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PubMed1995

Platelet-derived growth factor-modulated guided tissue regenerative therapy.

The goal of this study was to develop an effective regenerative therapy capable of achieving periodontal regeneration of Class III furcation defects. We attempted to achieve this goal by combining three therapeutic approaches. First, the lesion was protected by an expanded polytetrafluoroethylene barrier membrane that prevents migration of gingival fibroblasts as well as osteogenic cells from the mucoperiosteal flaps. Second, platelet-derived growth factor-BB (PDGF-BB), which has potent chemotactic and mitogenic effects on periodontal ligament fibroblasts (PDL), was used to promote migration of fibroblasts and their proliferation on the root surface. Third, the root surface, demineralized by citric acid conditioning, was chosen as the primary site for PDGF-BB application. The demineralized root surface appeared to have the capability of providing a sustained release of the applied growth factor. This seemed to facilitate rapid repopulation of PDL fibroblasts on the root surface and new PDL formation in the early stages of repair, which contributed to complete periodontal regeneration without root resorption and ankylosis in later stages. Combining these approaches, we developed a therapy referred to as "PDGF-modulated guided tissue regenerative therapy." Unlike guided tissue regenerative therapy alone (without PDGF-BB), this therapy effectively promoted periodontal regeneration of Class III furcation defects in the beagle dog without significant ankylosis or root resorption.

Animals↗

PubMed1999

Endodontic-orthodontic relationships: a review of integrated treatment planning challenges.

Literature review There is a paucity of information on the concise relationship between endodontics and orthodontics during treatment planning decisions. This relationship ranges from effects on the pulp from orthodontic treatment and the potential for resorption during tooth movement, to the clinical management of teeth requiring integrated endodontic and orthodontic treatment. This paper reviews the literature based on the definition of endodontics and the scope of endodontic practice as they relate to common orthodontic-endodontic treatment planning challenges. Literature data bases were accessed with a focus on orthodontic tooth movement and its impact on the viability of the dental pulp; its impact on root resorption in teeth with vital pulps and teeth with previous root canal treatment; the ability to move orthodontically teeth that were endodontically treated versus nonendodontically treated; the role of previous tooth trauma; the ability to move teeth orthodontically that have been subjected to endodontic surgery; the role of orthodontic treatment in the provision for and prognosis of endodontic treatment; and, the integrated role of orthodontics and endodontics in treatment planning tooth retention. Orthodontic tooth movement can cause degenerative and/or inflammatory responses in the dental pulp of teeth with completed apical formation. The impact of the tooth movement on the pulp is focused primarily on the neurovascular system, in which the release of specific neurotransmitters (neuropeptides) can influence both blood flow and cellular metabolism. The responses induced in these pulps may impact on the initiation and perpetuation of apical root remodelling or resorption during tooth movement. The incidence and severity of these changes may be influenced by previous or ongoing insults to the dental pulp, such as trauma or caries. Pulps in teeth with incomplete apical foramen, whilst not immune to adverse sequelae during tooth movement, have a reduced risk for these responses. Teeth with previous root canal treatment exhibit less propensity for apical root resorption during orthodontic tooth movement. Minimal resorptive/remodelling changes occur apically in teeth that are being moved orthodontically and that are well cleaned, shaped, and three-dimensionally obturated. This outcome would depend on the absence of coronal leakage or other avenues for bacterial ingress. A traumatized tooth can be moved orthodontically with minimal risk of resorption, provided the pulp has not been severely compromised (infected or necrotic). If there is evidence of pulpal demise, appropriate endodontic management is necessary prior to orthodontic treatment. If a previously traumatized tooth exhibits resorption, there is a greater chance that orthodontic tooth movement will enhance the resorptive process. If a tooth has been severely traumatized (intrusive luxation/avulsion) there may be a greater incidence of resorption with tooth movement. This can occur with or without previous endodontic treatment. Very little is known about the ability to move successfully teeth that have undergone periradicular surgical procedures. Likewise, little is known about the potential risks or sequelae involved in moving teeth that have had previous surgical intervention. Especially absent is the long-term prognosis of this type of treatment. During orthodontic tooth movement, the provision of endodontic treatment may be influenced by a number of factors, including but not limited to radiographic interpretation, accuracy of pulp testing, patient signs and symptoms, tooth isolation, access to the root canal, working length determination, and apical position of the canal obturation. Adjunctive orthodontic root extrusion and root separation are essential clinical procedures that will enhance the integrated treatment planning process of tooth retention in endodontic-orthodontic related cases.

Dental Pulp↗

PubMed1999

A method of adapting gutta-percha master cones for obturation of open apex cases using heat.

CLINICAL TECHNIQUE: It is generally accepted that the success of root-canal treatment is mainly dependent on the proper cleaning, shaping and hermetic obturation of root canals. Obturation of the root canal is of importance as 60% of endodontic failures are attributable to incomplete obliteration of the root-canal system. The clinical application of many obturation techniques used today demands the preservation of the natural apical construction or the preparation of an artificial equivalent during chemo-mechanical preparation. However, in clinical practice there are cases where the apical foramen is wide because of over-instrumentation, root-end resection during periradicular surgery, root resorption or because the apex of the root is incompletely formed. Thus the preparation of an artificial apical stop is very difficult to achieve. It is a common experience that performing usual gutta-percha condensation techniques in such canals often results in overfilling and therefore special obturation techniques are needed. Some clinical cases of teeth with wide apical foramen treated by a special obturation method are presented in this paper. In this method the end point of the primary gutta-percha cone is elasticized with a heated instrument and inserted into the root canal to record the internal morphology of the apical portion.

Gutta-Percha↗

PubMed1994

Incidence of invasive cervical resorption in bleached root-filled teeth.

Invasive cervical resorption, a form of external root resorption, has been reported to be associated with intra-coronal bleaching of root-filled teeth and this has raised concerns about carrying out such bleaching procedures. The purpose of the present study was to examine the incidence of invasive cervical resorption in root-filled teeth which had been bleached using a standardized technique. Three observers examined records and radiographs from a total of 158 patients, whose bleaching treatment had been carried out in a specialist endodontic practice. The sample comprised 204 teeth with a review period of between 1 and 19 years. One-hundred-and-fifty-one teeth (77.94 per cent) had an associated history of traumatic injury. All teeth had been treated with a combination of thermocatalytic and 'walking bleach' procedures using 30 per cent hydrogen peroxide. In 54.41 per cent of teeth, gutta-percha and AH26 root-fillings were kept at the height of the cemento-enamel junction while 18.63 per cent were below and 26.96 per cent were above the CEJ. Sealing cement was not placed over the gutta-percha and AH26 root-fillings in any of the teeth in the study. It was found that a total of four teeth from the sample group (1.96 per cent) had developed invasive cervical resorption during the review period. All of these teeth had a history of traumatic injury and the level of gutta-percha was at the CEJ.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1985

Long-term periodontal status of teeth moved into extraction sites.

The present study was undertaken to assess the long-term periodontal status adjacent to teeth that had been moved orthodontically into extraction sites. Twelve persons with a mean age of 29.2 +/- 5.7 (SD) years, who had completed orthodontic therapy at least 10 years previously, were examined. The orthodontic treatment had included bilateral premolar extraction in only the maxilla. Interproximal tooth surfaces in the maxilla adjacent to the extraction sites (study group) were compared to corresponding tooth surfaces in the mandible (control group) with respect to plaque, visual inflammation, bleeding after probing, pocket depth, gingival recession, loss of connective tissue attachment, radiographic bone height, and root resorption. Statistical comparisons were made via analyses of variance and t tests. There were no differences between the groups for any clinical parameter except the presence of less visual inflammation in study subjects. Radiographically, there were no differences in crestal alveolar bone levels measured from the cementoenamel junction. Bone height evaluation by the Bjorn method showed less alveolar support in the study group. However, this was due to the influence of root resorption rather than an effect on crestal height. It was concluded that orthodontic movement of teeth into extraction sites had been without detrimental effect upon the adjacent periodontal status.

Adult↗

PubMed1989

Intrusion of incisors in adult patients with marginal bone loss.

Elongated and spaced incisors are common problems in patients suffering from severe periodontal disease. Thirty patients characterized by marginal bone loss and deep overbite were treated by intrusion of incisors. Three different methods for intrusion were applied: (1) J hooks and extraoral high-pull headgear, (2) utility arches, (3) intrusion bent into a loop in a 0.17 x 0.25-inch wire, and (4) base arch as described by Burstone. The intrusion was evaluated from the displacement of the apex, incision, and the center of resistance of the most prominent or elongated central incisor. Change in the marginal bone level and the amount of root resorption were evaluated on standardized intraoral radiographs. The pockets were assessed by standardized probing and the clinical crown length was measured on study casts. The results showed that the true intrusion of the center of resistance varied from 0 to 3.5 mm and was most pronounced when intrusion was performed with a base arch. The clinical crown length was generally reduced by 0.5 to 1.0 mm. The marginal bone level approached the cementoenamel junction in all but six cases. All cases demonstrated root resorption varying from 1 to 3 mm. The total amount of alveolar support--that is, the calculated area of the alveolar wall--was unaltered or increased in 19 of the 30 cases. The dependency of the results on the oral hygiene, the force distribution, and the perioral function was evaluated in relation to the individual cases. It was obvious that intrusion was best performed when (1) forces were low (5 to 15 gm per tooth) with the line of action of the force passing through or close to the center of resistance, (2) the gingiva status was healthy, and (3) no interference with perioral function was present.

Adult↗

PubMed2002

Radiographic features of large cystic lesions of the jaws in children.

BACKGROUND: The surgical approach to cystic lesions of the jaws is either marsupialisation or enucleation. The treatment of choice is dependent on the size of the lesion, the bony integrity of the cyst and its proximity to anatomical structures. OBJECTIVES: To assess large (>2.0 cm) cystic lesions of the jaws using plain film radiography (PFR), CT, multiplanar reconstruction program (MPR) and three-dimensional CT (3D-CT). PATIENTS AND METHODS: Twelve children aged 7-14 years. RESULTS: The classic radiological feature was a unilocular radiolucent area surrounded by a well-defined radio-opaque margin adjacent to the root of a non-viable tooth or associated with the crown of an unerupted tooth. Malposition of teeth and root resorption were more common in dentigerous cysts. The features seen on CT were clear and more precise than those seen on PFR. MPR, by the three-dimensional visualisation of the jaw (axial, panoramic, and bucco-lingual), provided useful information for determining the outline of the cyst and its proximity to adjacent anatomical structures, such as teeth, nerves or maxillary sinus. 3-D CT further and more clearly demonstrated discontinuity in the buccal or palatal/lingual cortices of the jaw bone. PFR was very accurate in determining root resorption. CONCLUSIONS: CT with MPR and, ideally, 3-D CT should be used for the comprehensive diagnostic work-up and meticulous surgical management of large cystic lesions of the jaws in children.

Adolescent↗

PubMed1993

Maxillary incisor crown-root relationships in different angle malocclusions.

The long axis of the maxillary incisor root is not always identical to that of the crown. Instead, there is appreciable variation in the crown-root angle, generally with the crown torqued lingual to the root axis. In orthodontic cases assessed before and at the end of full-banded treatment, the crown-root angle was significantly deflected in the Class III molar relationship series, notably so in moderate to severe cases where the maxillary incisors are constrained lingual to the lower arcade. Apical root resorption was not significantly associated with the crown-root angle before or after comprehensive orthodontics. Cephalometric predictors of the amount of deflection of the crown-to-root axis were localized to intertooth relationships (overjet, interincisal angle). It is proposed that the large collum angles in Class III cases develop during tooth eruption when the maxillary incisors are trapped within the lower arch; this torques the crown of the maxillary incisor but leaves the unmineralized portion of the root free to develop as if the crown were still in its prior, more procumbent orientation.

Adolescent↗

PubMed1986

Allogeneic tooth transplantation in the dog.

Allogeneic tooth transplantation was evaluated as a functional and aesthetic treatment for dental fracture in the dog. Of 7 dogs that received tooth transplants, 5 were research animals and 2 were clinical patients. Canine teeth were transplanted immediately after extraction in the research dogs. Endodontic therapy had been performed on the affected canine tooth of one clinical patient. The other clinical patient had bilateral maxillary canine fractures 2 months earlier. One of the research dog transplants failed at 3 weeks as a result of improper surgical technique. Four of the research dogs had a solid implant for 18 months, after which time the dogs were euthanatized serially. All transplanted teeth were anchored firmly into the alveoli, but were nonviable. Root resorption, with bone replacement, was first noticed at 24 months. The transplanted tooth in the first clinical patient remained functional for 3 months, after which time the tooth was fractured. The right canine transplant in the second clinical patient failed by 3 months, probably because of preexisting periapical inflammation. The left transplanted tooth remains stable at 38 months. It was concluded that allogeneic tooth transplantation may have merit as a rapid and inexpensive method for replacement of fractured teeth in the dog. Function is compromised gradually as a result of root resorption and ankylosis, with tooth fracture likely to occur after 2 years.

Animals↗

PubMed2000

Periodontal health of orthodontically extruded impacted teeth. A split-mouth, long-term clinical evaluation.

BACKGROUND: Impaction of front teeth (often upper canines) can result in esthetic, functional, and phonetic problems, in addition to root resorption and chronic or acute infections. Most impacted front teeth can be extruded orthodontically after minor periodontal surgery. The purpose of this retrospective study was to examine the periodontal outcome of surgically exposed and orthodontically extruded impacted teeth compared with the spontaneously erupted contralateral teeth. METHODS: A total of 38 patients, who had been treated by a combined surgical and orthodontic approach (closed eruption technique by same periodontist and 2 associated orthodontists), underwent a periodontal re-examination after 4 to 10 years. Periodontal parameters (plaque and gingivitis indices, probing depth, bleeding on probing, gingival recession and width, bone level, and root resorption) of the orthodontically extruded teeth (test) were scored and compared with those of the contralateral naturally erupted teeth (control) in a masked set-up. RESULTS: No significant differences could be detected between test and control teeth, except for the gingival width, which was 1 mm larger for the spontaneously erupted teeth. CONCLUSIONS: The data indicate that orthodontic extrusion of impacted front teeth does not jeopardize their periodontal health. This procedure appears to be a satisfactory alternative to extraction and/or transplantation.

Adolescent↗

PubMed1989

[DMF study on extracted deciduous teeth].

The aim of the present investigation was to study the number of the carious surfaces of extracted primary teeth in order to determine component m in the dmf-s index. Altogether 903 deciduous teeth were examined under artificial light with a dental probe. The surfaces were evaluated separately. The examined teeth were divided into two groups according to the amount of root resorption. On the basis of the present study the following conclusion can be drawn: 1. The average of df surfaces of molars was 2.34, whereas it was 0.74 at the front teeth. The df number shows practically only caries, because filled surfaces were found in only 1.99% of the cases. 2. In any type of the teeth df lesions were the rarest on the vestibular and oral surfaces. 3. Caries (filling) was found most frequently on the occlusal surfaces of the upper and lower 1st molars. Caries (filling was the rarest on the vestibular surfaces of the upper 1st and 2nd molars. 4. The amount of root resorption did not show much influence on the df score. 5. During the calculation of the dmf-s average of the primary teeth the m value can be substituted for 2.0.

Child↗

PubMed1999

The effect of thyroid hormone on orthodontic tooth movement in rats.

The major goals of this study were to determine the effects of different doses of thyroxin on the rate of orthodontic tooth movement and the force-induced root resorption. In this study fifty male Sprague--Dawley rats were divided into five groups: a normal group with no intervention; a control group in which appliances were placed and 10 ml/kg i.p./day normal saline was injected; and three thyroxin groups in which appliances were placed and 5, 10 and 20/microgram/kg i.p./day L-thyroxin were administered, respectively. A fixed orthodontic appliance consisting of a 5 mm closed-coil spring was ligated between the maxillary incisor and maxillary first molar to deliver an initial force of 60 gm. The results showed that administration of 20/microgram/kg i.p./day L-thyroxin significantly increased the amount of orthodontic tooth movement (p < 0.001). The extent of root resorption as seen from scanning electron micrographs decreased with thyroxin administration.

Absorptiometry, Photon↗

PubMed2000

Ferric sulfate as pulpotomy agent in primary teeth: twenty month clinical follow-up.

Seventy primary molar teeth, carious exposed, symptom free, without any sign of root resorption in children aged from 3 to 6 years (main age 4.3 yr) were treated with conventional pulpotomy procedures. Ferric sulfate 15.5% solution (applied for 15 second for 35 teeth) and formocresol solution (five minute procedure of Buckley's formula for next 35 teeth) have been used as pulpotomy agents. In both groups, pulp stumps were covered with zinc-oxide eugenol paste. Permanent restorations were stainless steel crowns. Clinical check up was every three-months and radiographic follow-up time was six and twenty months after treatment. Our results within this period revealed 100% clinical success rate in both groups. Radiographic success rate was in both groups 97.2%, while in 2.8% cases has shown internal root resorption. On the basis of these results, we can recommend ferric sulfate as a pulpotomy agent in primary teeth in substitution for formocresol at the moment.

Child↗

PubMed1987

Tooth resorption associated with the eruption of maxillary canines.

Six cases of root resorption of lateral incisors, associated with buccally displaced maxillary canines are presented. In each case, the clinical appearance is described followed by a discussion drawing attention to the possible common features and the importance of a detailed radiographic investigation.

Adolescent↗

PubMed1991

In vitro efficacy of sodium perborate preparations used for intracoronal bleaching of discolored non-vital teeth.

Bleaching materials containing 30% hydrogen peroxide have been used successfully for the treatment of discolored non-vital teeth. Intracoronal application of these materials was occasionally associated with the development of external root resorption. Extracted human teeth with intact crowns were discolored in vitro and bleached with three preparations of sodium perborate. These preparations included: sodium perborate with 30% hydrogen peroxide, sodium perborate with 3% hydrogen peroxide and sodium perborate with water. The bleaching materials were placed in the pulp chamber of the discolored teeth and sealed with IRM for 14 days. They were replaced with fresh preparations after 3 and 7 days. The coronal tooth shades were evaluated after 3, 7 and 14 days and a comparison of the bleaching success of the groups was made at each interval. It was found that after 14 days and three bleachings there was no significant difference in success between the groups. It is therefore recommended that sodium perborate be used in combination with water rather than with hydrogen peroxide to reduce the risk of post-bleaching external root resorption.

Borates↗

PubMed2001

Re-inventing intentional replantation: a modification of the technique.

Intentional Replantation (IR) has traditionally been considered a treatment of last resort due to complications during extraction, handling, and replantation. Root resorption and failure often resulted from drying of the root surface during extraoral manipulations. Replantation techniques have been recently modified to prevent desiccation. This article presents a modified IR technique with continuous immersion of the tooth in a tissue culture solution. This allows extension of the extraoral time period to permit inspection of the root surfaces, precise root-end resections and preparations, and placement of root-end fillings.

Adult↗

PubMed1999

Clinical, radiologic, and histopathologic features of invasive cervical resorption.

Invasive cervical resorption is a relatively uncommon form of external root resorption. There may be no external signs, and the resorptive condition is often detected by routine radiographic examination. Where the lesion is visible, the clinical features vary from a small defect at the gingival margin to a pink coronal discoloration of the tooth crown resulting in ultimate cavitation of the overlying enamel. The condition is usually painless unless pulpal or periodontal infection supervenes. Radiographic features of lesions vary from well-delineated to irregularly bordered mottled radiolucencies, and these can be confused with dental caries. A characteristic radiopaque line generally separates the image of the lesion from that of the root canal, because the pulp remains protected by a thin layer of predentin until late in the process. Histopathologically, the lesions contain fibrovascular tissue with resorbing classic cells adjacent to the dentin surface. More advanced lesions display fibro-osseous characteristics with deposition of ectopic bonelike calcifications both within the resorbing tissue and directly on the dentin surface. Secondary invasion of microorganisms into the pulp or periodontal ligament space will elicit a normal inflammatory response.

Adolescent↗

PubMed1985

Central odontogenic fibroma. A case report.

A case of central odontogenic fibroma is reported. The clinical, radiological and pathological features are discussed. It is of particular interest because of its maxillary location and the severe external root resorption associated with the tumour.

Adult↗