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PubMed2004

Federal University of Santa Catarina follow-up management routine for traumatized primary teeth -- part 1.

The objective of this study was to verify if the follow-up management routine of traumatized primary teeth set up by Federal University of Santa Catarina, which performs clinical and radiographic assessments (15 and 45 days; 4, 8 and 12 months) after the oral trauma, enabled an early diagnosis of sequelae which would indicate the need for endodontic intervention, as well as the influence a type of trauma and the child's age could have in the severity of the sequelae. In this study 52 sets of records were used of patients being seen in the last 6 months, with a total of 70 teeth that were receiving follow-up treatment. Patients returned for regular visits set up by the management routine, where clinical and radiographic examinations were performed to check for sequelae, which justified endodontic intervention. Mobility (51.2%) and crown discoloration (25.6%) were the most common sequelae found in the patient's first appointment. In the follow-up visits, replacement root resorption (22.5%) was the second most common sequela found, suggesting endodontic intervention. No significant association was found between severe sequelae, types of trauma and a child's age (chi(2) = 0.3, P = 0.8613). During the intervals of the follow-up visits, it was noticed that between 46 days and 8 months a higher number of sequelae were diagnosed (P < 0.05). The diagnosis of sequelae such inflammatory and replacement root resorption, which can lead to an early loss of a primary tooth, are frequent and that the interval between the follow-up visits has to be changed, suggesting the setting up of management routine 2. The study also concluded that the type of trauma and the child's age are not fundamental factors in the diagnosis of severe sequelae.

Child, Preschool↗
PubMed1994

Periodontal repair in dogs: space provision by reinforced ePTFE membranes enhances bone and cementum regeneration in large supraalveolar defects.

Regeneration of alveolar bone and cementum following reconstructive therapy with reinforced space providing expanded polytetrafluorethylene (ePTFE) membranes was evaluated in supraalveolar mandibular premolar periodontal defects in five beagle dogs. The surgically-created defects in contralateral jaw quadrants were randomly assigned to receive the dome-shaped membrane or serve as surgical control. Flaps were positioned to completely submerge the teeth and sutured. The dogs were sacrificed 8 weeks after surgery and tissue blocks including teeth and surrounding structures processed for histology. Membrane treated defects in two animals became exposed and infected leaving intact quadrants in three dogs for histometric analysis. Parameters evaluated included defect height, height and area of regenerated alveolar bone, height of regenerated cementum, root resorption, and ankylosis. Mean defect height approximated 4.1 mm. Mean height (+/- s.d.) of regenerated alveolar bone amounted to 2.9 +/- 0.6 and 0.6 +/- 0.2 mm for membrane and control defects, respectively (P = 0.006). Corresponding values for bone area were 1.4 +/- 0.7 and 0.4 +/- 0.4 mm2 (P = 0.02). Cementum regeneration was observed in all teeth averaging (+/- s.d.) 1.6 +/- 0.3 mm for membrane treated and 0.1 +/- 0.1 mm for control defects (P = 0.01). Small amounts of root resorption were seen in all teeth with no significant difference between treatments. Ankylosis was noticed in three membrane treated and two control teeth. The present study provides a biologic rationale for space provision for enhanced bone and cementum regeneration in periodontal defects subject to reconstructive therapy.

Alveolar Bone Loss↗
PubMed1991

pH variation among materials used for intracoronal bleaching.

Intracoronal bleaching of pulpless teeth with 30% hydrogen peroxide may result in external cervical root resorption. One of several suggested etiological factors associated with this complication is the pH of the bleaching materials. Because the available data on the pH values of bleaching materials were conflicting, it was the purpose of this study to measure the pH of the materials commonly used for bleaching pulpless teeth. The pH of different concentrations of sodium perborate and 30% hydrogen peroxide, alone or in combination, were measured for a period of 14 days. Sodium perborate was confirmed to be alkaline, whereas 30% hydrogen peroxide was acidic. The pH of the materials when mixed together gradually changed from acidic to alkaline as the concentration of sodium perborate was increased. A thick clinical consistency mixture of both materials was alkaline, and its alkalinity increased with time. These results do not support the theory relating bleaching-induced root resorption to an acidic pH of the bleaching pastes.

Borates↗
PubMed1994

Clinical and histological evaluation of ligature-induced periodontitis in the domestic ferret.

The aim of this study was to evaluate the clinical and histological characteristics of ligature induced periodontitis in 12 domestic ferrets. On day 0, silk ligatures were placed at the gingival margin level of selected experimental teeth. The contralateral teeth served as control teeth. On day 14, 4 animals and on day 28, 8 animals were sacrificed. Clinical measurements including gingival index (GI), probing pocket depth (PPD) and probing attachment level (PAL) were taken in 5 animals on days 0, 14 and 28. Histological sections were prepared for light microscopy. The histometric measurements performed were (1) the distance between the cemento-enamel junction (CEJ) and the alveolar bone crest and (2) the distance between CEJ and connective tissue attachment level. The number of sections with root resorption areas was also observed. Cell counts were taken in 4 different areas. Clinical results showed, on days 14 and 28, a significant increase of the mean values of PPD and PAL at the experimental teeth when compared to the control teeth. The histometric results showed a significant loss of connective tissue attachment and bone loss in the experimental teeth on day 14. On day 28, the results were similar, although more sections with root resorption areas were observed in the experimental teeth. The predominant inflammatory cell in all the 4 experimental areas analyzed was polymorphonuclears (PMN), and they were mainly increased in areas closely related to the junctional epithelium. The results indicate that the domestic ferret may be used as an experimental animal in the ligature-induced periodontitis model.

Alveolar Bone Loss↗
PubMed1990

[An experimental study on healing process of replanted mature permanent teeth. Changes of periodontal vascular network].

This study was conducted to clarify both changes of periodontal vascular architecture and concomitant remodelling phenomena associated with hard tissues in the healing process of replanted teeth of first premolar. Utilizing both vascular corrosive resin casts method, scanning electron microscopy, and histological examinations, 45 matured mongrel dogs were used for this study. The results were as follows: 1. 4 days after operation: Newly formed vascular networks with a exceedingly irregular course were observed on lower two thirds of the alveolar wall. They derived from comparatively less damaged periodontal vascular components. No vascular networks were observed surrounding in the crevicular area of the replanted tooth where the periodontal membrane tissue was thoroughly damaged when tooth was extracted. 2. 1 week after operation: Newly formed periodontal vascular networks with a slightly irregular course were observed over the entire alveolar bone surface. 3. 2 weeks after operation: Formation of Sharpey's fibers occurred. The surrounding alveolar bone was remodelled and rearrangement of periodontal vascular architecture was observed. Also, several Howship's lacunae were observed on the root surface where characteristic capillary loops with glomerular-like appearance penetrated into these lacunae. 4. 3 weeks after operation: Root resorption was advanced and capillary loops with glomerular-like appearance were extensively distributed in association with each lacunae. On the other hand, the less space where periodontal membrane vasculature occupied, the more space was occupied by osteoid tissue. 5. 4 weeks after operation: Blood vessels within the periodontal space were reduced in number and the osteoid tissue showed bony fusion adjacent to the extensively resorbing surface of dentin. 6. 12 weeks after operation: Functional arrangement of Sharpey's fibers was completed. Restoration of Howship's lacunae on the root surface and two layered arrangements of vascular network within the periodontal space were observed. Newly formed periodontal vascular architecture showed a fine meshwork pattern, which was somewhat different from that of the control (noreplantation) group. 7. 20 weeks after operation: Increased number of capillary loops was observed with leakage of methacrylate resin through the weakened endothelial linings of capillaries in one case. It is supposed that this leakage through capillaries is correlated with the inflammatory root resorption that occurs clinically in marginal periodontitis. Also in some cases, periodontal capillary network showed secondary occlusal traumatic changes. Above results indicated that periodontal vascular architecture varied depending upon the reactions of periodontium following tooth replantation and the prognosis of replanted tooth was deeply associated with repair of periodontal vascular network.

Alveolar Process↗
PubMed1998

Periodontal repair in dogs: effect of allogenic freeze-dried demineralized bone matrix implants on alveolar bone and cementum regeneration.

The objective of this study was to evaluate alveolar bone and cementum regeneration following surgical placement of an allogenic, freeze-dried, demineralized bone matrix (DBM) cortical strip implant. Critical size, supraalveolar periodontal defects were surgically created around the second, third, and fourth mandibular premolar teeth in eight mongrel dogs. Contralateral jaw quadrants in six animals were randomly assigned to receive the DBM implant, or serve as surgical control. Two additional animals received bilateral DBM implants. Flaps were coronally advanced to submerge teeth and implants, and sutured. Three animals were exited from the study due to extensive early wound failure. Remaining animals were sacrificed at 8 weeks postsurgery. Histometric recordings included defect height, bone regeneration/DBM implant height, cementum regeneration height, root resorption, and ankylosis. Large areas of unresorbed DBM exhibiting fragmentation and empty osteocyte lacunae were observed adjacent to new bone formation, or bone formation was observed adjacent to or within the implant, often exhibiting ankylosis. Cementum regeneration appeared enhanced in shelter of the DBM implant. Histometric recordings (mean+/-SD) for DBM and control defects, respectively, were: defect height, 4.8+/-0.2 mm and 4.4+/-0.2 mm; bone regeneration/DBM implant height, 4.0+/-1.3 mm and 1.2+/-0.6 mm; cementum regeneration height, 1.4+/-0.4 mm and 0.7+/-0.2 mm; root resorption, 0.5+/-0.3 mm and 1.2+/-0.3 mm; and ankylosis, 0.5+/-0.2 mm and 0.1+/-0.1 mm without statistically significant differences between experimental conditions (N=3). Within the limitations of this study, the histologic observations suggest that surgical implantation of allogenic, freeze-dried DBM cortical strip implants may have a potential to support cementum regeneration, possibly by providing conditions for guided tissue regeneration, however, alveolar regeneration appears unpredictable.

Alveolar Bone Loss↗
PubMed1999

Periodontal repair in dogs: histologic observations of guided tissue regeneration with a prostaglandin E1 analog/methacrylate composite.

This report describes observations of healing following guided tissue regeneration (GTR) including surgical implantation of the prostaglandin E1 analog misoprostol with calcium-layered methacrylate particles. Critical size, supra-alveolar periodontal defects were surgically created around the 3rd and 4th mandibular premolar teeth in 4 beagle dogs. Wound management included soaking with a 24 microg/ml misoprostol solution and implantation of the misoprostol/methacrylate composite. One jaw quadrant per animal was prepared for GTR using expanded polytetrafluoroethylene membranes. The gingival flaps were coronally advanced and sutured to submerge the teeth. The tissues covering the surgical sites daily received topical misoprostol in an oral adhesive over the 4-week healing interval. Upon euthanasia, tissue blocks were prepared for histometric analysis of regeneration of alveolar bone and cementum, root resorption and ankylosis. The defect area underneath the membrane and the density of methacrylate particles were recorded for the GTR defects. The methacrylate particles appeared encapsulated in a dense connective tissue without signs of an inflammatory reaction, some in contact to newly formed bone. Alveolar bone regeneration height averaged (+/-SD) 1.2+/-1.0 and 1.0+/-0.6 mm for GTR and non-GTR defects, respectively. Corresponding values for bone regeneration area were 1.3+/-1.0 and 0.7+/-0.5 mm2. Cementum regeneration was confined to the apical aspect of the defects. Small areas of root resorption and ankylosis were observed for all teeth. Bone regeneration area correlated positively to the defect area and negatively to the density of methacrylate particles in the GTR defects. The histologic observations suggest that the methacrylate composite has marginal potential to promote bone and cementum regeneration under provisions for GTR.

Alveolar Bone Loss↗
PubMed1995

Periodontal repair in dogs: recombinant human bone morphogenetic protein-2 significantly enhances periodontal regeneration.

This study evaluated bone and cementum regeneration following periodontal reconstructive surgery using recombinant human bone morphogenetic protein-2 (rhBMP-2) in six beagle dogs. Surgically created mandibular supraalveolar premolar tooth defects in contralateral jaw quadrants were randomly assigned to receive rhBMP-2 or control vehicle. Clinical defect height was prepared to 5 mm. rhBMP-2 was applied with synthetic bioerodable particles and autologous blood using 20 micrograms rhBMP-2 per 100 microliters implant volume. Flaps were advanced to submerge the teeth and sutured. The dogs were sacrificed 8 weeks postsurgery. Histometric recordings included defect height, height and area of alveolar bone regeneration, height of cementum regeneration, root resorption, and ankylosis. Group means, standard deviations, and P values are shown (Student t test; n = 6). Histometric defect height for rhBMP-2 and control defects was 3.7 +/- 0.3 and 3.9 +/- 0.4 mm, respectively (P = 0.446). Height of alveolar bone regeneration amounted to 3.5 +/- 0.6 and 0.8 +/- 0.6 mm for rhBMP-2 and control defects, respectively (P = 0.000). Corresponding values for bone area were 8.4 +/- 4.5 and 0.4 +/- 0.5 mm2, respectively (P = 0.006). Cementum regeneration was observed in all experimental defects (17/17) and in 15 out of 17 controls, averaging 1.6 +/- 0.6 and 0.4 +/- 0.3 mm for rhBMP-2 and control defects, respectively (P = 0.005). Small amounts of root resorption were seen in rhBMP-2 defects, whereas controls exhibited substantial resorption (0.2 +/- 0.1 and 1.1 +/- 0.3 mm, respectively; P = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Alveolar Bone Loss↗
PubMed1989

[Application of calcium phosphate ceramics to periodontal therapy. 8. Effects of orthodontic force on repaired bone with hydroxyapatite].

It has been unclear whether M.T.M. is acceptable for patients treated with bone grafts using hydroxyapatite (HAP), which is not biodegradable. Therefore we studied histological changes in bone among HAP during orthodontic tooth movement. HAP was implanted into artificial bone defects adjacent to second premolars in beagle dogs, and as a control no material was implanted Three months after implantation, the second premolars were moved with orthodontic force. Then they were observed histopathologically. The results obtained were as follows. The amount of movement of the teeth in implanted sites was less than in the controls. In the pressure zone, resorption of bone by osteoclasts was observed in both the implanted and the control sites, in addition, root resorption occurred adjacent to HAP. Furthermore multinucleated giant cells were closely attached to HAP and were surrounded by bone and connective tissue. In retention period there was ankylosis between the roots and bone around HAP. In the tension zone, additional bone from HAP was observed. Bone defects were filled with bone in the implanted sites, but with connective tissue in the controls. These results suggest that bone among HAP was resolved by osteoclasts. Clinically, HAP implantation for the pressure zone should be avoided because of the occurrence of root resorption and ankylosis. But for the tension zone it seems to be effective because HAP implantation produces more repaired bone.

Animals↗
PubMed1998

Effect of orthodontic appliance reactivation during the period of peak expansion in the osteoclast population.

BACKGROUND: Delays in the appearance ofosteoclasts at compression sites occur following orthodontic appliance reactivation when this is done during the period of osteoclast recruitment. This study examined changes in alveolar bone after appliance reactivation at a time coinciding with the peak expansion of the osteoclast population following the first appliance activation. METHODS: Orthodontic appliances were activated with 40 g on maxillary molars followed by a reactivation with the same force after 4 days in one group and sham reactivation in the other. Rats were killed at 0, 1, 3, 6, and 10 days thereafter. Orthodontic movement was measured cephalometrically. TRAP and interleukin-1 alpha (IL-1alpha) were measured biochemically, and changes in osteoclasts and root resorption were assessed at both compression and tension sites histomorphometrically. RESULTS: Teeth in the reactivated group displayed more initial displacement than controls but no more tooth movement 10 days following appliance reactivation. Also, increases in osteoclast numbers and surface percent, as well as alveolar bone Tartrate-resistant acid phosphatase (TRAP), became evident in the treated animals only 10 days after reactivation. However, IL-1alpha was elevated in alveolar bone within 1 hr following appliance reactivation but returned to baseline by day 1. There were no treatment-related difference in nuclear number per osteoclast or trabecular surface per osteoclast. Significant treatment-related increases in root resorption were evident at compression sites by day 10. CONCLUSIONS: These findings indicate that after appliance reactivation during the height of osteoclastic stimulation, a second cohort of osteoclasts can be recruited, but only after a delay of several days. This delay is not due to a failure to produce IL-1alpha in the tissues.

Acid Phosphatase↗
PubMed2003

Experimental autogenous tooth transplantation in the dog: a comparison between one- and two-stage surgical techniques.

Crucial if tooth transplantation is to succeed is preservation of the vitality of the cells of the periodontium and cementum of the tooth graft. Poor contact between the tissues of the recipient site and the root surface when teeth are transplanted to recipient sites prepared immediately prior to transplantation (one-stage technique) could, after transplantation, result in insufficient nutrition to the cells of the root surface and contribute to necrosis of the cells. To improve nutrition, tooth transplantation to recipient beds left to heal for 14 days was performed (two-stage technique). Clinical trials of tooth transplantation by the two-stage technique resulted in a low incidence of tooth graft loss and root resorption. The different results between these two methods, as well as difficulties in evaluating clinical trials, called for an experimental model to be established. In 5 beagle dogs, fully developed autogenous teeth were transplanted using both one-stage and two-stage surgical techniques. The control teeth were transplanted by the one-stage method to recipient beds prepared immediately before transplantation. The test teeth were transplanted using the two-stage method to recipient beds prepared and left to heal for 5 days prior to transplantation. Four pairs of teeth (1 test and 1 control) were transplanted in each dog. One pair of incisors and one pair of premolars were transplanted in the maxilla and in the mandible. Altogether 20 pairs of teeth were included in the study. One pair of teeth fractured during extraction and was therefore excluded from the study. Two pairs of teeth were lost in the first hours after transplantation. Evaluation of the remaining 17 pairs of teeth was made by routine histological examinations after a 6-month period of healing. The blinded examination failed to show a difference between the two surgical methods in terms of frequency of various types of root resorption. The differences between the results after long-term observation of human teeth transplanted by the one- and two-stage tooth transplantation techniques were not found by this experimental model.

Animals↗
PubMed2002

Effect of surgical implantation of recombinant human bone morphogenetic protein-2 in a bioabsorbable collagen sponge or calcium phosphate putty carrier in intrabony periodontal defects in the baboon.

BACKGROUND: Recombinant human bone morphogenetic protein-2 (rhBMP-2) in a proper carrier has been shown to induce clinically relevant bone formation for several oral/maxillofacial and periodontal indications and to stimulate regeneration of the periodontal attachment. The objective of this study is to evaluate regeneration of alveolar bone, cementum, periodontal ligament, and associated root resorption and ankylosis following surgical implantation of rhBMP-2 in an absorbable collagen sponge (ACS) or a calcium phosphate putty (alphaBSM) carrier in 3-wall intrabony periodontal defects in the baboon. METHODS: rhBMP-2/ACS and rhBMP-2/alphaBSM were implanted in surgically produced, maxillary and mandibular, large size, 3-wall intrabony defects in 4 baboons. Contralateral jaw quadrants were implanted with buffer/ACS, buffer/ alphaBSM, or served as sham-operated surgical controls. Treatments were allocated to left and right, maxillary and mandibular, jaw quadrants following a randomization schedule. Four months following implantation, block biopsies of defect sites were obtained, processed, and subjected to histologic and histometric analysis. RESULTS: Defect sites receiving rhBMP-2/ACS and rhBMP-2/alphaBSM demonstrated significantly greater regeneration than controls. No significant differences were observed between defect sites receiving rhBMP-2/ACS or rhBMP-2/alphaBSM regarding epithelial migration and connective tissue attachment and new bone formation. However, rhBMP-2/ACS supported significantly greater new cementum formation. Ankylosis or root resorption were not observed. CONCLUSIONS: The results of this study support the use of rhBMP-2 to enhance periodontal regeneration of intrabony periodontal defects. While this novel technology holds promise, refinement in carrier systems may provide the key to enhancement of the regenerative potential.

Alveolar Bone Loss↗
PubMed1995

The effects of exogenous prostaglandins on orthodontic tooth movement in rats.

The long-term effects of varying concentrations and frequencies of injectable, exogenous prostaglandin E2 (PGE2) on the rate of tooth movement and the amount of root resorption were evaluated. There were 132 male Sprague-Dawley rats 8 weeks old that initially weighed 225 to 250 gm. Five animals were in a pilot study, while seven were baseline controls and eight were appliance controls. The remaining 112 animals were divided into two experimental time periods of 2 and 4 weeks. Then, each experimental time period was divided into four subgroups of 14 animals based on concentration levels of PGE2 injections, i.e., 0.1, 1.0, 5.0 and 10.0 micrograms. Half of these animals in the dosage subgroup received a single injection at appliance placement and the other half received weekly injections. A fixed orthodontic appliance consisting of closed-coil nickel-titanium springs were ligated between the maxillary incisors and maxillary first molars. The initial activating force was 60 gm. The results showed that injections of exogenous PGE2 over an extended period of time in rats did enhance the amount of orthodontic tooth movement. However, there was no statistically significant difference in tooth movement between the single and multiple injection groups or among the four concentration levels of PGE2 used in either the 2- or 4-week time periods. The amount of root resorption as seen from scanning electron micrographs did increase with the use of prostaglandin injections, specifically with increased numbers of injections and with increased concentrations of PGE2.

Anesthetics, Local↗
PubMed1985

Clinical observations regarding the treatment of traumatically avulsed mature teeth. Part 2.

Two documented cases involving avulsions of an incisor and a cuspid are reported. Long-term observations following replantations indicated factors in addition to those reported in Part 1 of this study. Endodontic metallic implants may retard the intrusive process. A fixed-bridge splint also appears to have retarded the ankylosis phenomenon. The three case reports in the two parts of this study indicated that splint time may not be a critical factor in the prognosis of replanted teeth. Calcium hydroxide failed to prevent early root resorption and eventual ankylosis in an early replantation case; the other two cases, with longer replant time, fared better without calcium hydroxide. Endodontic treatment of avulsed teeth soon after replantation is suggested; a time period of several weeks does not appear critical to the prognosis. Removal of the apical root segment prior to replantation does not appear to affect the replacement root resorption process. The reporting of long-term documented cases should be encouraged in order that replantation techniques may be evaluated.

Adult↗
PubMed2004

Absence of apical resorption during orthodontic treatment on a tooth with a complicated crown fracture and root canal treatment: a case report.

Root resorption often occurs after tooth trauma and may also occur during orthodontic tooth movement. This has been attributed to bacteria and inflammation or a combination of both aetiologies. The literature suggests that root canal treatment performed on a traumatized tooth that will concurrently or subsequently undergo orthodontic tooth movement may forestall the resorptive process. This case report provides evidence for this prevention and discusses the hypothesis for the absence of resorption on root-treated teeth.

Adolescent↗
PubMed1991

A study on citric acid as a proposed replacement resorption inhibitor.

The material consisted of 36 one-rooted immature teeth in 6 mongrel dogs. 12 teeth were immediately replanted after extraction, while 24 teeth were extracted and stored dry for 120 min before re- or autotransplantation. Root planing and topical citric acid treatment of the root of dry-stored teeth did not prevent the development of progressive root resorption and ankylosis, not even when special care was taken to prevent damage to the superficial, demineralized layer of the root during and after the transplantation procedures in an experimental model, which included autotransplantation of teeth to sockets, which were much larger than their original sockets.

Alveolar Process↗
PubMed1994

The role of guided tissue regeneration and guided bone regeneration.

The goal of periodontal therapy includes not only the halting of the progressive loss of connective tissue attachment but also the restitution of those parts of the supporting apparatus which have been destroyed. The cells which repopulate this area may originate from any number of the different tissue components of the periodontium: the dentogingival epithelium, the gingival connective tissue, the alveolar bone, and the periodontal ligament (PDL). The size and shape of the wound and the potential of the different types of tissues cells to migrate, determines the type of healing. Previous studies have revealed that root resorption was found to occur when granulation tissue derived from the gingival connective tissue or alveolar bone was proliferating into contact with the root surface, while re-epithelialization of the surface prevented both connective tissue attachment and root resorption. The only cells which appear to have the capacity to form a new attachment were cells originating from the PDL. Based on this knowledge of the biological behaviour of the different periodontal tissues during wound healing, the principle of Guided Tissue Regeneration (GTR) was introduced and tested. A membrane section was placed over the debrided root surface in such a way that all periodontal tissues except the PDL cells were prevented from reaching contact with the root. Healing resulted in extensive amounts of new connective tissue attachment, that is, the formation of new cementum with inserting collagen fibres. The objective was, and is, assessment of how predictably new attachment may form when treatment included GTR.(ABSTRACT TRUNCATED AT 250 WORDS)

Alveolar Bone Loss↗