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PubMed1981

Ectopic eruption of the mandibular first permanent molar.

In this case, a clear pathway for eruption was provided for the mandibular left first permanent molar by reducing the distal surface of the primary molar. The occlusal surface was also surgically uncovered to remove any possibility of a mucosal barrier. It was thought that the loss of arch length was not too great a sacrifice if the tooth could be brought into occlusion. The tooth proved not to be ankylosed and was, therefore, able to erupt into occlusion. The patient may have some crowding in the mandible; however, it appears to be within normal limits and no further orthodontic treatment is anticipated. When the relative simplicity of treatment is weighed against the severity of the consequences of untreated cases of ectopic eruption, it is suggested that treatment should be started as soon as the condition is diagnosed, to establish a normal eruption pathway and avoid any detrimental effects on a developing occlusion.

Child↗

PubMed1981

Asymptomatic nonulcerated swelling of the mandible.

This case emphasizes that radiographic changes, although not diagnostic, can be characteristic and highly suggestive of a disease process especially a benign or malignant tumor. Radiographic changes that suggested the possibility of a malignant process in this case included ill-defined margins of the lesion; bone production within the lesion, especially interdentally at the alveolar crest; widening of the periodontal ligament space around tooth roots within the lesions; and perpendicular bony striae extending outward from the surface of the bone (sun-ray effect). THese changes are not specific for a malignant process: however, when coupled with the clinical history, the probability of malignancy is high. Failure of recognition is considered the greatest problem in malignancy of the oral cavity. Clinicians should consider every abnormal condition as suspicious unless there are valid reasons for ruling out cancer.

Diagnosis, Differential↗

PubMed2002

A new scale to assess radiographic success of secondary alveolar bone grafts.

OBJECTIVES: To propose a new scale for evaluating the position of the bone graft within the cleft and assess its inter- and intraobserver reliability. DESIGN: Sixty-six patients (70 cleft sites) over a 14-year period were assessed, 90% of patients retrospectively and 10% prospectively. The radiographs were reviewed by two clinicians in controlled conditions twice, with 1 week between assessments. Both clinicians were blind to patient identity. OUTCOME MEASURES: A new scale subdividing the position of the bone into one of six categories was used. The radiographs were also assessed using the Bergland scale. RESULTS: Using the Bergland scale, 62.9% of the cleft sites were type I, 21.4% type II, 4.3% type III, and 5.7% type IV. It was not possible to assess 5.7% of the clefts with this scale because the canine was unerupted. Using the Chelsea alveolar bone graft scale, 58% were category A, 20% B, 7% C, 3% D, 3% E, and 9% F. CONCLUSIONS: The above scale can be used to determine accurately the position of bone within the cleft site. It can be used in the mixed dentition prior to eruption of the canine. It demonstrated moderate to substantial inter- and intraobserver reliability and offers several advantages, compared with other scales.

Adolescent↗

PubMed1993

The existence and distribution of melanocytes in the periodontal ligament of the mongrel dog.

The existence and distribution of melanocytes in the periodontal ligament of the mongrel dog were investigated. Melanocytes were found in the periodontal ligament of the maxillary incisor and premolar segments. Melanocytes in the periodontal ligament varied in number, and generally appeared as dendritic or elongated cells with several, long cytoplasmic processes. These melanocytes were always distributed closer to the tooth root side of the periodontal ligament than the alveolar bone side, but did not contact the cementum. Melanocytes were longitudinally distributed in the apical half of the periodontal ligament. There were no findings suggestive of a relationship between melanocytes and epithelial rests of Malassez or other cellular elements of the periodontal ligament. Although some parts of the gingival mucosa of all dogs in this study showed pigmentation, no relationship was seen between melanocytes in the periodontal ligament and those in the gingival mucosa. This is the first report of melanocytes in the periodontal ligament under normal conditions.

Animals↗

PubMed2003

A SEM investigation of accessory foramina in the furcation areas of primary molars.

The purpose of this study was to determine the prevalence and anatomic characteristics of accessory foramina in the external and internal furcation areas of primary molars. Sixty human primary molars were divided into two equal groups. The teeth of the experimental group showed in previous radiographic examination the presence of a radiolucency area confined to the inter-radicular region, while the teeth of the control group had no sign of pulpal inflammation in the clinical and/or radiographic examination. The specimens were observed by scanning electron microscope (SEM). The external furcation area (EFA) showed a higher prevalence of accessory foramina than the internal furcation area (IFA) (P<0.05). However, the comparison between the two groups did not show statistically significant difference (P>0.05). The presence of accessory canals should not be considered the only reason for inter-radicular pathological bone resorption following pulpal necrosis in deciduous molars.

Analysis of Variance↗

PubMed2003

Failure of eruption of first and second permanent molars.

Failure of eruption of permanent molars is an uncommon condition with a range of possible causative factors. This retrospective study of 35 pediatric subjects assesses the influence of these factors in the prognosis. The study aims to broaden our understanding of an abnormality, which has a considerable clinical impact, and proposes a treatment protocol for the management of these patients.

Adolescent↗

PubMed2005

Orthodontic treatment of an impacted dilacerated maxillary incisor: a case report.

Dilaceration is one of the causes of permanent maxillary incisor eruption failure. It is a developmental distortion of the form of a tooth that commonly occurs in permanent incisors as result of trauma to the primary predecessors whose apices lie close to the permanent tooth germ. We present a case of post-traumatic impaction of a dilacerated central maxillary left incisor in a young patient with a class II malocclusion.

Cephalometry↗

PubMed1998

The pathobiology of periodontal diseases may affect systemic diseases: inversion of a paradigm.

A new paradigm for the pathobiology of periodontitis is presented, and the manner in which periodontitis may relate to susceptibility for certain systemic diseases such as cardiovascular disease and preterm labor is described. Periodontitis is caused by a small group of Gram-negative bacteria present on the tooth root surfaces as bioffilms. Lipopolysaccharide (LPS) and other substances gain access to the gingival tissues, initiate and perpetuate immunoinflammation, resulting in production of high levels of proinflammatory cytokines. These induce production of matrix metalloproteinases which destroy the connective tissues of the gingiva and periodontal ligament, and prostaglandins which mediate alveolar bone destruction. Periodontitis may enhance susceptibility to systemic diseases in several ways. LPS and viable Gram-negative bacteria from the biofilms and proinflammatory cytokines from the inflamed periodontal tissues may enter the circulation in pathogenic quantities. In addition, periodontitis and certain systemic diseases, such as cardiovascular disease, share risk factors including tobacco smoking, male gender, race/ethnicity, stress, and aging.

Animals↗

PubMed1976

Accelerated reattachment with cementogenesis to dentin, demineralized in situ. II. Defect repair.

Three surgical experiments, with histologic evaluation, were performed to study induced gingival reattachment to tooth root dentin demineralized in situ during flap surgery in adult mongrel dogs. Experiments demonstrated aspects of: (1) Weekly histochemical and morphological sequences of repair; (2) Repair of chronically inflamed bony defects simulating periodontal pockets; and (3) Six and 12 month repair of reattached surgical defects. Flap reattachment with cementogenesis was induced by in situ root demineralization using citric acid at pH 1.0 applied for 2 minutes. Results demonstrate: (1) The production of anchoring cementum pins extending into dentin tubules widened by demineralization; (2) Reattachment with cementogenesis of inflamed gingiva to roots exposed to chronically-infected surgical defects for 3 months; (3) Success in repairing chronic interproximal one-walled and labial one surface defects by reattachment; (4) Relative failure to repair bifurcation and horizontal bone defects by flap reattachment; and (5) Complete alveolar bone repair over most labial defects by 1 year, with maintenance of a periodontal ligament between induced bone and cementum. These findings, together with previous reports of induced reattachment to demineralized roots, provide further evidence for mechanisms and consistency and suggest that this regenerative phenomenon may be useful in repairing osseous defects in periodontal therapy.

Alveolar Process↗

PubMed1984

The lateral periodontal cyst. A report of 37 cases.

The lateral periodontal cyst is a developmental cyst of odontogenic origin which is located along the lateral aspect of a tooth root. Thirty-seven previously unreported lateral periodontal cysts ( LPCs ) are presented. Clinical, roentgenographic and histologic features of the LPC are reviewed. Further, the importance of distinguishing the developmental LPC from laterally positioned inflammatory cysts of pulpal or periodontal disease origin and laterally occurring odontogenic keratocysts is stressed.

Adult↗

PubMed1987

Microfilaments in human cementoblasts and periodontal fibroblasts.

An electron microscopic survey was carried out on the human periodontal ligament (PDL), including a part of the gingival connective tissue attached to extracted tooth roots (11 functioning premolars and 6 nonfunctioning third molars) in order to examine the characteristics of microfilaments (6 nm) in cementoblasts and PDL fibroblasts. Microfilaments which were grouped in bundles with semiperiodic dense nodes or in meshworks just beneath the cell membrane were seen predominantly in the cells characterized by their ultrastructurally immature appearance. These microfilaments were more commonly observed in third molar PDL than in premolar PDL and, in general, more conspicuous in cementoblasts than in fibroblasts. The significance of microfilaments in human PDL is discussed, particularly in relation to cell differentiation and morphogenesis.

Actin Cytoskeleton↗

PubMed2000

Osteoblast proliferation and differentiation on dentin slices are modulated by pretreatment of the surface with tetracycline or osteoclasts.

BACKGROUND: Implant surface roughness and chemical composition, as well as other factors, affect the ability of osteogenic cells to form bone adjacent to an implant. The same principles may also apply to the tooth root and some reports have shown that surface modification of the root may lead to improved restoration of the periodontal apparatus. The most common of these surface modification techniques involves demineralization with citric acid or treatment with tetracycline to expose collagen fibrils. In addition, during normal bone remodeling, osteoclasts demineralize the extracellular matrix, leaving resorption pits and exposed collagen fibrils. In this study, the effect of different dentin surface-preparation techniques on osteoblasts were compared. METHODS: Slices of sperm whale dentin were mechanically polished and surfaces were treated with tetracycline-HCl (TCN) or were cultured with mouse bone marrow cells to create a surface with osteoclast (OC) resorption pits or left untreated. Profilometry, x-ray photoelectron spectroscopy (XPS), and scanning electron microscopy (SEM) were used to evaluate the 3 different dentin surfaces. MG63 osteoblast-like cells were cultured on the 3 different surfaces and the effect of dentin surface preparation technique on MG63 cell proliferation (cell number), differentiaton (alkaline phosphatase specific activity of isolated cells and cell layer lysates; osteocalcin production), and local factor production (transforming growth factor (TGF)-beta1 and prostaglandin E2 (PGE2) compared. RESULTS: Profilometry showed the polished and TCN surfaces were smooth with comparable Ra values, whereas the OC surfaces were slightly rougher due to resorption pits which covered 3.7% of the surface. XPS measurements showed that TCN treatment reduced the Ca and P content of the surface, indicating that it had dissolved the mineral. Osteoclast-resorption also reduced the Ca and P content, but to a lesser extent. MG63 cell proliferation on polished dentin and tissue culture polystyrene was equivalent. In contrast, cells grown on the TCN- and OC-treated surfaces exhibited increased proliferation. No effect of surface treatment on cell alkaline phosphatase activity was observed, but activity in the cell layer lysates was increased on the TCN- and OC-treated surfaces. Osteocalcin production was reduced on all dentin surfaces, but the greatest reduction was found on the TCN-treated surface. Production of both TGF-beta1 and PGE2 was increased on the treated surfaces. All effects were greatest in cultures grown on the TCN-treated dentin. CONCLUSIONS: These data indicate that demineralization of the dentin surface promotes proliferation of osteoblasts and early differentiation events like production of alkaline phosphatase and autocrine mediators such as PGE2 and TGF-beta1. However, later differentiation events like osteocalcin production are decreased. Osteoclast-mediated bone resorption elicits similar responses; less than 4% of the dentin surface resulted in approximately 75% of the response caused by TCN treatment. These observations suggest that greater attention should be paid to the effects of osteoclastic resorption in designing methods for enhancing bone and cementum formation adjacent to root surfaces.

Alkaline Phosphatase↗

PubMed2000

Ridge preservation utilizing an acellular dermal allograft and demineralized freeze-dried bone allograft: Part I. A report of 2 cases.

Alveolar ridge deformities are usually the result of trauma, periodontal disease, surgical insult, or developmental defects. Preventing ridge collapse with the extraction of maxillary anterior teeth is vital to an esthetic restorative result. Several techniques are available to prevent ridge collapse. In these case presentations, ridge preservation was achieved utilizing an acellular dermal matrix as a barrier membrane with a demineralized freeze-dried bone allograft. This report demonstrated an acceptable esthetic result with no loss of ridge height or width. Soft tissue dimensions were also preserved. The two graft materials were well accepted by the body and healing was rapid and without significant discomfort. The technique illustrated provides the surgeon with another option to prevent ridge collapse and ultimately improve esthetics.

Adult↗

PubMed2001

Platelet-derived growth factor (PDGF) gene delivery for application in periodontal tissue engineering.

BACKGROUND: A challenge in the reconstruction of periodontal structures is the targeted delivery of growth-promoting molecules to the tooth root surface. Polypeptide growth factors such as platelet-derived growth factor (PDGF) stimulate both cementogenesis and osteogenesis. Recent advances in gene therapy offer the advantage of delivering recombinant proteins to tissues for extended periods of time in vivo. METHODS: Recombinant adenoviral vectors encoding for the PDGF-A gene were constructed to allow delivery of PDGF transgenes to cells. The recombinant adenoviruses were assembled using the viral backbone of Ad2/CMV/EGFP and replacing GFP (reporter gene encoding green fluorescent protein driven by the cytomegalovirus promoter [CMV] within adenovirus type 2) with the PDGF-A gene. Root lining cells (cloned cementoblasts) were transduced with Ad2/PDGF-A and evaluated for gene expression, DNA synthesis, and cell proliferation. PDGF-inducible genes, c-myc and osteopontin, were also evaluated following gene delivery of Ad2/PDGF-A. RESULTS: The results revealed high level transduction of cementoblasts by gene transfer for 7 days as evidenced by flow cytometry and Northern blotting. Cementoblast DNA synthesis and subsequent proliferation were stimulated by Ad2/PDGF-A at levels equal to or greater than continuous rhPDGF-AA application. Strong message for the PDGF-A gene and protein as evidenced by Northern blotting and immunocytochemistry was noted. Furthermore, the potent induction of c-myc and osteopontin mRNA was found after PDGF gene delivery to cementoblasts. CONCLUSIONS: These findings demonstrate that gene delivery of platelet-derived growth factor stimulates cementoblast activity that is sustained above that of rhPDGF-AA application. The use of gene therapy as a mode of growth factor delivery offers a novel approach to periodontal tissue engineering.

Adenoviridae↗

PubMed2004

Effect of sustained gene delivery of platelet-derived growth factor or its antagonist (PDGF-1308) on tissue-engineered cementum.

BACKGROUND: Cementum, a mineralized tissue lining the tooth root surface, is destroyed during the inflammatory process of periodontitis. Restoration of functional cementum is considered a criterion for successful regeneration of periodontal tissues, including formation of periodontal ligament, cementum, and alveolar bone. Short-term administration of platelet-derived growth factor (PDGF) has been shown to partially regenerate periodontal structures. Nonetheless, the role of PDGF in cementogenesis is not well understood. The aim of the present study was to determine the effect of sustained PDGF gene transfer on cementum formation in an ex vivo ectopic biomineralization model. METHODS: Osteocalcin (OC) promoter-driven SV40 transgenic mice were used to obtain immortalized cementoblasts (OCCM). The OCCM cells were transduced with adenoviruses (Ad) encoding either PDGF-A, an antagonist of PDGF signaling (PDGF-1308), a control virus (green fluorescent protein, GFP), or no treatment (NT). The transduced cells were incorporated into polymer scaffolds and implanted subcutaneously into severe combined immunodeficient (SCID) mice. The implants were harvested at 3 and 6 weeks for histomorphometric analysis of the newly formed mineralized tissues. Northern blot analysis was performed to determine the expression levels of mineral-associated genes including bone sialoprotein (BSP), OC, and osteopontin (OPN) in the cell-implant specimens at 3 and 6 weeks. RESULTS: The results indicated mineralization was significantly reduced in both the Ad/PDGF-A and Ad/PDGF-1308 treated specimens when compared to the NT or Ad/GFP groups at 3 and 6 weeks (P<0.01). In addition, the size of the implants treated with Ad/PDGF-A and Ad/PDGF-1308 was significantly reduced compared to implants from Ad/GFP and NT groups at 3 weeks (P<0.05). At 6 weeks, the size of implants and mineral formation increased in NT, Ad/GFP, and Ad/PDGF-A groups, while the Ad/PDGF-1308 treated implants continued to decrease in size and mineral formation (P<0.01). Northern blot analysis revealed that in the Ad/PDGF-A treated implants OPN was increased, whereas OC gene expression was downregulated at 3 weeks. In the Ad/PDGF-1308 treated implants, BSP, OC, and OPN were all downregulated at 3 weeks. At 3 weeks, the Ad/PDGF-A treated implants contained significantly higher multinucleated giant cell (MNGC) density compared to NT, Ad/GFP, and Ad/PDGF-1308 specimens. The MNGC density in NT, Ad/GFP, and Ad/PDGF-A treated groups reduced over time, while the Ad/PDGF-1308 transduced implants continued to exhibit significantly higher MNGC density compared with the other treatment groups at 6 weeks. CONCLUSIONS: The results showed that continuous exposure to PDGF-A had an inhibitory effect on cementogenesis, possibly via the upregulation of OPN and subsequent enhancement of MNGCs at 3 weeks. On the other hand, Ad/PDGF-1308 inhibited mineralization of tissue-engineered cementum possibly due to the observed downregulation of BSP and OC and a persistence of stimulation of MNGCs. These findings suggest that continuous exogenous delivery of PDGF-A may delay mineral formation induced by cementoblasts, while PDGF is clearly required for mineral neogenesis.

Animals↗

PubMed2005

Oral reconstructive and corrective considerations in periodontal therapy.

This paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. It is intended to provide information for the dental profession and other interested parties. The purpose of this paper is to provide a general overview of oral reconstructive and corrective procedures used in periodontal therapy. It is not intended to be a comprehensive review of this subject.

Connective Tissue↗

PubMed2001

Influence of an interdental full pin on stability of an acrylic external fixator for rostral mandibular fractures in dogs.

OBJECTIVE: To determine total stiffness and gap stiffness of an external fixation system in a canine mandibular fracture gap model incorporating a full interdental pin as the only point of rostral fixation in a bilateral type-I external fixator. SAMPLE POPULATION: 10 canine mandibles. PROCEDURE: Bilateral mandibular ostectomies were performed between premolars 3 and 4. A type-I external fixator incorporating a full interdental pin was placed to stabilize a 0.5-cm fracture gap. Four pin configurations (intact mandibular bodies with fixator; ostectomized mandibular bodies and complete fixator; ostectomized mandibular bodies with caudal pins of rostral fragment cut; ostectomized mandibular bodies with all pins of rostral fragment cut) were tested in dorsoventral bending 5 times on each mandible. The full interdental pin remained intact in all configurations. Total stiffness and gap stiffness were determined for each configuration on a materials testing machine. RESULTS: Total stiffness of intact mandibles was significantly greater than that of ostectomized mandibles, regardless of external fixator configuration. However, total stiffness and gap stiffness were not significantly different among different external fixator configurations applied to ostectomized mandibles. CONCLUSION AND CLINICAL RELEVANCE: External fixator configurations with only the full interdental pin engaging the rostral fragment were as stiff as configurations that had 2 or 4 additional pins in the rostral fragment for the applied loads. External fixators for rostral mandibular fractures may be rigidly secured with rostral fragment implants applied extracortically, avoiding iatrogenic trauma to teeth and tooth roots.

Animals↗

PubMed2003

Spiral colon bypass in a geriatric Vietnamese potbellied pig.

An 8-year-old potbellied pig was evaluated for anorexia, decreased fecal production, signs of depression, inappetence, and abdominal distension. During hospitalization, a tooth root impaction and abscess were diagnosed, and abdominal radiography revealed severely distended, gas-filled large and small intestines. Exploratory laparotomy revealed a stricture of the proximal centripetal loop of the spiral colon and megacolon of the proximal portion of the spiral colon and cecum. A side-to-side spiral colon anastomosis was performed to create a partial bypass of the spiral colon. The success of this procedure suggests that spiral colon bypass is a treatment option for spiral colon stricture formation in potbellied pigs. Spiral colon stricture formation should be considered as a differential diagnosis in geriatric potbellied pigs that are anorectic, have abdominal distension, and have decreased fecal production.

Anastomosis, Surgical↗