. Most of the root fractures occurred in the 16-20 year age group (38%) followed by the 11-15 year age group (29%). Males were involved more often than females. Fifty-two percent of the patients visited the dental clinic within the first week, while 48% did so 1 month-31 years later after the injury. The leading cause of root fractured injuries was falls (46%) and mostly involved one tooth (71%). Maxillary central incisors were the most often affected teeth (95%). The most common type of root fracture was in the middle third of the root (57%) followed by apical part (34%). About 59% of untreated or splinted teeth maintained their vitality. Healing with connective tissue was observed in 19 teeth, with calcified tissue in 15 teeth and with osseous tissue in only one tooth. There was partial or complete obliteration of the pulp space in these healed cases (62.5%). The formation of pulpal hard tissue produced no additional clinical problems. Partial or total pulp necrosis were noted in 21 (37.5%) teeth. Endodontic treatment was successful in 12 cases. The remaining 9 teeth were extracted due to the loss of marginal alveolar bone and apical periodontitis.

Adolescent↗
PubMed1998

Complicated crown fracture of an unerupted permanent tooth--a case report.

Trauma to primary teeth may result in direct damage to underlying developing permanent teeth because of the close relationship that exists between the apices of the primary teeth and their permanent successors. Injuries to developing teeth have been classified into ten different categories, using a classification that is largely based on developmental alterations to the permanent teeth. However, this classification does not include other types of trauma that may occur to developing teeth, such as crown fractures. Although apparently rare, such injuries can occur by direct contact of the impacting object with a developing tooth, as illustrated by the following case report.

Child, Preschool↗
PubMed1998

Tooth replantation in germ-free and conventional rats.

The purpose of the present study was to evaluate the influence of bacterial infection on the pulpal and periodontal tissues in replanted teeth using germ-free and conventional rats. Forty maxillary and mandibular first molars from ten 6-week-old germ-free male Wistar rats were used. The animals and all materials were maintained in a germ-free environment inside vinyl isolators throughout the experimental periods. Twenty conventional male Wistar rats served as controls. The first molars were intentionally replanted immediately after extraction. At 3 days, and 1, 2, 4 and 8 weeks after replantation, animals were sacrificed and the replanted teeth were histopathologically evaluated. Diversity of pulp tissue response was notable in conventional rats, which initially showed various degrees of neutrophil infiltration and then displayed different types of response, including revascularization with reparative dentin formation and complete necrosis. Pulpal responses of germ-free rats were less variable, being characterized by an almost complete lack of neutrophil infiltration and a high frequency of bone-like tissue ingrowth. Typical inflammatory resorption was detected only in conventional rats, whereas a higher incidence of ankylosis was notable in germ-free rats. The present results may corroborate the concept that bacterial infection is a major cause of serious healing complications following tooth replantation, such as pulp necrosis and inflammatory root resorption. The difficulty in optimally controlling bacterial infection seems to be highly relevant to the complexity and unpredictability of the outcome of this procedure. It should also be emphasized that extensive mechanical damage to the periodontal tissues may trigger the development of unfavorable healing complications as ankylosis, even under strictly aseptic conditions.

Animals↗
PubMed1998

A retrospective evaluation of patients with uncomplicated crown fractures and luxation injuries.

This paper is a review of the clinical findings from my thesis "Pulp survival and hard tissue formation subsequent to dental trauma". Traumatic injuries in children and adolescents are a common problem, and the prevalence of such injuries has increased over the last 10-20 years. The purpose of the present investigations was to evaluate the long-term results following uncomplicated crown fractures and luxations involving subsequent pulp canal obliteration. A total of 241 patients with 545 injured teeth were available for clinical examination, of whom 102 answered a questionnaire and were interviewed before oral examination. In addition, 82 permanent incisors presenting with pulp canal obliteration were followed for a period of 7 to 22 years (mean 16 years). The findings showed little pulpal response to crown fracture and subsequent restorative procedures as long as there was no concomitant periodontal injury (15-year follow-up). Approximately every fourth resin composite filling was rated as unacceptable at clinical examination. The interview showed that half of the individuals were dissatisfied with the color and/or anatomic form of the composite restoration. Pulp canal obliteration was found in all luxation categories, and 69% of the teeth demonstrated yellow crown discoloration. According to the survival curve the 20-year pulp survival rate diagnosed radiographically was 84%. Although the risk of pulp necrosis increased with time, routine endodontic intervention of teeth with ongoing pulp canal obliteration of the root canal did not seem justified.

Adolescent↗
PubMed1998

Pulpal injury: pathology, diagnosis and periodontal reactions.

Diagnosis of pulpal disease can be difficult due to the lack of diagnostic signs and symptoms available to the practitioner. An understanding of the possible underlying pathological processes, combined with an exact assessment of the pain history, and appropriate clinical tests, should aid the practitioner in determining the nature of pulpal inflammation, and differentiating it from dentine sensitivity and cracked teeth. The responses of the pulp to traumatic injury to the periodontal membrane (PDM) require special consideration, particularly with respect to the assessment of pulp vitality, and the determination of cases requiring pulp extirpation in order to avoid inflammatory root resorption. Although the pulp is relatively isolated from the rest of the dentoalveolar complex by a dentine/cementum barrier, it is important to remember that it can communicate with the PDM through apical and lateral foramina, and areas of damaged cementum. Hence, it is a priority to both preserve the integrity of the cemental layer in cases of traumatic injury and periodontal disease, and to prevent the inflammation and resorption associated with periapical lesions by accurate diagnosis of irreversible pulpitis and pulp necrosis, followed by appropriate endodontic debridement procedures.

Cracked Tooth Syndrome↗
PubMed1998

Trauma quiz. Terribly troublesome, trauma teeth.

Unfortunately, we come across many traumatised teeth during our practising career. Some of these traumatic injuries are rather simple to treat whereas others provide us with a real challenge. It is absolutely essential that the diagnosis of the injury be known before any treatment is attempted. When it comes to trauma, however, defining the exact form of treatment can often be very difficult. In this paper I will discuss some of the cases that I have managed and leave it up to YOU to decide whether my treatment has been correct, incorrect or whether there is some other form of treatment that we have at our disposal that could have been attempted.

Adolescent↗
PubMed2004

Combined endodontic and surgical treatment of a three-rooted maxillary first premolar.

A case is reported in which endodontic treatment of a maxillary first premolar was complicated by the fact that the tooth had three roots. One of the roots was completely calcified and therefore could not be negotiated with endodontic files. There was a large periapical lesion associated with the tooth and this was surgically removed. During the surgical procedure a retrograde cavity was prepared on the calcified root using ultrasonic instruments and this was filled using Super EBA cement. Twelve months later the tooth was asymptomatic and the periapical tissues had completely healed.

Aged↗
PubMed2001

Further observations on tertiary dentin in human deciduous teeth.

The structure of reparative tertiary dentin in human deciduous teeth has been studied. Reparative dentin is secreted by a new generation of odontoblast-like cells which have been subject to strong stimuli, e.g., trauma or deep active caries lesions with associated pulp inflammation. Ground sections of 25 teeth were prepared, and contact microradiographs were produced. Another 30 teeth were demineralized, embedded in paraffin, sectioned, and stained with hematoxylin and eosin. Some demineralized sections from each tooth were also studied in the scanning electron microscope. Most of the teeth showed some type of tertiary dentin formation. Mineralized tissue with a varied morphology was observed. In teeth which had been subject to trauma, the entire pulp chamber was sometimes obliterated. Mineralization seemed to start in the incisal region, and the central part of the pulp was the last part to be obliterated. Radiolucent voids and canals were seen. The organic matrix was dense and fibrous. In the pulp chamber and especially in the root canals, resorption had often occurred, indicating that signals giving rise to odontoclasts were also present. Resorption was often followed by deposition of various amounts of cementum-like repair tissue. The cells responsible for the formation of reparative dentin are believed to be subodontoblasts or undifferentiated ectomesenchymal cells. The varied morphology of the reparative dentin, observed in the pulp of the teeth examined, indicates that different stimuli lead to induction of hard-tissue-forming cells which produce different types of hard tissue.

Cementogenesis↗
PubMed1999

The orthodontic implications of traumatized upper incisor teeth.

With the demand for orthodontic treatment increasing, it is inevitable that the practitioner will see a significant number of patients with previously traumatized teeth who require orthodontic treatment. The possible risks and guidelines for the management of these teeth during active tooth movements are discussed. The use of orthodontic appliances in the management of incisors traumatized during active orthodontic treatment is also discussed.

Contraindications↗
PubMed2001

Endodontic status in older U.S. adults. Report of a survey.

BACKGROUND: Aging people experience a number of changes in the root canal systems of teeth that, while they are normal, have the potential to compromise the pulp's response to injury. METHODS: To better understand the dental perspective on these changes, the authors mailed a questionnaire to diplomates of the American Board of Endodontics. The questions dealt with the respondents' experiences, ages of their patient population and their perception of root canal changes in aging patients. The authors analyzed the data in terms of number of diplomates providing a response and stratified them on the basis of the respondents' number of years in practice. RESULTS: Respondents indicated that the number of patients aged 65 years and older in their practices is increasing. Virtually all of the diplomates agreed that the root canal gets smaller with age, but that this diminution does not contribute to the failure of treatment of affected teeth. Most respondents indicated that aging patients' teeth are in poorer condition than those of younger patients. CONCLUSIONS: As the U.S. population ages, clinicians need to have a better understanding of the physiological changes occurring in older patients' teeth that may influence the treatment required to help patients retain their natural dentition. Further studies are needed to determine the impact of aging on dental disease and treatment modalities. CLINICAL IMPLICATIONS: Recognition of changes in the dentition of aging patients will lead to more successful treatment, retention of functional natural dentition and better maintenance of general health.

Aged↗