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Sequelae of trauma to primary maxillary incisors. I. Complications in the primary dentition.

Two hundred and eighty-seven children with a total of 545 traumatized primary upper incisors were followed using standardized procedures until the age of 10. Extraction was the only treatment offered when intervention was necessary. The immediate as well as the long-term consequences of trauma were studied on the basis of this material. Consequences in the primary dentition comprised: color changes (53%), pulp necrosis (25%), pulp canal obliteration (36%), gingival retraction (6%), permanent displacement after luxation (5-22%), pathological root resorption (1-10%) as well as disturbances in physiological root resorption (4%) and, lastly, premature tooth loss (46%). In a multivariate analysis of the development of pulp necross in primary teeth after trauma, the following decisive factors were found: age of the patient at the time of injury, degree of displacement of the tooth as well as the degree of loosening and presence of crown fracture. The factors found to influence development of pulp canal obliteration were: displacement of the tooth at time of injury as well as detectable physiologic root resorption at time of trauma. The presence of crown fracture seemed to decrease the risk of obliteration. The need for scientifically based treatment strategies for managing and reducting complications after trauma in the primary dentition is stressed.

Age Distribution↗

Zinc oxide-eugenol and calcium hydroxide pulpectomies in baboon primary molars: histological responses.

AIM: To compare histological responses to zinc oxide-eugenol (ZOE) and calcium hydroxide (CH) pulpectomies in primary molar teeth with inflamed pulps. STUDY DESIGN: This was an experimental study in 17 juvenile baboons (Papio ursinus). METHODS: Pulpitis was induced with fresh human carious dentine or Streptococcus mutans placed into occlusal cavities in 78 primary molars; after 14 days a pulpectomy was performed on the same primary molars with the two root fillings randomly allocated. The root canal openings were then covered with IRM and the cavity filled with amalgam. After 90 days specimens were harvested and examined under the light microscope with the examiner blind to the treatment. RESULTS: Reaction frequencies in the ZOE-treated versus CH-treated teeth were: no recognisable pulp 89% and 82%, internal root resorption 0% and 1%, external root resorption 11% and 24%, presence of bacteria 5% and 18%, periapical abscesses 24% and 52%. STATISTICS: Fisher's exact probability test showed a statistically significant higher prevalence of periapical abscesses in the CH-treated group (P=0.03, relative risk 2.2). CONCLUSIONS: ZOE pulpectomy is preferred to CH for the treatment of infected pulps in primary molars.

Animals↗

Effect of orthodontic force on periodontal tissue metabolism. A histologic and biochemical study in normal and hypocalcemic young rats.

The relationship between force and degradation activity after application of orthodontic force is still obscure. Of particular clinical interest are the etiologic factors behind excessive root resorptions appearing in connection with orthodontic movement of teeth that has been proposed to be influenced by systemic factors regulating the tissue-degrading activity in periodontal tissues. Thus, the aim was, by histologic and new biochemical methods, to investigate the effect of orthodontic forces on the periodontal tissues in the normal and the hypocalcemic situation with secondary hyperparathyroidism. Root resorptions were induced in upper incisors of normal and hypocalcemic rats by subjecting the teeth to a moderate orthodontic force. In both groups the resorption of the roots occurred consistently in the vicinity of reorganizing areas of the periodontal ligament (PDL) with ongoing degradative activities and alveolar bone resorption. Furthermore, specific cell metabolic changes in alveolar bone and PDL in tension and pressure zones were detected and quantified by biochemical determination of alkaline phosphatase activity. This biochemical quantification of the metabolic changes together with the morphologic observations gave the clinically valuable information that the observed increase in occurrence and severity of root resorptions in moderate hypocalcemia was related to an increase in alveolar bone turnover. This study has shown that root resorptions were clearly related to the degradation process occurring in the vicinity of the hyaline zone and that in the hypocalcemic situation, the increase in root resorptions was related to an enhanced alveolar bone resorption. Thus, factors that minimize the time for resorptive/degradative activity should be discussed in this context rather than force per se.

Alkaline Phosphatase↗

Localization of cathepsin K in bovine odontoclasts during deciduous tooth resorption.

Cathepsin K is a cysteine proteinase, which is abundantly and selectively expressed in osteoclasts. It is believed to play an important role in the proteolysis of bone resorption by osteoclasts. The objectives of this study were to investigate the association of cathepsin K in the physiological root resorption of deciduous teeth and to identify the cathepsin K-producing cells in deciduous root resorption. RT-PCR and Northern blot analysis of the total RNAs extracted from bovine active and resting root-resorbing tissues, which lie between the root of deciduous tooth and its permanent successor, were performed. The active root-resorbing tissue, which has a high population of odontoclasts on its surface that is attached to resorbing root surface, showed an extremely high expression of cathepsin K in comparison with the resting root-resorbing tissue. By in situ hybridization, cathepsin K mRNA was highly and selectively expressed in multinucleated odontoclasts that aligned along the surface of the tissue and apposed to the resorbing root surface of the deciduous tooth. Western blot analysis of the active root-resorbing tissue was used to characterize the anti-cathepsin K antibody. A band of 27 kDa, corresponding with the predicted size for mature cathepsin K, was demonstrated. Immunohistochemistry confirmed the specific localization of cathepsin K protein to the odontoclasts. These results demonstrate that odontoclasts in the deciduous root resorption express cathepsin K mRNA and protein that may participate in the proteolysis of root resorption of the deciduous tooth.

Animals↗

Autogenous free tooth transplantation with a two-stage operation technique.

If tooth transplantation is to succeed, it is crucial to preserve the vitality of the cells on the root surface of the tooth transplant. Insufficient postoperative nutrition to the cells on the root surface of the tooth transplant was thought to contribute to their devitalization of these cells. Impaired nutrition may be a result of poor contact between the recipient bed and the root surface of the transplanted tooth, and development of an interposed blood clot. To improve postoperative nutrition to the root surface cells, teeth were transplanted to the recipient beds in which the tissues were regenerated during a 14 day period, i.e., using the two-stage transplantation technique. In a clinical study of this technique, a total of 95 autogenous teeth with fully developed roots were transplanted in 84 patients, and examined both clinically and radiographically for up to 13 years after the transplantation. In a dog model, a comparative experimental study was made between teeth transplanted to beds left to heal for 5 days and teeth transplanted to beds prepared immediately before the transplantation. The clinical study showed a low prevalence of tooth graft loss and root resorption even when infection of the root canal occurred. Periodontal attachment loss of less than 3 mm was found in 97% of 6 defined surfaces around the transplanted teeth. Transplanted teeth which were later extracted were often hypermobile, and signalled pain when provoked with heavy loading. Excessive extraction trauma, fixation failure, and excessive plaque accumulation after transplantation were all shown to be detrimental to tooth transplant. Transplanted teeth were used as abutments for fixed partial dentures and provided the necessary dental support for crowns and bridges even in patients with atrophic alveolar bone. The experimental histological study showed no differences between test and control teeth in terms of the prevalence of root resorption, which was suspected to be caused by traumatic injuries to the roots during extraction and non-rigid fixation of the transplanted teeth.

Age Factors↗

Twelve-year follow-up of a replanted incisor.

A case report with a 12-yr follow-up of a replanted maxillary incisor is presented. A maxillary incisor, #8, with incomplete root formation was replanted without splinting following a 2-h sojourn in salt water. The pulp responded positively to the electric pulp tester for 2 yr. There was no response to the electric pulp tester 5 yr postoperatively. Although there was some external root resorption, the root appeared to have reached normal length. Two parallel vertical radiolucent slits were present in a trabeculated substance in the site normally occupied by the pulp. This case illustrates an example of revascularization and pulp obliteration. Interestingly, at the 12-yr follow-up, the replanted tooth, as well as tooth 7, showed blunted apices that occurred following orthodontic tooth movement.

Child↗

Denervation resulting in dento-alveolar ankylosis associated with decreased Malassez epithelium.

Inferior alveolar nerve denervation causes appreciable decreases in the distribution of epithelial rests of Malassez. To explore roles of the Malassez epithelium, we attempted to evaluate possible changes in dento-alveolar tissues surrounding this epithelium by experimental denervation. We found that denervation led to dento-alveolar ankylosis with a decrease in the width of the periodontal spaces. Interestingly, with regeneration of the Malassez epithelium 10 weeks after the denervation, the periodontal space width showed a correspondingly significant increase. These findings suggest that the Malassez epithelium may be involved in the maintenance of periodontal space and that sensory innervation might be indirectly associated with it. In addition, it is of interest that denervation activated root resorption of the coronal root surface and that the consequently resorbed lacunae were repaired by cellular cementum. It is suggested that Malassez epithelium may negatively regulate root resorption and induce acellular cementum formation.

Acid Phosphatase↗

Assessment of a novel alternative to conventional formocresol-zinc oxide eugenol pulpotomy for the treatment of pulpally involved human primary teeth: diode laser-mineral trioxide aggregate pulpotomy.

OBJECTIVE: The purpose of this study was to investigate whether a diode laser pulpotomy with mineral trioxide aggregate (MTA) sealing could be an acceptable alternative to the conventional formocresol pulpotomy and zinc oxide eugenol (ZOE) sealing in human primary teeth. METHODS: A randomized, single-blind, split-mouth study was used with a sample of 16 children aged from 3 to 8 years (mean age=5.10 years). A total of 26 pairs of teeth from these 16 patients were selected based on clinical and radiographic criteria. One tooth from each pair was randomly assigned to either the laser-MTA pulpotomy group or the formocresol-ZOE pulpotomy group. All teeth were followed up clinically and radiographically at 2.3, 5.2, 9.5 and 15.7 months. All extracted failures were sectioned and photographed to assess possible reasons for this. RESULTS: A total of seven laser-MTA-treated teeth were deemed to be radiographic failures (mean time until failure=9.1 months) compared to three formocresol-ZOE treated teeth (mean time until failure=12.5 months). These results were not significant using Fisher's exact test (P>0.05). Six of the laser-MTA failures and all three formocresol-ZOE failures exhibited furcal and/or periapical radiolucencies with or without pathologic root resorption. One of the laser-MTA failures displayed premature root resorption and is being observed for exfoliation. Analysis of photographs of teeth available for extraction revealed errors in clinical technique in addition to expected signs of a disease process such as the presence of granulation tissue and areas of pathologic root resorption. CONCLUSIONS: The laser-MTA pulpotomy showed reduced radiographic success rates compared to the formocresol-ZOE pulpotomy at 15.7 months; however, these results were not statistically significant. Improved success rates among a larger patient sample and a longer follow-up period would be required for the laser-MTA pulpotomy to be considered a routine alternative to the conventional formocresol-ZOE procedure. Meticulous restorative techniques must be followed to ensure the success of laser-MTA pulpotomies.

Aluminum Compounds↗

Effect of denervation on healing after tooth replantation in the ferret.

Studies have shown that the sensory nerves participate in inflammation and immune responses and possess trophic-facilitating wound healing in general. Tooth avulsion represents a pulpal and periodontal injury, and the mechanisms involved in the healing responses subsequent to replantation of teeth are still unclear. The objective of this study was to investigate the healing responses after denervation and replantation of teeth. Unilateral denervation was performed in 15 ferrets by axotomy of the inferior alveolar nerve, 5 days before extraction of the first lower premolars. Six weeks later the mandibles were excised and processed for histological evaluation. Immunohistochemistry was performed using antibodies against the sensory neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP), and measurements of root resorption and ankylosis were performed in four sections from each replanted tooth. After 6 weeks substantial reinnervation was observed in the jaws. Immunoreactivity in the pulp was observed in only two replanted teeth on the denervated side, compared with four on the innervated side. Total pulp necrosis appeared in 10 replanted teeth on the denervated side and in 5 on the innervated, indicating that sensory nerves promote survival of the pulp after replantation. SP-immunoreactive (IR) fibers were more frequently observed in the resorptive lacunae than CGRP-IR fibers. However, resorptive areas lacking IR fibers were frequently found along the root surface. Root resorption averaged 0.062 +/- 0.029 mm2 on the innervated side compared to 0.016 +/- 0.0043 mm2 on the denervated (P< 0.02). Ankylosis was observed in four of the replanted teeth on the innervated side (169.3 +/- 49.7 microm) and in six on the denervated side (332.56 +/- 193.2 microm) (P = 1). It is concluded that the sensory nerves promote root resorption after pulpoperiodontal injuries but have less influence on the osteoblastic activity expressed by ankylosis.

Animals↗

[Clinical observation of dental pulp and root changes of juvenile anterior permanent teeth after concussion and luxation].

OBJECTIVE: To observe the incidence of pulp necrosis and root resorption of the juvenile anterior permanent teeth with concussion and luxation injuries and analyze the relationship between the type of injury and form of root resorption. METHODS: 157 teeth of 79 patients were chosen from 201 patients with concussion and luxation treated with functional-bite-plate at the Department of Pedodontics, School of Stomatology, Beijing Medical University from 1984 to 1996. RESULTS: High occurrence of pulp necrosis and root resorption were found in teeth with intrusion, and pulp necrosis occurred most within 3 months after the injury, while root resorption occurred during 3 weeks to 2 years. At the same time, surface resorption occurred mainly in the teeth with intrusion, extrusion and lateral luxation, and replacement resorption occurred only in intrusive teeth, however inflammatory resorption occurred in extrusive teeth whose pulp was infected. CONCLUSION: Intrusion is the most severe type of tooth trauma.

Adolescent↗

Distal movement of premolars to provide posterior abutments for missing molars.

In 24 patients with missing molar teeth in the upper and/or in the lower jaw, 32 premolars were distalized. The mean orthodontic distalizing distance was 9.4 mm (SD 2.6). After distalization all these teeth served as posterior abutments for fixed restorations. The investigation period ranged between 2.5 to 14.1 years, average 9.6 years (SD 3.2). The clinical examination criteria were sensitivity, mobility, probing depth, sulcus bleeding index; the radiologic criteria were root resorption (lateral and apical) marginal bone level and axial position. None of the 32 premolar abutments were lost during investigation period. All the teeth maintained their vitality. The measured probing depths and sulcus bleeding indices were low. Of the teeth tested 40.6% revealed localized lateral root resorption on the pressure side; the average postorthodontic depth of root resorption was 0.7 mm (SD 0.3), and the length 2.3 mm (SD 0.6). The follow-up examination revealed a partial repair of the lateral root lesions. The extent of apical root resorption amounted to 0.9 mm (SD 1.1). The marginal bone level showed a bone loss of 0.5 mm mesially and 0.2 mm distally. The findings confirm that the distalized premolar functioning as a posterior bridge abutment represents a prognostically favorable alternative to an implant.

Adolescent↗

Repair of periodontal furcation defects in beagle dogs following reconstructive surgery including root surface demineralization with tetracycline hydrochloride and topical fibronectin application.

This study examines the effects of root surface demineralization and topical fibronectin as adjuncts to reconstructive periodontal surgery. In 14 beagle dogs, horizontal periodontal defects were surgically induced around the mandibular premolars followed by a 6-week period without plaque control. Reconstructive surgery of the defects was subsequently carried out. The root surfaces were debrided and superficially demineralized with citric acid or tetracycline hydrochloride, with or without subsequent application of fibronectin. Mucoperiosteal flaps were raised to cover most of the crowns and sutured. The animals were sacrificed 12 weeks after surgery and block sections of the teeth and surrounding tissues were processed for histology. Analysis included incidence of furcation defects presenting with an epithelial lining, quantification of connective tissue repair relative to the furcation circumference, and regeneration of alveolar bone relative to the furcation defect height. The incidence of root resorption and ankylosis was also analyzed. Within the limitations of this study it was concluded that: (1) citric acid conditioning of the root surface frequently resulted in complete connective tissue repair of the furcation defect; (2) root resorption and ankylosis were prevalent features of the healing response; (3) citric acid and tetracycline treatment had similar potential to induce connective tissue repair and resulted in corresponding incidences of root resorption and ankylosis; (4) application of fibronectin to demineralized root surfaces did not enhance the amount of connective tissue repair and did not alter the pattern of root resorption and ankylosis.

Administration, Topical↗

The effects of exclusion of epithelium from healing periodontal pockets.

Epithelium was excluded experimentally from artificially induced periodontal pockets by cutting off the crowns of vital teeth and covering the roots with mucoperiosteal flaps. This procedure was carried out on 58 teeth in eight rhesus monkeys and specimens recovered at from five to 36 weeks postoperatively. Thirty-eight (66%) of the teeth remained completely covered by soft tissue for the duration of the experiment. Up to 4.4 mm (mean = 0.9 mm) of new attachment with cementum and attached collagen fibers was found on both the sides of the roots and the cut ends, but root resorption and downgrowth of epithelium over root surfaces were about equally common. Thus, even when epithelium is excluded from healing periodontal pockets, reattachment with new cementum and attached collagen fibers is not consistently achieved, even after periods of 36 weeks. Root resorption and ankylosis are major complications. Although most new attachment appears to result from cells originating in the periodontal ligament, it can also arise from cells from the gingival connective tissue.

Animals↗

Effect of delayed calcium hydroxide treatment on periodontal healing in contaminated replanted teeth.

The effect of delayed intracanal calcium hydroxide treatment on experimentally induced extensive inflammatory root resorption in monkeys was studied. A significant shift from inflammatory resorption to ankylosis was noted following calcium hydroxide treatment. Furthermore, calcium hydroxide treatment appeared to change the pattern of ankylosis over time, although the total ankylotic area remained the same. Ankylosis preceded by root resorption (replacement resorption) increased, while ankylosis not associated with root resorption decreased. It was concluded that intracanal calcium hydroxide treatment of teeth with compromised PDM may cause unnecessary replacement resorption if left in the root canal for a long time or changed repeatedly.

Alveolar Process↗

Replantation of enzymatically treated teeth in monkeys. Part I.

Chemical alterations in cementum of avulsed teeth may be implied as a causative factor in their eventual resorption when replanted. Root surface decalcification, with subsequent enzymatic deletion of glycoproteins and cross linking of cementum collagen, results in little or no root resorption for up to 3 months after replantation.

Animals↗

Intermittent force in orthodontic tooth movement.

A single orthodontic activation lasting one hour can initiate tooth movement. The purpose of this study is to examine tooth movement, osteoclasts, and root resorption in rats following several one-hour activations. Rats (n = 144) were randomly assigned to intermittent (multiple activations of 1 hr/day), continuous, and sham appliances. Twelve rats were killed at 3, 5, 7, and 14 days. Tooth movement, osteoclasts, osteoclast %, and root resorption % were quantified. Continuous force moved molars mesially at days 3 and 14 (p < 0.05), but intermittent and sham did not. Intermittent and continuous force increased osteoclast numbers at days 3, 5, and 7 (p < 0.05). Continuous force increased osteoclast surface on days 3 and 14 (p < 0.05). Continuous force increased root resorption at days 5, 7, and 14 (p < 0.05). These results demonstrate that orthodontic force for one hour in 24 stimulates osteoclasts at compression sites but does not stimulate tooth movement or root resorption.

Alveolar Process↗

Periodontal healing in one-wall intra-bony defects in dogs following implantation of autogenous bone or a coral-derived biomaterial.

AIM: Autogenous bone grafts and bone biomaterials are being used as part of protocols aiming at reconstruction of periodontal defects. There is a limited biologic information on the effect of such materials on periodontal healing, in particular aberrant healing events that may prevent their general use. The objective of this study was, using histological techniques, to evaluate periodontal healing with focus on root resorption and ankylosis following implantation of autogenous bone and a coral-derived biomaterial into intra-bony defects in dogs. METHODS: One-wall intra-bony periodontal defects were surgically created at the distal aspect of the second and the mesial aspect of the fourth mandibular premolars in either right or left jaw quadrants in four Beagle dogs. Each animal received particulated autogenous bone and the resorbable calcium carbonate biomaterial into discrete one-wall intra-bony defects. The mucoperiosteal flaps were positioned and sutured to their pre-surgery position. The animals were euthanized 8 weeks post-surgery when block sections of the defect sites were collected and prepared for qualitative histological analysis. RESULTS: There were no significant differences in periodontal healing between sites receiving autograft bone and the coral-derived biomaterial. A well-organized periodontal ligament bridging new bone and cementum regeneration was observed extending coronal to a notch prepared to delineate the apical extent of the defect. Osteoid and bone with enclosed osteocytes were formed onto the surface of both autograft and coral particles. Although small resorption pits were evident in most teeth, importantly none of the biomaterials provoked marked root resorption. Ankylosis was not observed. CONCLUSION: Particulated autogenous bone and the coral-derived biomaterial may be implanted into periodontal defects without significant healing aberrations such as root resorption and ankylosis. The histopathological evaluation suggests that the autogenous bone graft has a limited osteogenic potential as demonstrated in this study model.

Animals↗

Periapical condition of anterior teeth after surgical correction of mandibular prognathism. A radiographic study.

Extrusion and root resorption of the mandibular anterior teeth have been reported after surgical correction of mandibular prognathism by horizontal osteotomy of the rami. The aim of the present study was to find out whether oblique sliding osteotomy also has such side effects. Intraoral radiographs of the maxillary and mandibular anterior teeth of 61 patients were studied. Enlargement of the periodontal space and signs of root resorption were estimated postoperatively and at a later review 1 1/2-5 years after the operation. Enlargement of periodontal space occurred postoperatively in 16.2% of the maxillary incisors and 52.2% of the mandibular incisors. The enlargements were mostly reversible and at the final review only 1.1 and 8.5% of the maxillary and mandibular incisors, respectively, showed such enlargements. Root resorption was rarely found in radiographs from the postoperative control. At the final review, however, there were signs of root resorption of 1.6 and 20.8% of the maxillary and mandibular incisors, respectively. It appears warranted to conclude that the anterior teeth, especially the mandibular incisors, are exposed to strong forces also after oblique sliding osteotomy of the mandibular rami.

Adolescent↗