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PubMed2003

Avulsions and intrusions: the controversial displacement injuries.

Avulsions and intrusions are the most complicated and controversial displacement injuries of permanent teeth. Clinical guidelines published by authorities such as the American Association of Endodontists, the Royal College of Surgeons of England and the International Association of Dental Traumatology are inconsistent. While a certain amount of inconsistency might be expected, some of these guidelines recommend treatments that are experimental or have not incorporated research information from the past 5 years, and in one case the guidelines incorrectly describe the nature of Hank's balanced salt solution. Recent laboratory studies support previous clinical outcome studies in emphasizing that only for teeth replanted within 5 minutes of avulsion is there a chance of regeneration of the periodontal ligament and normal function. Teeth replanted beyond 5 minutes will take another path, that of repair followed by root resorption, ankylosis and eventual extraction. Dentists should explain these outcomes at the time of the replantation decision. Severe intrusions also have predictable outcomes. Teeth intruded beyond 6 mm cannot regenerate a functional periodontal ligament and so are prone to root resorption and eventual extraction as well. In this situation the decision is one of immediate extraction or repositioning, with the understanding that it is inevitable that the tooth will eventually be extracted. Authoritative clinical guidelines available on the Internet provide the clinician with useful outlines for treatment. However, individual inconsistencies stimulate academic controversies and, in some cases, clinical misdirection.

Dental Enamel Proteins↗

PubMed1989

[Two case reports of extraction with the upper central incisors].

Although extraction of the upper central incisors is very rare because of their esthetical importance, they are sometimes extracted when impaction, root resorption, abnormal morphology, severe caries and/or trauma are involved. When extracted, tooth size adjustment, crown-bridge and/or orthodontic treatment are proposed for functional and/or esthetic improvement. Two present cases were reported of Angle class I crowding with root resorption of the upper central incisors caused by apical abscess (case 1) and impacted canines (case 2). The above central incisors were extracted and orthodontic tooth alignment was performed on both cases prior to final occlusal adjustment. Problems we encountered in through these cases were tooth size ratio between the upper and lower teeth causing spacing arch and/or disharmony of occlusion. In case 1, edge to edge anterior relationship was established because the over-all tooth ratio was 93.30% which was out side one standard deviation although the upper lateral incisors were tipped mesially to create some spaces. The over-all tooth ratio in case 2, however, was 92.13% which was inside one standard deviation and normal occlusion was restored. It is suggested that final tooth size adjustment is necessary for good occlusion in extraction cases of upper central incisors.

Adolescent↗

PubMed1983

The effect of extraction and orthodontic treatment on dentoalveolar support.

Full-mouth radiographs of ninety-six patients treated by extraction of four first premolars were taken at least 10 years postextraction. Three groups were established: one with extensive crowding in the full permanent dentition treated by extraction and fixed appliance therapy; one treated by serial extraction and fixed appliance therapy; and one treated by serial extraction only. Measurements of tooth length and alveolar bone height were made from the projected radiographs, and buccolingual socket areas were measured from direct tracings of the radiographs. Comparison between groups revealed reduced mean radiographic tooth lengths for incisors and mandibular molars in the orthodontically treated groups. The incidence of root resorption was similar for both treated groups. Reduced alveolar bone heights were noted in the extraction sites of the two orthodontically treated groups but not in the group treated by serial extraction only. Most reduction in long-term dentoalveolar support occurred as a result of root resorption except in the extraction sites, where it occurred largely as a result of bone loss. Root parallelism did not appear to influence proximal bone heights at the extraction site. In malocclusions involving arch length deficiency, maximally displaced canines had reduced long-term proximal bone compared to nondisplaced canines, supporting the concept of encouraging autonomous distal eruption through serial extraction.

Adult↗

PubMed1989

Spontaneous loss of permanent teeth: a case report.

Pathological root resorption has clinical symptoms of great importance when it appears in permanent teeth, as its etiology is not always clear. It is important to examine all local and general factors before determining its "idiopathic" cause. A case of spontaneous loss of permanent teeth in a 19 year-old female is presented. Through a meticulous study correlating the clinical history and the evolution of the symptoms, we can suspect that non-dental medical interventions requiring general anesthesia can lead to the loss of permanent teeth through root resorption.

Adult↗

PubMed1995

"Collagen adhesion" revisited.

Histologic studies of periodontal reconstructive therapies have repeatedly shown a zone of nondescript connective tissue adaptation, or collagen adhesion, to the root surface between the apical extension of the junctional epithelium and the coronal extension of identifiable regenerated cementum. To clarify the nature of this zone, supra-alveolar periodontal defects were created bilaterally in the mandibular premolar region in three beagle dogs, and exposed roots were instrumented to remove the cementum. Flaps were then coronally advanced and sutured. Histologic analysis after 12 weeks of healing showed instrumented root dentin not associated with junctional epithelium, new cementum, root resorption, or ankylosis in 27 of 60 root surfaces. In 10 of these specimens subsequently examined by transmission electron microscopy, collagen fibrils were generally oriented parallel to and in close proximity to the root. A mechanism of collagen attachment was, in fact, functioning at sites of collagen adhesion; these areas may validly be included in the histologic attachment level reported in studies of periodontal reconstructive therapy.

Animals↗

PubMed2001

The influences of molar intrusion on the inferior alveolar neurovascular bundle and root using the skeletal anchorage system in dogs.

The skeletal anchorage system (SAS) was developed as intraoral rigid anchors for open-bite correction by intrusion of molars. Since the application of SAS is a new modality in orthodontic treatment, the influences of radical molar intrusion on the root and the inferior alveolar neurovascular bundle were unknown. The purpose of this research is to verify the effect of molar intrusion on the neurovascular bundle, the level of osseointegration of bone screws, and root resorption. The results of this study showed mandibular molars were intruded 3.4 mm on the average over 7 months in dogs. The miniplates were well stabilized with osseointegrated bone screws and the peri-implant soft tissues showed slight inflammatory changes. Neither nerves nor blood vessels were damaged. Root resorption was observed but was repaired with new cementum. We concluded that the SAS utilizing transmucosal titanium miniplates as an immovable orthodontic anchorage could provide a new modality for molar intrusions without serious iatrogenic problems.

Alveolar Process↗

PubMed2006

The displaced maxillary canine--a retrospective study.

OBJECTIVE: The re-alignment of retained maxillary canines was studied in relation to the degree of displacement in panoramic radiographs, mesiodistal root deviations, length of treatment and side-effects. The aim was then to determine whether the decision between surgical removal and orthodontic re-alignment can be made on the basis of panoramic radiographs alone. MATERIALS AND METHODS: Forty-seven panoramic radiographs with 59 displaced canines were used to determine their distance and inclination to the occlusal plane (similar to the method described by Dausch-Neumann [8]), the position of the crown tip, and the frequency of mesiodistal root deviations. The length of active treatment was recorded and analyzed statistically in relation to the degree of displacement and incidence of root deviation. Finally, pre- and post-therapeutic panoramic radiographs were compared to determine the incidence of root resorptions and marginal bone defects. RESULTS: The mean values for the angle of inclination and the distance of the maxillary canines from the occlusal plane were 57.4 degrees (+/- 14.3 degrees ) and 10.5 mm (+/- 3.8 mm), respectively. In 21 canines, the crown tips projected most frequently between the central and lateral incisors. Twelve canines presented root deviations. Treatment lasted an average of 1.9 years (+/- 0.7 years). No correlation was found between the treatment time and the canine's distance from the occlusal plane (r = 0.03), its angle of inclination (r = 0.06), position of the crown tip (r = 0.12), or root deviation (r = -0.07). Root resorptions were found in nine canines (15.3%) and marginal bone defects in 24 canines (40.7%). CONCLUSION: Fifty-nine retained maxillary canines, some showing extreme displacement, were re-aligned in an average of 1.9 years. There was no correlation between the degree of canine displacement in the panoramic radiographs or the incidence of mesiodistal root deviations and active treatment time. For this reason, the indication to remove displaced maxillary canines should not be taken from panoramic radiographs alone.

Adolescent↗

PubMed1983

Long-term evaluation of autotransplanted maxillary canines with completed root formation.

Autotransplantation of 33 maxillary canines was followed up in 29 patients with an average age of 27.5 years. The mean follow-up period was 6.0 years. Endodontic treatment was performed in 23 teeth. Signs of root resorption were found in an increasing number of canines during the follow-up period. At the last examination eight canines showed no signs of resorption. External and internal resorption of inflammatory type were the most frequent forms of resorption and were also found to be the most hazardous factors for the prognosis of the transplanted tooth. Extraction of the transplant was necessary in four cases because of root resorption or poor bone regeneration.

Adolescent↗

PubMed1997

Hydroxyl radical activity in thermo-catalytically bleached root-filled teeth.

Intra-coronal bleaching of root-filled teeth has been associated with invasive cervical root resorption. It is considered that during bleaching hydrogen peroxide diffuses through the tooth structure into the cervical periodontium, resulting in periodontal tissue destruction and initiating a resorptive process. Hydrogen peroxide is capable of generating hydroxyl radical, an oxygen-derived free radical, in the presence of ferrous salts. Hydroxyl radicals are extremely reactive and have been shown to degrade components of connective tissue, particularly collagen and hyaluronic acid. The aim of the present study was to determine whether hydroxyl radicals are generated during the bleaching of root-filled teeth which have been discoloured by blood. Forty extracted human premolar teeth were root-filled with gutta-percha and AH26 sealer cement. Twenty of the teeth were experimentally discoloured by blood. All teeth were then thermo-catalytically bleached using 30% hydrogen peroxide while tooth roots were seated in a test solution of sodium salicylate. Hydroxyl radical generation was determined by the detection of reaction products of this radical with salicylate using high performance liquid chromatography with electrochemical detection (HPLC-ECD). The presence of hydroxyl radicals was detected in twenty-five of the teeth. There was a significant association between the production of hydroxyl radicals and the presence of tooth discolouration caused by blood components. Greatest yields of hydroxyl radicals occurred in teeth in which EDTA had been used to clean the pulp chamber prior to bleaching. It was concluded that hydroxyl radicals are generated during the thermo-catalytic bleaching of root-filled teeth. Generation of this toxic chemical species may be one mechanism underlying periodontal tissue destruction and root resorption after intra-coronal bleaching.

Analysis of Variance↗

PubMed1998

[Injuries to the permanent teeth. Periodontal lesions].

Tooth luxations are relatively common. In case of concussion or subluxation the tooth is not displaced. The treatment will consist of relief of the tooth. Most frequent complications are pulp necrosis and obliteration of pulpal tissues. In case of extrusive luxation pulpal tissues and the periodontal ligament are injured. When tooth mobility is increased flexible splinting should be considered. Endodontic treatment is necessary after extrusive luxation of a tooth with completed root formation. Teeth with open apex often show pulpal obliteration after extensive luxation. Lateral luxation is more complex than extrusive luxation since the alveolar bone is also damaged. Repositioning and splinting of the tooth are necessary. When the apical foramen in closed, endodontic treatment will be necessary. Teeth with incomplete root formation will develop pulp obliteration. Following lateral luxation, external root resorption and loss of marginal bone are not infrequent. Intrusive luxation is the type of trauma with most unfavorable prognosis. All intruded teeth will become necrotic and external root resorption and marginal bone loss are frequent. There is no consensus regarding the therapeutic approach. Orthodontic extrusion or surgical mobilisation are possible options. In case of avulsion, both the pulpal tissues and the periodontal ligament are disrupted. Preservation of the vitality of the periodontal ligament covering the root will determine the prognosis of the reimplanted tooth. Therefore the tooth will be repositioned as soon as possible. When this is not possible, milk or a specific solution are most appropriate for tooth conservation. When the reimplanted tooth has complete root formation, devitalization will be performed one week after after repositioning. In case of a tooth with open apex revascularisation can be awaited. Healing of the periodontal ligament will determine prognosis. When a normal ligament is obtained during healing or when surface resorption is obtained, the tooth can be preserved for a long period. When progressive replacement resorption (ankylosis) develops, most teeth can remain in position for about 10 years. When inflammatory resorption develops, the tooth will be lost within a short time.

Dental Pulp Calcification↗

PubMed1978

Traumatized primary anterior teeth. Prognosis related to calcific reactions in the pulp cavity.

The frequency of a complicating pulp necrosis and the process of the physiologic root resorption were studied in traumatized primary teeth exhibiting partial or total pulp obliteration. The material comprised 88 incisors in 72 children aged 0.7--5.7 years (mean 2.9 years) at the time of injury. Trauma had resulted either in subluxation (25 teeth), or luxation (13 teeth), whereas the type of injury was unknown in 50 teeth. All cases were observed until eruption of the permanent incisors. Forty-four teeth initially displayed a reversible greyish color. The ultimate finding observed in all teeth was, however, varying degrees of yellow discoloration. Periapical pathologic findings indicative of pulp necrosis were observed in 9 teeth, from 1.6--4 years (mean 3 years) after the time of injury. Extraction was performed immediately, and none of the successional teeth showed developmental disturbances. The process of root resorption was classified as normal in all primary teeth. Subsequent eruption of the permanent successors occurred without any registered complications.

Child, Preschool↗

PubMed1998

Computed tomographic features of calcifying odontogenic cysts.

OBJECTIVES: To describe the CT appearances of 4 cases of the calcifying odontogenic cyst (COC) with particular reference to the effect of varying the window settings. METHODS: Conventional radiographs and CT scans of 4 calcifying odontogenic cysts were analyzed with respect to the presence of an impacted tooth, root resorption and calcification. In addition, increased attenuation by desquamated keratin was examined by varying the window settings on CT. RESULTS: All lesions were located in the maxilla and on conventional radiographs, had unilocular radiolucency with a well-defined margin. Calcifications and inclusion of an impacted tooth were seen in all cases. Root resorption was observed in two cases, but was not prominent. On CT, calcification was detected at the periphery of the lesion and/or around the impacted tooth in all cases. Varying the window setting revealed an increased attenuation area due to desquamated keratin. CONCLUSIONS: Varying the window setting on CT is useful as a means of identifying both desquamated keratin and peripheral calcification in COC.

Adolescent↗

PubMed1980

Criteria for diagnosis of pulp necrosis in traumatized permanent incisors.

Records and radiographs of 108 patients (6-18 years) with 134 root canal treated incisors were examined. Subluxation was the most common type of injury, followed by intrusive, extrusive or lingual luxation, exarticulation and uncomplicated crown fracture. Negative response to electric stimulation was noted in 107 teeth from the first examination. In 23 teeth an initial positive response changed to negative within 3 weeks to 9 months, whereas persistent positive reactions were recorded in four teeth. The diagnosis of necrosis was based on the following observations: negative vitality and radiographic changes (76 teeth), negative vitality and discoloration (45 teeth), negative vitality only (nine teeth), positive vitality and radiographic changes (four teeth). External inflammatory root resorption confirmed the diagnosis of necrosis in all replanted teeth and in 13 of 16 intruded teeth. Discoloration and periapical lesions were the most important diagnostic factors following subluxation, extrusive and lingual luxation. Necrosis was disclosed within 4 months in 117 teeth (87%). Diagnoses based on negative vitality and discoloration were made within 6 days to 3 months in all but one case. All external root resorptions and 37 of the 49 periapical lesions were observed within 3 weeks to 4 months of the injury.

Adolescent↗

PubMed1993

Treatment and prognosis of avulsed teeth. A discussion and case report.

A documented case that involves avulsion of an incisor is reported. Calcium hydroxide failed to prevent progressive irreversible root resorption. The importance of extraoral time, transport media, duration and type of splinting, as well as the rationale for the use of calcium hydroxide in the treatment of avulsed teeth are discussed. This case could serve as a reminder to practitioners, that patient compliance, timing and sequencing of endodontic therapy, and regular recalls is critical in the prevention or treatment of root resorption in avulsed teeth. It also emphasizes the frustration of many clinicians in treating avulsed immature teeth. The reporting of long-term documented cases should be encouraged so that replantation techniques may be evaluated.

Animals↗

PubMed2006

Vertical control by combining a monoblock appliance in adult class III overclosure treatment.

Monoblock appliances were used in combination with intermaxillary elastics for treatment of adult skeletal Class III patients. The patients showed predisposing upper incisors problems, significant mobility in patient 1 and root resorption in patient 2, which contraindicated direct intrusion of the incisors. Using the monoblock with selective extrusion of the molars, a clockwise rotation was induced to reduce overbite and to achieve a better profile. It was also possible to reduce the excessive force to the upper incisors during and after treatment, which improved incisor mobility to a physiologic extent (patient 1) and prevented further progression of root resorption (patient 2). Stability was high after the 2-year follow-up, which suggests a stable vertical control approach by using the monoblock appliance in combination with a fixed appliance in adults.

Adult↗

PubMed1993

Experimentally induced dentoalveolar ankylosis in rats.

Dentoalveolar ankylosis is a common complication after replantation of teeth with injured periodontal ligaments. This is a serious complication for the tooth since it leads to progressive root resorption. In young individuals it may also cause infra-occlusion and reduced development of the alveolar process. The purpose of this study was to develop a method applicable to rats in order to follow the effect of systemic and local factors on the development of ankylosis and their possible effect on the length of the functional period of the ankylosed tooth before exfoliation. The maxillary first molars in adult rats were extracted. The periodontal ligaments were devitalized or removed before replantation of the teeth. Dentoalveolar ankylosis was clinically established 2 weeks after replantation. Induction was most reproducible after devitalization or removal of the PDL cells with Dakin's solution and after keeping the rats on a liquid diet up to 3 weeks after replantation. Exfoliation of the teeth usually occurred 6 weeks after replantation. Histological examination showed that the PDL was replaced by bone. The ankylosed teeth showed root resorption to a varying degree. The resorption was in some cases occasionally located in the supra-crestal part of the tooth. A bone-like tissue in the root canal was a rather common finding. In one of the ankylosed teeth cartilage formation was found adjacent to the cementum.

Animals↗

PubMed1980

Vascular response of the periodontal membrane after replantation of teeth.

Thirteen replanted maxillary central incisors were studied by means of histologic and cleared sections to evaluate the pattern of revascularization of the periodontal membrane and the modification of its vasculature due to root resorption, dentoalveolar ankylosis, and periapical processes. Early reparative activity was noted in the apical and cervical parts of the replanted membrane where proliferating vessels were intermingling with reparative cells and interrupted collagenous fibers. These areas of the membrane corresponded with those receiving a better vascular supply after replantation. The middle third of the membrane, however, showed a scarcity or absence of reparative cells as a result of delayed revascularization. Root resorption, dentoalveolar ankylosis, or periapical processes changed both the tissue specificity of the replanted membrane and its pattern of vascular supply. Revascularization of the pulps showed vacuolar degeneration due to lack of nutrition.

Alveolar Process↗

PubMed2005

Evaluation of the prognosis and causes of failure in 182 cases of autogenous tooth transplantation.

OBJECTIVES: Autotransplantation is a viable option for treating missing teeth when a donor tooth is available. The aim of this study was to evaluate the prognosis in addition to the causes of failure in 182 autotransplanted teeth. STUDY DESIGN: A total of 182 cases of autotransplantation were analyzed. All the transplants were performed according to a computer-aided rapid prototyping technique with an average extraoral time of 7.58 minutes. These cases were followed for 2 to 60 months after surgery. The prognosis was divided into 4 groups, complete healing, incomplete healing, uncertain healing, and failure. The initial stability, root resorption, and ankylosis were also analyzed. RESULTS: Most transplanted teeth showed complete healing between postoperative 2 months and 8 months. The transplanted teeth with a good initial stability showed better initial healing than those with a poor initial stability. The average extraoral time was 7.58 min (range: immediately after extraction up to 25 min). There was no relationship (P > .05) between the extraoral time and either root resorption (4 cases, 2.4%) or ankylosis (18 cases, 10.7%) within this experimental time period. Nine cases (4.5%) failed. CONCLUSION: This study showed a 4.5% failure rate during the short to intermediate observation period. Autotransplantation is a very useful method for replacing missing teeth, provided that the extraoral time and other factors are well controlled.

Adolescent↗