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At least 577 records · Page 32Linked to original sources

PubMed2003

Retrospective long term monitoring of tooth wear using study models.

OBJECTIVE: Tooth wear is recognised as a common feature of European dentitions. However, little is known about its progression in susceptible patients. The aim of this study was to assess the degree and progression of tooth wear in patients by examining study casts taken of their teeth on two separate occasions. DESIGN: Over 500 sets of study casts taken during an 18-year period from patients referred for a variety of restorative procedures, were examined at Guy's Dental Hospital. Of these, 34 cases were found to have consecutive models taken at two time intervals and these were used to assess the progression of tooth wear. Study models from 19 females and 16 males, with an average age of 26 years (range 18-60) at the time of their first presentation and were all examined by a single operator. The Smith and Knight tooth wear index was used to assess the degree of tooth wear at presentation and then at another time which was a median of 26 months (interquartile range 14 - 50 months) later. RESULTS: The most common initial TWI score per surface was 1, with 54% of surfaces affected at the first assessment and 57% at the second. Score 2 was less common (14% at both assessments) and the scores for 3 and 4 combined were relatively uncommon with 5% of surfaces effected. Minimal progression of tooth wear was observed on study casts with only 7.3% of surfaces involved. CONCLUSION: In this sample, tooth wear was a slow, minimally progressive process.

Adolescent↗

PubMed2001

Array-projection geometry and depth discrimination with Tuned-Aperture Computed Tomography for assessing the relationship between tooth roots and the inferior alveolar canal.

OBJECTIVES: The purpose of this study is to compare Tuned-Aperture Computed Tomography (TACT) image sets made with linear vertical, linear horizontal, conical, and x-shaped x-ray projection arrays with regard to observer accuracy in (1) measuring the distance from the apex of a tooth root to the middle of the inferior alveolar canal (IAC), (2) measuring the shortest distance from the surface of a tooth root to the surface of the IAC, and (3) determining whether the root is buccal or lingual to the IAC. The same relationships were also examined by means of pairs of images and the buccal object rule. STUDY DESIGN: Two artificial mandible sections with simulated IACs were fabricated. The same human mandibular premolar root was used in both models to prevent development of learning cues to differentiate between models. The models were imaged from both sides, resulting in 4 orientations. An optical bench was designed to precisely orient different beam projection arrays for production of TACT image sets and pairs of images for use with the buccal object rule. Twelve dentists participated as observers to independently assess the relationships between the tooth root and the IAC with regard to the 4 orientations. RESULTS: For measuring the distance from the tooth apex to the middle of the IAC, TACT image sets made from conical and x-shaped arrays proved significantly more accurate than TACT image sets made from linear vertical or linear horizontal projections or pairs of digital images used with the buccal object rule (P <.05). For measuring the shortest distance between the tooth surface and the IAC surface, TACT image sets made from linear vertical, conical, and x-shaped projection arrays were significantly more accurate than measurements made through use of the buccal object rule or TACT image sets made through use of a linear horizontal projection array (P <.05). The following percentages of mistakes were made in determining whether the tooth root was buccal or lingual to the IAC: buccal object rule (58%), linear horizontal array (31%), linear vertical array (2%), conical array (0%), and x-shaped array (0%). CONCLUSIONS: For TACT, images acquired with conical and x-shaped beam projection arrays are preferred to those acquired with linear arrays for assessing the relationship between tooth roots and the IAC. TACT was found to be significantly more accurate than standard application of the buccal object rule for the relationships investigated.

Alveolar Process↗

PubMed2006

Gender differences in tooth loss among Chilean adolescents: socio-economic and behavioral correlates.

OBJECTIVE: To investigate gender differences in tooth loss among Chilean adolescents and its association with selected socio-economic indicators and oral-health-related behaviors. MATERIAL AND METHODS: Data on 9,163 Chilean adolescents obtained using multistage random cluster procedures. Clinical recordings included information on missing teeth and the participants provided information on socio-demographic factors and oral-related behaviors. Two eruption-time-adjusted logistic regression analyses were used to investigate the associations between gender, tooth loss and socio-economic position/oral-health-related behaviors. RESULTS: The association between gender and tooth loss remained after adjusting for age, eruption times in both the socio-economic position regression model and the oral-health-related behaviors model. Tooth loss followed social gradients for the variables paternal income and achieved parental education, with students reporting a paternal income < 100,000 US dollars (OR = 2.0), and having a father (OR = 1.8) and a mother (OR = 2.0) who achieved only primary school education being more likely to experience tooth loss. The adjusted regression model for behavioral indicators revealed that students who reported brushing their teeth once a day (OR = 1.6) were more likely to have experienced tooth loss than those who reported more frequent toothbrushing. Students who visited a dentist rarely (OR = 0.8) or never (OR = 0.5) were less likely to have lost first molars and/or incisors. CONCLUSIONS: The results demonstrate that gender differences in tooth loss among young Chileans are related to socio-economic position; and selected oral-health-related behaviors after adjusting for eruption time variation.

Adolescent↗

PubMed1997

A study on factors associated with pathologic tooth migration.

The purpose of this cross-sectional epidemiological study was to determine the prevalence of pathologic tooth migration (PTM) among periodontal patients and to investigate the relationship and degree of association between PTM and the following factors: bone loss, tooth loss, gingival inflammation according to the gingival index, age, lingual interposition, parafunctions and oral habits. 852 periodontal patients (36.7% male, 63.3% female) whose ages ranged from 19 to 72 years (mean 42.5 +/- 9.9) were studied. PTM was defined as the presence of a developing diastema in the upper anterior sextant, which was not present in the past or already existed but increased. Statistical analysis was performed using the Wald test and the Mantel-Haenszel test. Estimates odds ratio were also calculated to assess increased PTM probability as a function of a single variable, or a combination of several. PTM prevalence of 55.8% was found, and it was statistically associated with bone loss (p<0.001), tooth loss (p<0.001) and gingival inflammation (p<0.001), while no association was observed with the remaining variables. The odds ratio indicated that PTM probability increased between 2.95 to 7.97 times as bone loss increased. For tooth loss this probability increased 2.76 times when no tooth loss was compared to 4 or more teeth lost. Likewise the probability increased 2.23 times when the gingival index was above 2. According to the single effect as well as the combined effect of these 3 main factors, it was concluded that: (1) no single factor by itself is clearly associated with PTM: (2) the factor mainly related to PTM is bone loss, followed by tooth loss and gingival inflammation: (3) as bone loss increases, the association of additional factors with PTM, such as tooth loss and gingival inflammation, increases.

Adult↗

PubMed1990

Cracked tooth syndrome: diagnosis, treatment and correlation between symptoms and post-extraction findings.

Although the cracked tooth syndrome has been known for over twenty years, it frequently remains undiagnosed because the condition is not sufficiently well recognized. Cracked tooth syndrome has been defined as an incomplete fracture of the dentine in a vital posterior tooth, and must be distinguished from a split tooth. A diagnosis can often be made by means of the history, and must be confirmed by reproducing the patient's symptoms. The ideal treatment consists of applying a stainless steel band to the tooth, with cessation of symptoms confirming the diagnosis, followed by a full coverage restoration. Case histories illustrating the syndrome are presented, and a further case is reported where a diagnosis of cracked tooth syndrome was made, and the tooth extracted, sectioned and stained to show the nature of the cracks and their relationship to the pulp.

Adult↗

PubMed1997

Localization of nerve cells in the developing rat tooth.

Earlier studies have shown that mammalian tooth formation can take place in the absence of peripheral nerve fibers. This has been taken to indicate that neurons are not needed for mammalian tooth development. However, our recent localization of peripherin, which is a neuronal cell marker, has suggested that neuronal cell bodies may be associated with developing teeth. In this study, we have analyzed in vivo and in vitro the presence of neuronal cells in developing rat tooth germs. When E14 and E16 rat first molars (thickening of presumptive dental epithelium and bud-stage tooth germ, respectively) were cultured in vitro, peripheral trigeminal axons degenerated. However, with antibodies against peripherin and L1 neural cell adhesion protein, we detected neuronal cell bodies and their axons in the explants. Next, the expression of neurofilament light-chain (NF-L) mRNAs was studied by in situ hybridization of embryonic E12 first branchial arches and tooth germs from initiation to completion of crown morphogenesis (E13, five-day post-natal teeth). NF-L transcripts were first seen at the bud stage (E15) next to the dental epithelium at the buccal side of the tooth germ. At the cap stage (E18), NF-L mRNAs were located under the oral epithelium at some distance from dental epithelium. These expression patterns correlate to the previous localization of peripherin-positive cells and suggest that NF-L expression also revealed neuronal cells. Taken together, these results demonstrate that, in addition to projections of peripheral neurons, neuronal cells are associated with the developing teeth. Hence, it is possible that neuronal cells may participate in the regulation of mammalian tooth formation.

Animals↗

PubMed2005

Tooth avulsion in the school setting.

Tooth avulsions occur when a tooth is displaced from its socket. Tooth avulsions are common dental injuries that may occur before, during, or after school. Therefore, it is essential that school nurses be well prepared to intervene when such a dental emergency arises. It is also imperative that school nurses and school personnel are fully equipped to manage a tooth avulsion. Time is of the essence when attempting to save an avulsed tooth. The goal is to successfully reinsert the avulsed tooth and to preserve the periodontal ligament. The school nurse is responsible for implementing the appropriate actions needed to save the avulsed tooth.

Adolescent↗

PubMed1991

[In vitro effect of chlorpromazine on the mineralization of tooth germ in mice--comparison with that of retinoic acid and HEBP].

Effects of chlorpromazine on the mineralization and alkaline phosphatase activity (ALP) in the tooth germ were examined and compared with those of retinoic acid and HEBP (1-hydroxyethylidene-1, 1-bisphosphonate). Mandibular first molars from 17-day-old mouse embryos were cultured with or without drugs. Calcium content and ALP in the tooth germ increased gradually from 0 to 7 days in culture, the increase of calcium being preceded by that of ALP. Retinoic acid suppressed increases of calcium and ALP in the tooth germ but not in the specimens precultured for 2 days, suggesting that retinoic acid inhibits the mineralization at an early developmental stage of the tooth. HEBP, a physiochemical inhibitor of mineralization, suppressed the increase of calcium, but significantly enhanced the increased of ALP in the tooth germ. Chlorpromazine, which has an antagonistic action towards calmodulin, also suppressed the increases of calcium and ALP in the tooth germ. Calmodulin antagonists W-7 and W-5 similarly suppressed the increases of calcium and ALP; W-5 had less effects on both calcium and ALP. These results indicate that calmodulin may be involved in the regulation of the mineralization in the tooth germ. These drugs are shown to possess different modes of inhibitory action on the mineralization.

Alkaline Phosphatase↗

PubMed2004

Two related low molecular mass polypeptide isoforms of amelogenin have distinct activities in mouse tooth germ differentiation in vitro.

UNLABELLED: Embryonic mouse tooth germs were cultured in vitro in the presence of two related amelogenin isoforms to determine their effects on tooth development. Our results show that these individual proteins have specific but quite different effects on epithelial-derived ameloblasts versus mesenchymal-derived odontoblasts. INTRODUCTION: Amelogenins, the main protein components of enamel matrix, have been shown to have signaling activity. Amelogenin isoforms differing only by the presence or exclusion of exon 4, designated [A+4] (composed of exons 2, 3, 4, 5, 6d, and 7) and [A-4] (composed of exons 2, 3, 5, 6d, and 7), showed similar, but different, effects both in vitro and in vivo on postnatal teeth. MATERIALS AND METHODS: Lower first molar tooth germs of E15/16 CD1 mice were microdissected and cultured in vitro in a semisolid media containing either 20% FBS, 2% FBS, or 2% FBS with either 1.5 nM [A+4], [A-4], or both for 6 days. Tooth germs were analyzed by H&E staining and immunohistochemistry for collagen I, dentin matrix protein 2, and DAPI nuclear staining. RESULTS: Teeth cultured in media containing 20% FBS showed normal development with polarized ameloblasts, and odontoblasts producing dentin matrix, and DMP2 expression in odontoblasts and pre-ameloblasts. Culture in 2% FBS media resulted in no ameloblast polarization and modest odontoblast differentiation with scant dentin matrix. Tooth germs cultured with [A+4] in 2% FBS media had well-polarized odontoblasts with robust dentin production and concomitant ameloblast polarization. DMP2 expression was equal to or greater than seen in the 20% FBS culture condition. In cultures with [A-4] in 2% FBS media, odontoblast polarization and dentin production was reduced compared with [A+4]. However, the pre-ameloblast layer was disorganized, with no ameloblast polarization occurring along the dentin surface. DMP2 expression was reduced in the odontoblasts compared with the 20% FBS and [A+4] conditions and was almost completely abrogated in the pre-ameloblasts. CONCLUSION: These data show different signaling activities of these closely related amelogenin isoforms on tooth development. Here we make the novel observation that [A-4] has an inhibitory effect on ameloblast development, whereas [A+4] strongly stimulates odontoblast development. We show for the first time that specific amelogenin isoforms have effects on embryonic tooth development in vitro and also hypothesize that DMP2 may play a role in the terminal differentiation of both ameloblasts and odontoblasts.

Amelogenin↗

PubMed1996

Dental caries and tooth loss in adolescents with early-onset periodontitis.

The aim of this study was to assess the caries experience and tooth loss over 6 years in subjects with early-onset periodontitis as compared to their matched controls, and to describe the characteristics of teeth lost during this period. A multi-stage probability sample representing 8th to 12th grade U.S. schoolchildren were screened during the 1986/1987 school year to identify subjects with early-onset periodontitis (cases). The examination included measuring the clinical attachment level, presence of caries and dental restorations, and tooth loss. A random sample of controls without early-onset periodontitis were selected for a follow-up examination and were matched to cases on gender, race, age, and geographic location. A total of 266 subjects, with a mean age of 16 years at baseline, were examined during the 1992/1993 school year and were classified into localized (LJP) and generalized juvenile periodontitis (GJP), incidental attachment loss (IAL), and control groups. Whites had more caries experience than Blacks and Hispanics, but there were no significant differences in tooth loss between the ethnic groups. The LJP and the IAL groups, respectively, had higher and lower overall caries experience than the control group. The LJP group had a significantly higher number of missing teeth at follow-up, and exhibited more extensive tooth mortality during 6 years than the control group. The GJP group also showed more tooth loss than the control group, but the difference was not statistically significant. In the LJP, GJP, IAL, and control groups, respectively, 43%, 32%, 26%, and 18% of the subjects lost teeth over 6 years due to disease. The findings showed differences in caries activity between the early-onset periodontitis groups and a variation by race. The findings suggest that loss of periodontal support was the principal cause for tooth loss in the LJP and GJP groups, and that dental caries was the principal cause for tooth extraction in the IAL and the control groups.

Adolescent↗

PubMed2000

Non-surgical periodontal therapy and tooth loss. A cohort study.

BACKGROUND: No reliable evidence is available regarding the effect of periodontal therapy on major disease endpoints such as tooth loss, edentulism, or quality of life. The primary objective of this study was to assess the association between tooth loss and the non-surgical periodontal treatment history of 1,021 members of the Kaiser Permanente Dental Care Program. METHODS: Tooth loss rates were estimated using Poisson regression models, adjusting for some of the potentially confounding variables such as initial disease severity and extent. RESULTS: Continuous non-surgical therapy (one or more non-surgical procedures performed during 3 successive years), as opposed to no therapy during such a 3-year period, reduced the subsequent tooth mortality rate by 58% (relative rate, 0.42; 95% confidence interval, 0.29-0.61). Intermittent non-surgical therapy reduced the tooth mortality rate by 48% (RR = 0.52; 95% confidence interval, 0.34-0.80). As the number of non-surgical procedures increased, tooth loss rates decreased. CONCLUSIONS: These findings suggest that non-surgical periodontal therapy may be associated with a substantial reduction in tooth mortality. Different study designs and populations are needed to confirm these findings.

Adult↗

PubMed2005

Relative contribution of patient-, tooth-, and site-associated variability on the clinical outcomes of subgingival debridement. I. Probing depths.

BACKGROUND: The objective of this clinical trial was to assess the relative contribution of patient-, tooth-, and site-associated variables on changes in probing depths (PD) following delivery of a standard non-surgical phase of periodontal therapy. METHODS: Ninety-four (94) systemically healthy subjects with severe generalized periodontitis were included in this 6-month prospective longitudinal study. Medical, periodontal, and microbiological parameters were collected at baseline and 2 and 6 months after completion of oral hygiene instructions, motivation, and subgingival debridement using a piezoelectric instrument. The relative contribution of patient-, tooth-, and site-associated variables was evaluated with a hierarchical multilevel analysis. RESULTS: Eighty percent (80%) of variability in PD reductions was attributed to site level parameters, while 12% was at the tooth level and 8% at the patient level. The multilevel analysis associated PD reductions with patient factors (cigarette smoking status and carriage of the rare allele of a specific polymorphism for the interleukin-6 [IL-6] gene), tooth factors (tooth mobility and tooth type), and site factors (mesial and distal location). Cigarette smoking and carriage of the rare allele of the IL- 6-174 G/C polymorphism were associated with less PD reduction. Incisors and canines responded better than premolars and molars. A dose-dependent effect of mobility was observed: teeth with higher baseline mobility resulted in significantly greater decreases in PD. At the site level, greater reductions were observed at interdental sites (compared to facial or oral), and at deeper sites (1.2 mm for 4 to 5 mm pockets and 2.4 mm for pockets > or =6 mm). CONCLUSION: These data provided an estimation of the relative contribution of site-, tooth-, and patient-associated variables in terms of PD reductions following a standard course of machine-driven subgingival debridement.

Cytosine↗

PubMed1999

A six-week clinical efficacy study of a new dentifrice for the removal of extrinsic tooth stain.

The objective of this double-blind clinical study was to investigate the tooth whitening efficacy of a new dentifrice (Colgate Tartar Control Plus Whitening Fluoride Toothpaste) for the removal of extrinsic tooth stain, through a comparison with two commercially available dentifrices, Aquafresh Whitening Toothpaste with Fluoride, and Crest Regular Fluoride Toothpaste. Following a baseline examination for extrinsic tooth stain area and intensity, qualifying adult male and female subjects from the Mississauga, Ontario, Canada area were randomized into three treatment groups which were balanced for age, gender, and level of extrinsic tooth stain. Subjects were instructed to brush their teeth twice daily (morning and evening) for one minute with their assigned dentifrice using a soft-bristled toothbrush. Examinations for extrinsic tooth stain were repeated after six weeks' use of the study dentifrices. One hundred twenty-two (122) subjects complied with the protocol and completed the entire study. At the six-week examination, subjects assigned to the Colgate Tartar Control Plus Whitening treatment group and subjects assigned to the Aquafresh Whitening treatment group exhibited statistically lower levels (p < 0.0001) of extrinsic tooth stain area and intensity than did those subjects assigned to the Crest Regular Fluoride treatment group. Further, subjects assigned to the Colgate Tartar Control Plus Whitening treatment group exhibited significantly lower levels of extrinsic tooth stain area and intensity than did those assigned to the Aquafresh Whitening treatment group (p < 0.0001).

Adolescent↗

PubMed2005

The art and science of tooth whitening.

Although tooth whitening is one of the most popular dental procedures, it is also one of the least understood. We are still unclear as to its mechanism of action. There is little data as to the effects of both concentration and dose on outcome. The techniques for measuring color change have been brought into question. The cause(s) of sensitivity and the effects of long-term exposure to hydrogen peroxide are not clear. The issue of rebound in color has not been well examined, and issues related to maintenance of the whitening effect are also poorly understood. The immediate placement of composite resin on bleached teeth has been controversial. According to a study evaluating the shear bond strength of composite restorations placed on bleached and nonbleached teeth, there was no statistically significant difference when the composites were placed at 24 hours, 48 hours, four days, or six days. A different study, which evaluated the effects of take-home bleaching systems on enamel surfaces, suggests that a period of four days must elapse before bonding to a tooth bleached with a peroxide material, while no delay is necessary for a non-peroxide-based bleaching system. Most recently, there has been a push to find ways to accelerate and improve the delivery of the whitening process. These include the application of a number of different light sources believed to accelerate the breakdown of peroxide and thus speed up the whitening process. However, the research in this area has been controversial, with publications having quite different conclusions as to the efficacy of light-activated bleaching. Finally, the issues of adverse events and possible side effects were reviewed. The toxicological side effects of tooth bleaching systems seem to be minimal. However, tooth sensitivity can be quite significant. Although its causes are poorly understood, tooth sensitivity is most often seen as the result of tooth dehydration. So while patient demand for tooth whitening is at an all-time high, and dentists have more options for treatment, it's important that dentists evaluate which of these options is most ideal for their patients, factoring in the patients' cost and time issues, as well as sensitivity to the procedure.

Color↗

PubMed2006

Effects of hydrogen peroxide bleaching strips on tooth surface color, surface microhardness, surface and subsurface ultrastructure, and microchemical (Raman spectroscopic) composition.

OBJECTIVE: This study examined the effects of hydrogen peroxide tooth bleaching strips on the surface hardness and morphology of enamel and the ultrastructure and chemical composition of enamel and dentin in vitro. METHODOLOGY: Sound human molars were ground and polished to prepare a uniform substrate for bleaching treatments. A cycling treatment methodology was employed which alternated ex vivo human salivary exposures with bleaching treatments under conditions of controlled temperature and durations of treatment. Bleaching treatments included commercial Crest Whitestrips bleaching strips, which utilize hydrogen peroxide in a gel as the in situ bleaching source at 6.0 and 6.5% concentrations of H2O2. Control treatments included an untreated group. Crest Whitestrips bleaching included treatment exposures simulating 2x the recommended clinical exposures (28 hours bleaching). Surface color measurements were taken prior to and following bleaching to ensure tooth bleaching activity. The effects of bleach on physical properties of enamel were assessed with microhardness measures. Ultrastructural effects were classified by surface and subsurface confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) techniques. In addition, the effects of bleaching on tooth microchemical composition was studied in different tooth regions by coincident assessment of Raman spectroscopic signature. RESULTS: Color assessments confirmed significant ex vivo tooth bleaching by Whitestrips. Surface microhardness and SEM measures revealed no deleterious effects on the enamel surfaces. CLSM micromorphological assessments supported the safety of hydrogen peroxide bleaching strips both on surface and subsurface enamel, DEJ, and dentin ultrastructure. Raman spectroscopy analysis demonstrated no obvious effects of bleaching treatments on the microchemical composition of enamel and dentin. CONCLUSION: These results confirm that tooth bleaching with hydrogen peroxide whitening strips does not produce changes in surface/subsurface histomorphology or in surface microhardness and ultrastructure of treated teeth. In addition, for the first time, these results confirm the safety of hydrogen peroxide bleaching strips to tooth microchemical composition as measured by Raman spectroscopy.

Dental Enamel↗

PubMed1997

Single-tooth implant-supported restorations in the anterior maxilla.

With the development of advanced surgical techniques, implants can now be utilized in a variety of applications, including replacement of a single tooth. The form of an artificial restoration is determined by the existing tooth morphology and periodontal architecture; when placing single-tooth implants, the original structure of the tooth and periodontium must be recreated. Osseointegrated single-tooth implants have a success rate that is comparable to that of implant-supported prostheses in totally edentulous patients; a 98.5% success rate has been reported following 3 years in situ. The learning objective of this article is to gain an understanding of pretreatment guidelines, such as soft tissue considerations, bone dimension, root morphology, and site preparation with osteotomes for single-tooth implant placement. The review also includes the discussion of the placement of single-tooth implants, flap design, prosthetic considerations, and the final restoration. Two case reports are presented to document and illustrate the clinical procedure.

Adult↗

PubMed2006

Radiographic evaluation of the fate of developing tooth buds on the fracture line of mandibular fractures.

PURPOSE: The goal was to suggest guidelines for the treatment of developing tooth buds located on the fracture line of mandibular fractures. PATIENTS AND METHODS: The long-term radiographic follow-up records of 28 patients with mandibular fractures involving 66 tooth buds were examined for the occurrence of abnormalities in development or eruption. The fates of the involved teeth were compared according to the fracture conditions and other factors, and the cause of the abnormalities was surveyed. RESULTS: Abnormal findings were observed in 30 of 66 developing teeth (45%); these included deficient root formation, abnormal bend of the root, nodule formation on the root, partial obliteration of the pulp cavity, impaction, growth arrest, and external resorption. No relationship was found between the presence of abnormalities and the condition of the fracture or the developmental stage of the tooth buds. However, infection, rotation of the tooth bud, and a surgical wire passing through the follicular space were associated with arrested growth and impaction. CONCLUSIONS: The tooth buds present on the fracture line should be preserved except in cases of infection, and careful attention should be paid to avoiding further injury to the tooth bud and the soft tissues of the follicle at the time of surgery.

Adolescent↗

PubMed2005

Results after replantation of avulsed permanent teeth. III. Tooth loss and survival analysis.

Avulsed permanent teeth were replanted following immediate extraoral endodontic treatment by insertion of posts from a retrograde direction. Some teeth were rescued in a physiologic environment (tissue culture medium contained in a tooth rescue box), and in some cases antiresorptive-regenerative therapy (ART) was used. The aim of the study was to identify variables that influence the incidence of tooth loss and the survival of avulsed and replanted permanent incisors. Twenty-eight permanent teeth in 24 patients aged 7-17 years were investigated. In all teeth extraoral endodontic treatment by retrograde insertion of posts was performed. All nine teeth with functional healing (FH) were in situ. Of the 19 teeth with non-FH, seven were removed to allow transplantations. Two teeth were removed due to severe infrapositions. One tooth was lost following a new trauma. No tooth was lost due to acute infections. In descriptive statistics the incidence of tooth loss was significantly related to healing (P = 0.0098, Fisher's exact test), to treatment planning, i.e. consecutive replantation of premolars and primary canines (P = 0.0001, Fisher's exact test) and to immediate physiologic rescue (P = 0.0394). ART was related to tooth loss when tested in teeth with a compromised periodontal ligament (P = 0.0389). No influence could be found for the parameters maturity, age and all other factors. In a regression analysis treatment planning was the only factor left which had a significant influence (P = 0.0002). The estimated mean survival time (Kaplan-Meier analysis) for all teeth was 57.3 months. The survival was significantly reduced (P = 0.0002, log rank test) when consecutive transplantations were intended and performed. No influence could be found for maturity, age and all other factors. The different findings to previous studies can be explained by the prevention of complications related to conventional endodontic treatment approaches. Statistics have to be carefully interpreted due to case preselection which is determined by the treatment guidelines and actual treatment options of the individual treating dentist.

Adolescent↗