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[Desmodont remains after tooth extraction in digital image processing].

Breakage of the dentoalveolar gomphosis during tooth extraction results in varying amounts of desmodont remaining at the surface of the root. By dying the remnants of desmodont with toluidine blue, the surface of the root can be made accessible to computerized optical analysis. After clinically induced extraction of 102 human teeth, and after the loosening of 24 sheep teeth by mechanical vibration, the remaining area of desmodont was compared to that of the entire surface. Except in one case, no parameters were found to influence the amount of desmodont. However, tooth extraction in sheep previously treated with ultrasound or low-frequency vibrations demonstrate more desmodont-free areas.

Animals↗

[Periodontal ligament anaesthesia in tooth extraction].

The article deals with the application of periodontal ligament anesthesia (PA) in mandibular tooth extraction. The aim of the study was to examine the efficiency of PA; to assess the pain during the application of PA and tooth extraction; and to compare PA with mandibular anaesthesia using the same criteria for assessment. The frequency of PA was 66%. No significant differences were observed between the assessment of pain during PA and mandibular anaesthesia. However, about 96% of patients agreed with PA in next tooth extraction. There was no complication of PA during the study. Therefore, there is no substantial contraindication for PA in oral surgery.

Adolescent↗

Differences in total tooth extraction between an urban and a rural area in the Netherlands.

Differences in total tooth loss between an urban and a rural area (dentist-patient ratio 1:2500 and 1:5700 respectively) have been studied. Patients who participated in this study were those who received total tooth extraction during the calendar yr 1982 (urban area) and 1983 (rural area). The overall dentist response was 90%, the combined patient response was 75%. During the year, in the urban area 137 cases of total tooth extraction were recorded; in the rural area this was 237. This frequency is equivalent to 109 and 226 total tooth extractions per 100,000 inhabitants, respectively. The age and sex distribution of the urban and rural population could not account for this difference. The rural population had a lower educational level and more people insured in a State Health Scheme, which is related to income. The frequency of symptomatic attenders was highest in the rural area among those who were insured in a State Health Scheme. It is concluded that differences in numbers of total extractions between the rural and urban areas cannot be explained entirely by differences in population characteristics.

Adult↗

Placement of endosseous implants into tooth extraction sites.

This study reports 4-year experiences with placement of hydroxylapatite-coated dental implants into extraction sites immediately after tooth extraction. Small defects present after implant placement were treated with dense, nonresorbable hydroxylapatite. Larger defects present after implant placement were treated with demineralized bone. Indications and contraindications for placement, as well as surgical techniques, are discussed.

Bone Resorption↗

The effect of alendronate on resorption of the alveolar bone following tooth extraction.

Maintenance of alveolar bone width and height following tooth loss is essential with regard to the restoration of missing teeth with endosseous dental implants or prosthodontics approaches. A various amount of alveolar ridge resorption is likely to occur after tooth extraction at the buccal and lingual alveolar bone plates. Bisphosphonates, alendronate, is well known for its potent inhibition of osteoclast-mediated bone resorption. The objective of this study was to examine the inhibitory effect of alendronate on alveolar bone resorption following tooth extraction in rats. Male Wistar Albino rats were divided into three groups: baseline group, saline-treated group and alendronate-treated group. The saline-treated group was administered with daily saline solution for 2 and 4 weeks respectively while the alendronate-treated group was given a daily amount of 0.25 mg/kg alendronate subcutaneously for the same periods. The level of urinary calcium, creatinine, and serum calcium, alkaline phosphatase and phosphate were measured. Serum alkaline phosphatase level was measured as a marker of osteoblastic activity. Histopathological sections of 4 microm thickness were obtained from the right first mandibular molar region in a bucco-lingual direction. The number of osteoclasts, osteoblasts, and haversian canals, the number and size of resorptive lacunae, and osteoid formation were evaluated histopathologically. The mean thickness of buccal and lingual alveolar bone was measured. In the alendronate-treated group, both buccal and lingual alveolar bone volume reduction was significantly less than the saline treated group. Significant reduction in serum and urinary calcium levels and the number of osteoclasts revealed the pronounced suppression of bone resorption in the alendronate-treated group.

Alendronate↗

Sympathetic activity-mediated neuropathic facial pain following simple tooth extraction: a case report.

This is a report of a case of sympathetic activity-mediated neuropathic facial pain induced by a traumatic trigeminal nerve injury and by varicella zoster virus infection, following a simple tooth extraction. The patient had undergone extraction of the right lower third molar at a local dental clinic, and soon after the tooth extraction, she became aware of spontaneous pain in the right ear, right temporal region, and in the tooth socket. At our initial examination 30 days after the tooth extraction, the healing of the tooth socket was normal; however, the patient had a tingling and burning sensation (dysesthesia) and spontaneous pain of the right lower lip and the right temporal region, both of which were exacerbated by non-noxious stimuli (allodynia). The patient also showed paralysis of the marginal mandibular branch of the facial nerve, taste dysfunction, and increased varicella zoster serum titers. A diagnostic stellate ganglion block (SGB) 45 days after the tooth extraction using one percent lidocaine markedly alleviated the dysesthesia and allodynia. These symptoms are characteristic of neuropathic pain with sympathetic interaction. The patient was successfully treated with SGB and a tricyclic antidepressant.

Aged↗

Impact of recombinant human bone morphogenetic protein-2 on residual ridge resorption after tooth extraction: an experimental study in the rat.

Residual ridge resorption begins following tooth extraction and continuously reduces alveolar bone volume, potentially creating a significant problem in dental implant treatment. In this study, the role of recombinant human bone morphogenetic protein-2 (rhBMP-2) in residual ridge resorption after tooth extraction was investigated. A polylactic acid/polyglycolic acid copolymer-coated gelatin sponge carrier was implanted with or without rhBMP-2 (1 microg) in the mesial root sockets after removal of maxillary first molars in male Wistar rats. Fine structural and histomorphologic analyses were conducted 3 to 84 days after implantation. Direct bone formation was first observed after 5 days on the rhBMP-2 side, which was transformed into cortical alveolar ridge with a smooth periosteal layer by 84 days, whereas the control side displayed slower healing. Bone histomorphometry revealed greater total bone area and increased bone height after 14, 28, 56, and 84 days on the rhBMP-2 side compared to the control side, and differences were significant after 14, 28, and 56 days. Larger numbers of proliferating cells and densely populated differentiating mesenchymal cells were observed on the rhBMP-2 side than on the control side in the early stage, and chondrogenesis was not observed. The findings indicate that rhBMP-2 may stimulate proliferation and differentiation of mesenchymal cells in the rat maxillary root socket to preserve cortical bone volume in the socket without any evidence of chondrogenesis.

Alveolar Process↗

Reasons for permanent tooth extraction in the North of Afghanistan.

OBJECTIVES: The aim of this study was to study the pattern of and reasons for permanent tooth extraction in a group of Afghan patients attending a dental clinic in the North of Afghanistan. METHODS: A simple clinical survey was done in Afghan population sample that has undergone or planned for tooth extraction. RESULTS: A total of 184 permanent teeth were extracted from 123 patients ranging in age from 9 to 62 years during the three-month study period. Males were 54.5% while females formed 45.5%. Overall, caries was the most frequent reason for tooth extraction (59.2%), followed by periodontal disease (35.3%), surgical indications (4.9%) and patient request (0.5%). Caries was the main reason for tooth loss up to 50 years of age. However, periodontal disease became the principal reason in 51 years old and over. Posterior teeth represented the highest percentage (84.2%) of extraction. CONCLUSIONS: Both caries and periodontal disease were the main reasons for tooth extraction in the North of Afghanistan, so that proper oral health system including efficient programs focusing on prevention and treatment of these diseases should be created and developed.

Adolescent↗

The normative need for tooth extractions in older adults in Ontario, Canada.

OBJECTIVE: To determine the reasons for clinically defined need for tooth extractions were examined. DESIGN: Descriptive survey; interview and clinical data. SETTING: The City of North York, Canada. SUBJECTS: 1,531 dentate adults aged 65 and over, 69% being nursing home residents. MEASUREMENTS: Age, sex, type of residence and dental attendance pattern. OUTCOME MEASURE: Normative need for tooth extraction. RESULTS: One or more extractions were required by 38% of nursing home residents and 21% of independently-living subjects. The mean number of teeth indicated for extraction were 1.4 and 0.6, respectively. Among nursing home residents, caries was more often the reason for extraction for almost all tooth types, but for independently-living subjects periodontal reasons were more common. Overall, a significantly higher proportion of nursing home residents needed extractions due to both caries and periodontal reasons (25% and 16%) compared to subjects who lived independently (10% and 11%). For nursing home residents in all age groups, more subjects required caries-related extractions, but for independently-living subjects about equal proportions required extractions due to caries and periodontal diseases. Although the percentage of subjects requiring extraction due to caries varied significantly by age and residence type, the percentage needing extractions due to periodontal diseases showed slight variation and remained under 20%. CONCLUSION: This study indicates that among high risk groups of older adults caries continues to be the major reason for tooth extraction. However, problems with sampling limit the external validity of these results.

Adult↗

Healing of tooth extraction sockets in experimental diabetes mellitus.

PURPOSE: This study was undertaken to examine the healing of molar tooth extraction sockets in the streptozotocin-treated, diabetic rat. MATERIALS AND METHODS: Insulin-dependent diabetes mellitus was induced in a group of mature Sprague-Dawley rats by injecting streptozotocin. Control animals were injected with citrate buffer only. A third group of rats were also injected with streptozotocin, but the diabetes was controlled by daily injections of insulin. After 2 weeks, all of the rats underwent extraction of the right maxillary molar teeth under general anesthesia. The rats were killed at varying intervals and the maxilla and calvaria recovered in continuity. Tissue sections were stained with hematoxylin-eosin and periodic acid-Schiff (PAS), the latter to identify diabetic microangiopathy. RESULTS: At 10 days after tooth extraction in the control and insulin-streptozotocin-treated rats, thick collagen fibers formed a pretrabecular scaffold that dictated the direction of the forming trabeculae. The collagen fibers in the diabetic socket were thin and scanty, and formed a narrow layer in the apical part. There was no evidence of diabetic microangiopathy in the extraction sockets of diabetic, insulin-treated diabetic, or normal rats. CONCLUSION: These histologic observations suggest that in uncontrolled, insulin-dependent diabetes, the formation of the collagenous framework in the tooth extraction socket is inhibited, resulting in delayed healing and increased alveolar destruction.

Alveolar Bone Loss↗

Time-dependent changes of collagen crosslinks in the socket after tooth extraction in rabbits.

Time-dependent changes of the reducible collagen crosslinks in the healing tissue of rabbit tooth extraction wounds were analyzed chromatographically. The ratio of dihydroxylysinonorleucine to hydroxylysinonorleucine in the collagen from normal alveolar bone was 4.4. This value increased about four times, on the 10th day after tooth extraction, coinciding with the phase of active woven bone formation, and then decreased rapidly toward a normal value on the 14th day after tooth extraction. The data suggest that active biosynthesis and fibrillogenesis of bone collagen precede the morphological completion of lamellar bone formation.

Alveolar Process↗

Sinus floor augmentation through a rotated palatal flap at the time of tooth extraction.

Rapid crestal bone resorption following maxillary tooth loss is further accentuated in the posterior regions because of pneumatization and enlargement of the maxillary sinuses. A treatment rationale that allows preservation and/or augmentation of vertical available bone at the time of posterior maxillary tooth extraction may offer numerous therapeutic benefits. The present study comprised 14 patients in whom 18 posterior maxillary teeth with no evident bone between the tooth apex and sinus floor, as estimated through preoperative radiographic analysis, were carefully extracted using a palatal approach. The empty alveolus was thoroughly debrided and incrementally filled with tricalcium phosphate. The graft material was gently pushed beyond the empty alveolus to elevate the sinus membrane using an osteotome. Primary soft tissue closure over the grafted sites was achieved by a rotated palatal flap. The distance between bone crest and sinus floor was radiographically estimated 6 to 7 months after the first procedure. Another procedure was then carried out to place the 10- to 14-mm implants, together with a bone-added osteotome sinus floor elevation. At uncovering, all implants were clinically stable, with no signs of infection. The presented surgical procedure performed at the time of extraction of posterior maxillary teeth in close proximity to the sinus floor allowed placement of implants of proper length and width, together with a bone-added osteotome sinus floor elevation during a second procedure.

Adult↗

Full-mouth tooth extraction lowers systemic inflammatory and thrombotic markers of cardiovascular risk.

Prior studies of a link between periodontal and cardiovascular disease have been limited by being predominantly observational. We used a treatment intervention model to study the relationship between periodontitis and systemic inflammatory and thrombotic cardiovascular indicators of risk. We studied 67 adults with advanced periodontitis requiring full-mouth tooth extraction. Blood samples were obtained: (1) at initial presentation, immediately prior to treatment of presenting symptoms; (2) one to two weeks later, before all teeth were removed; and (3) 12 weeks after full-mouth tooth extraction. After full-mouth tooth extraction, there was a significant decrease in C-reactive protein, plasminogen activator inhibitor-1 and fibrinogen, and white cell and platelet counts. This study shows that elimination of advanced periodontitis by full-mouth tooth extraction reduces systemic inflammatory and thrombotic markers of cardiovascular risk. Analysis of the data supports the hypothesis that treatment of periodontal disease may lower cardiovascular risk, and provides a rationale for further randomized studies.

Adult↗

Proteolytic activity of opossum tooth extracts.

Amelogenins are the main component of the developing enamel matrix. In placental mammals, amelogenins are rapidly cleaved following their secretion. HPLC fractionation of tooth extracts produces a complex chromatographic profile. The fractions are rich in amelogenin cleavage products that generally retain the amino-terminus of the parent protein but have varying lengths of peptide removed from the original carboxyl-terminus. In contrast, HPLC fractionation of opossum tooth extracts produces a simple profile with a single major chromatographic peak. SDS-and Western blot analyses demonstrated that most of the amelogenin consisted of a prominent protein band that migrated at 28 kDa. Mass spectroscopy confirmed the presence of two uncleaved, alternatively spliced forms of opossum amelogenin, Op202 and Op57, but did not detect major amelogenin cleavage products evident in tooth extracts from placental mammals. Amino acid composition analysis supported the conclusion that uncleaved amelogenin is the major component in the developing enamel matrix. Enzymogram analyses using gelatin, casein and recombinant amelogenin as substrates, comparing porcine, rat and opossum tooth extracts, suggested that fewer proteinases are present in opossum. These results identify potentially significant differences in the proteolytic processing of amelogenins between metatherian and eutherian mammals.

Amelogenin↗

[Examination of cardiovascular function variables in tooth extraction under local anesthesia].

BACKGROUND/AIM: Local anesthesia is the one of the most used procedures in surgical practice. It is used for toot extraction to produce analgesic and anesthetic effects. However, there is a question if it is equally safe to apply a local anesthetic combined with a vasoconstrictor (adrenaline) in healthy persons, and in the patients with a certain cardiovasccular system disease. The aim of this stady was to determine whether there were differences in cardiovascular variables during tooth extraction in healthy persons, and in cardiovascular patients when an anesthetic was applyted with adrenaline, or without it. METHODS: The examinees were divided into the group with cardiovascular diseases (CV, n=57) of H and III type, according to the American Society of Anesthesiologists (ASA) qualification, and healthy persons (H, n=55). Both groups were randomly divided into two subgroups: CVa and Ha--where the anesthetic solution had the vasoconstrictor (3% lidocaine, and 1: 100,000 adrenaline); CVb and Hb--where the anesthetic solution was without the vasoconstrictor (3% lidocaine). During the preparation for tooth extraction, the application of anesthetics, extraction and relaxation puls (fc), systolic (TAs) and diastolic arterial blood pressure (TAd) and ECG were registered. RESULTS: The values of fc did not significantly differ among the groups in any measured term. The values of systolic and diastolic blood pressure in the groups CVa and CVb were significantly higher in all the terms of measuring (p < 0.05) from the values in the groups Ha and Hb. A significant increase of TAs was registered only in the phase of tooth extraction in the CVa and CVb group (< 0.05). The values of TAd did not significantly differ between the groups in all the measured terms. Extrasystolic beats were registered in 11 patients of the CV group and in 7 patients of the H group in the phase of anesthetic application or tooth extraction. CONCLUSION: This research shoved that tooth extraction under local anesthesia did not cause complications in cardiovascular patients who were in II or III ASA qualification group, regardless the presence of a vasoconstrictor in the local anesthetic solution.

Adult↗

Scanning electron microscope study of the healing molar tooth extraction socket in the rat.

Healing molar tooth extraction wounds in rats were examined by scanning electron microscopy from 15 minutes to 40 days following tooth removal. The wound epithelium, which was derived mainly from the gingiva but also from the cheek and hard palate, migrated beneath the superficial socket contents. The contents were lost between 5 to 11 days, thus leaving a central epithelial-lined depression. This decreased in width with time as the level of the wound epithelium approached that of the hard palate but was still present at 40 days. Between 5 and 7 days, the wound epithelium became more regular. However, from 11 days on, it became more irregular with increasing numbers of saucer-shaped depressions, circular defects and circular whorls of epithelial cells. The surface structure of the epithelial cells changed as it migrated and matured. The initially plump, then flattened cells mostly had smooth areas along with variable numbers of irregular microridges and microvilli, although cells derived from the cheek had only smooth surfaces. With further maturation, all cells developed a regular honeycomb surface pattern of interconnecting microridges similar to that on the hard palate. Why the wound epithelium became more uneven after 11 days is not known.

Animals↗

Reasons for tooth extraction in four general dental practices in South Wales.

Tooth retention has been one of the main aims of oral care which in turn could have contributed to the social oral health divide. To investigate this issue further, data collected for a group audit was used to study the reasons for tooth extraction for patients attending for routine treatment at four dental practices. The practices served populations in areas with different levels of deprivation in South Wales. In 558 teeth extracted over 417 visits, the reasons for extractions were: caries 59%, periodontal disease 29.1%, pre-prosthetic 1%, wisdom teeth 4.6%, orthodontic 5.5%, trauma 1.2%, patient request 2.4% and 6.2% other reason. The number of extraction visits per day within the group of dental surgeons varied with three practitioners performing more than three extraction visits per day while one practitioner had only 0.51. These reasons did not significantly depend on levels of deprivation. However, significantly more teeth were extracted for caries in the most deprived group in comparison to the least deprived. Therefore, could there be a case for appropriate extractions in the quest for equitable care?

Adolescent↗

Anaerobic bacteremia following tooth extraction and removal of osteosynthesis plates.

The occurrence of bacteremia was investigated in 39 patients undergoing tooth extraction (Group 1), surgical removal of impacted third molars (Group 2), or removal of osteosynthesis plates (Group 3). None of the 39 patients had bacteremia before anesthesia or after nasal intubation for general anesthesia. In two of 23 patients bacteria could be isolated after local anesthesia. Microorganisms were isolated in 14 of 19 patients (74%) with tooth extraction. In nine, a mixture of facultative anaerobic ("aerobic") and strict anaerobic bacteria were identified; in five, anaerobes were isolated exclusively. Two to 130 bacteria were cultured per 10 ml venous blood. Endocarditis causing alpha-hemolytic streptococci were found in seven cases (50%). At least one of the predominating anaerobes (Bacteroides, Fusobacteria, or Peptostreptococci) were found in all positive cases. Bacteremia was found in 40% of the Group 2 patients. There was no bacteremia in the Group 3 patients. The pathogenic relevance of anaerobic bacteremia is discussed and as a consequence it is suggested that the risk of developing organ abscesses as well as the problem of endocarditis following dental bacteremia has to be taken into consideration. On the basis of sensitivity testing, erythromycin does not appear to be the drug of choice in penicillin-allergic patients.

Adolescent↗