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Ultrastructural localization and gradient of activity of alkaline phosphatase activity during rodent odontogenesis.

The ultrastructural localization and gradient of activity of alkaline phosphatase were studied with respect to cell differentiation, matrix synthesis, and matrix mineralization in the incisor and molar teeth of 4-day-old Sprague-Dawley rats. The animals were perfused intracardially at room temperature with 2.5% glutaraldehyde in 0.1M sodium cacodylate (pH 7.4) with 3-4% sucrose. The jaws were dissected, immersion-fixed for 24 h, and the incisor and molar tooth germs removed. These were determined in 10% EDTA in NaOH (pH 7.4) with 7% sucrose. After reactivation of the enzyme with 0.1M MgCl in Tris-maleate buffer (pH 7.4) at 4 degrees C, the medium consisting of 6 ml 3% sodium beta-glycerophosphate, 4 ml 0.2M Tris-HCl buffer (pH 9.2), 3 ml 1.6% MgSO4, 12 ml 0.5% lead citrate (pH congruent to 12), and 2.1 g sucrose. The pH was adjusted to 9.2 with 0.2M HCl, the volume made up to 30 ml, and the solution centrifuged for 10 min at 5000 rpm. Control teeth were incubated in medium minus the substrate. Finally, the specimens were routinely post-fixed and embedded for sectioning and examination with a Philips 300 electron microscopy. A gradient of alkaline phosphatase activity was mapped along the developing teeth in the cells of the stratum intermedium, the proximal borders of the ameloblasts, the early dentine matrix, the predentine-dentine border, matrix vesicles, and the plasma membranes of odontoblasts and subodontoblast cells. The gradient of alkaline phosphatase activity was evident in the forming tooth from the cervical loop to the crown apex and was related to the cellular events, matrix synthesis, and matrix mineralization occurring during odontogenesis.

Alkaline Phosphatase↗

The sealing ability and retention characteristics of mineral trioxide aggregate in a model of apexification.

Treatment of the immature pulpless tooth presents both an endodontic and restorative challenge. A more favorable long-term prognosis may be achieved with a mineral trioxide aggregate (MTA) apexification procedure followed by an internal bonding technique. We investigated the efficacy of this treatment option by testing the sealing ability and retention characteristics of MTA when placed as an apical barrier in a standardized in vitro open apex model. MTA was placed as an apical barrier at a thickness of 1 mm or 4 mm, with and without prior calcium hydroxide medication. The barriers were challenged with bacteria exposure within a leakage model and displacement forces on an Instron machine. In the leakage study, 100% of the MTA apical barriers showed bacterial penetration by day 70, compared with 20% of MTA root-end fillings used as controls. The displacement study demonstrated a statistically significant greater resistance to force with a 4-mm thickness of MTA, regardless of calcium hydroxide use. We concluded that it was the intracanal delivery technique and not the MTA that contributed to the leakage observed. MTA shows promise in our proposed treatment option of immature pulpless teeth if the sealing ability can be enhanced by improving the delivery technique.

Aluminum Compounds↗

Understanding, planning, and managing tooth movement: orthodontic force system theory.

A simple force may cause translation and/or rotation of the tooth upon which it acts. The closer the line of force to the tooth's center of resistance, the greater is the proportion of translation relative to rotation, and vice versa. When a tooth is subjected to a tipping moment, strain is concentrated in the areas of the alveolar crest and root apex. This may explain how a light force can tip a tooth readily, while translation, involving a more even distribution of strain throughout the length of the root, requires more force with little or no moment. It is difficult to sustain a desired combination of rotational and translational movement over any significant distance. Couples induce rotation only. Couples and simple forces can be used in combinations to effect movements that are not possible with either one alone. Molars provide anchorage for incisor intrusion. This "vertical anchorage" can be reinforced by elastics producing moments opposite those produced by arch wire anchor bends. Calculation of the elastics' contribution provides an indication of the intrusive force that may be applied to incisors without reciprocal molar tipping. The common use of the term center of rotation in orthodontics may be inappropriate and/or confusing. It may be more accurate and straightforward to view most tooth movements as combinations of linear translation with rotation about the center of resistance.

Adolescent↗

A devitalized tooth as a complication of septorhinoplasty.

Complications of septorhinoplasty often involve adjacent structures, resulting in cosmetic as well as functional abnormalities. Dental complications of nasal surgery are rare. We describe a patient who underwent septorhinoplasty with a postoperative complication of a devitalized tooth. To our knowledge, this is the first report of such a dental complication. Bony manipulation in the region of the nasal spine may have resulted in the interruption of the neurovascular supply to the right central incisor, yielding a devitalized tooth. An aberrant vascular supply, or root apex situated high in the premaxilla, can predispose to dental injury while performing bony manipulation near the nasal spine. Preoperative evaluation of patients who are at risk for dental complications may allow the surgeon to safely achieve the functional and cosmetic goals of septorhinoplasty.

Adult↗

Variation in morphology of the maxillary central incisors found in class II, division 2 malocclusions.

Class II, Division 2 malocclusions show several common characteristics. One of the features is the presence of a deep overbite ("deckbiss"), which can be the result of an excessive eruption of the maxillary central incisors. This study tested the theory that the deep overbite, together with the apparent entrapment of the mandible, may be partly due to the bending of the maxillary central incisors or the presence of the Collum angle. In a comparison between the group of patients with Class II. Division 2 malocclusions and the control group, it was determined that the former group exhibited significantly larger Collum angles than the latter group (p < 0.005). It is suggested that in describing the maxillary incisor angulation in this type of malocclusion, the long axis of the crown, rather than the long axis of the tooth connecting the incisal edge to the apex, be used as a measure of their position.

Adolescent↗

Pulp sensibility and pulp necrosis after Le Fort I osteotomy.

A longitudinal study comprising 617 teeth in 51 patients was carried out to determine the frequency of pulp necrosis and loss of pulpal sensibility after Le Fort I osteotomy. A negative pulpal sensibility was found in 39 (6%) teeth after an average follow-up period of 28 months, range 11-59 months. Development of pulp necrosis, determined by pulp testing and periapical radiolucency, was only demonstrated in 3 (0.5%) teeth. The extent of horizontal or vertical displacement of the maxilla had no influence on pulpal sensibility. Teeth adjacent to a vertical interdental osteotomy showed a significantly higher frequency of negative reactions compared to the group without an interdental osteotomy (p = 0.002). The canines demonstrated a significantly greater number of teeth with a negative sensibility reaction compared to the other tooth types. A close relationship between the apex of the canines and a wire osteosynthesis was demonstrated to have significant importance for pulpal sensibility.

Adolescent↗

The position of the inferior dental canal and its relation to the mandibular second molar.

Five hundred dental panoramic tomograms of patients over the age of 17 years were examined and any radiographic relationship of the mandibular second molar to the inferior dental canal noted. The position of the inferior dental canal within the mandible was also noted and compared with previous studies. In the population examined, 2% of mandibular second molars were radiographically related to the inferior dental canal and this was 2.5 times more common in women. The importance of the close proximity of the inferior dental nerve to the apex when root filling or extracting this tooth is considered.

Adolescent↗

The influence of endodontic infection on progression of marginal bone loss in periodontitis.

The purpose of the present investigation was to determine magnitude and rate of proximal radiographic attachment loss in relation to endodontic infection in periodontally involved teeth. The investigation was conducted as a retrospective longitudinal study on a periodontitis-prone randomly selected referral population, including 175 single-rooted, root-filled teeth in 133 patients. An observation period of at least 3 years was required. Periapical conditions of the selected sample at baseline and re-examination were evaluated on radiographs, independently by 3 investigators. Each single-rooted, root-filled tooth of the sample was given a score according to the combined registrations. Radiographic attachment level was measured as the distance between the most coronal point of the alveolar bone and the apex at the mesial and distal sides of the tooth, and expressed as relative radiographic attachment level (RRAL) (radiographic attachment level at baseline/root length) at proximal sites for every tooth. Multiple regression analysis was used to study change in RRAL over time. Teeth in periodontitis-prone patients with progressing periapical pathology indicating a continuous root canal infection were found to lose comparatively more radiographic attachment than teeth with no signs of periapical pathology or teeth with an established periapical destruction which subsided during the observation period. An approximate 3-fold amplification of the rate of marginal proximal radiographic bone loss by endodontic infection in periodontitis-prone patients was found with an average 0.19 mm/year, while 0.06 mm/year was lost for teeth without endodontic infection or subsiding endodontic involvement.

Adult↗

[Frequency of the external resorptions of tooth roots].

Root resorptions present a significant problem in endodontic therapy of the affected teeth and in dentistry in general. The objective of this study was to analyze, based on epidemiological and statistical research, the frequency of clinical incidence of pathological root resorptions in everyday practice related to localization, type of tooth, age and sex of patients. Radiographic documentation of patients treated from 1997 till 2002 at the Department of Conservative Dentistry and Endodontics, Faculty of Stomatology in Belgrade, was used as baseline for this study. Retroalveolar radiographs of teeth with visible signs of resorptions were singled out from 15654 patients' clinical records used for this study. The external resorptions were shown as radiolucent areas localized on various outer root surfaces, followed by significant or less significant resorption of lamina dura and alveolar bone. Out of all teeth analyzed in this study, 594 (3.79%) showed some kind of resorption. The external resorptions were found to be more present in the upper jaw (55.10%) and molars (50.30%) than in the lower jaw (44.90%) and single root teeth (49.70%), but in both cases without significant statistical differences. The most frequent localization of resorptions was root apex (82.44%). In regard to age, the most frequent resorptions were recorded in patients aged between 21 and 30 years (28.40%), and the lowest incidence was found in the youngest population (5.51%). The results also showed that resorptions were more frequent among the female population (59.04%) than among the male population (40.96%). Based on these results, we may conclude that the external root resorptions are not a frequent clinical phenomenon. Proper and early diagnostics of such tissue pathology is one of the basic prerequisites for successful endodontic therapy of the affected root.

Adolescent↗

Improvement of dental development in osteopetrotic mice by maternal vitamin D3 sulfate administration.

Utilizing the microphthalamic mouse, (mi/mi) as a model of osteopetrosis, vitamin D3 (cholecalciferol) was administered prenatally and postnatally to study its effects on tooth development and subsequent eruption. It has previously been reported that vitamin D3 crosses the placental barrier and is absorbed into mammary gland milk. Fifteen heterozygotes (+/mi) were used as breeders. There were three study groups: A) 5.0 ng/gm cholecalciferol sulfate; B) 2.5 ng/gm cholecalciferol sulfate; and C) no therapy. Intraperitoneal injections were administered three times per week, beginning when pregnancy was evident, and continuing for 4 additional weeks during lactation. Approximately half of the 59 offspring were sacrificed at age 1 day and the other half at 4 weeks. The former group was studied for crown development, and the latter group was studied for root development and eruption. When the osteopetrotic offspring of group A were compared with osteopetrotic offspring of group C, crown development and tooth eruption were substantially more advanced. Parameters examined were maturity of the ameloblasts and odontoblasts, dentin and enamel formation, root sheath development, status of eruption, and degree of apex closure. It was concluded that cholecalciferol sulfate significantly improves tooth development and subsequent eruption in the osteopetrotic mouse. A genetic disease has had its phenotype modified by vitamin therapy during gestation.

Animals↗

The fate of developing teeth in mandibular lengthening by distraction: an experimental study.

Purpose: The purpose of this study was to observe developing teeth in a lengthened mandible after distraction. Material: Ten mongrel dogs with deciduous dentitions were used. Methods: A corticotomy was carefully made around a tooth bud and the external distractor (Orthofix M-100((R))) was connected. After a 5-day latent period, distraction was started at a rate of 0.75 mm per day for 10 consecutive days. Then, the lower jaw was stabilized by an external fixation to allow ossification. While the operation was performed on the left side (Distraction group), the contralateral side was studied for comparison (Control). In addition, a corticotomy, artificial fracture and external fixation were carried out to confirm the influence of the operation (Fracture group). Then macroscopic, radiographic and histological evaluations were carried out. Results: In the Distraction group, the space between the wall of the dental follicle and the crown expanded as distraction began. The end of the calcified root became wider and irregular during the distraction period, and finally, the apex closed. In the Fracture group, the teeth erupted although slight alterations of the root shape were observed in association with the operation period. Conclusion: The root became irregular, but the teeth erupted within the distraction area. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗

[Comparisons of meter reading values in 5 electronic measuring devices].

The root apex values given in the manufacturers' introductions of 5 electronic measuring devices were compared with the mean values measured by each device in the following cases: a) The tip of file was at the apical constriction in the experimental tooth model. b) The tip of file was between 0 mm and -2.0 mm from the root apex in the vital teeth and the pulpless teeth. In the experimental tooth model, when the tip of file was at the apical constriction, the mean values measured by each device except EM were lower than the root apex values given in the manufacturers' introductions of each device. In the case of the vital tooth, when the tip of file was between 0 mm and -2.0 mm from the root apex, the mean values measured by EM-S II and EM were similar to the values given in the manufacturers' introductions of these devices, but not to those obtained by the other devices. Measurements of the pulpless tooth by each device revealed mean values lower than the values given in manufacturers' introductions for the root apex.

Dental Pulp Cavity↗

Oral malodor associated with internal resorption.

We report a case of oral malodor associated with internal resorption. A 39-year-old male attended our hospital complaining of oral malodor. Utilizing organoleptic measurement, the halimeter test and gas chromatography, it was diagnosed as a strong halitosis caused by oral origin. The pocket probing depth of tooth 21 was 10 mm, and X-ray examination revealed a vertical bone loss around this tooth. The patient had received periodontal treatment at two dental offices previously, but the periodontal conditions and oral malodor persisted. We performed an initial periodontal preparation, however a deep pocket remained. We therefore performed a surgical inspection including flap reflection, and found that the tooth had a large perforating defect in the distal surface. The extracted tooth had multiple perforating defects covered with granulation tissues on all root surfaces including the root apex. Taking into consideration the anamnesis and X-ray examination of the extracted tooth, internal absorption was considered to have been the cause of the multiple perforating defects. After extraction of the causative tooth, oral malodor dramatically decreased. To our knowledge, this is the first report of an oral malodor associated with internal resorption.

Adult↗

The formation of apical delta of the permanent teeth in dogs.

To determine the process of formation of apical delta, a histological study on the permanent teeth was carried out in dogs. A litter of 7 clinically healthy beagle dogs and 33 adult dogs (4- to 15- year-old) of 12 breeds with periodontal disease were used for the experiments. Teeth extracted from 6-,7-,8- and 9-month-old beagles were sectioned and stained with HE solution. Tooth roots obtained from adult dogs with periodontal disease were ground. Each tooth was classified into the following root types under a light microscope: Type I (no apical delta = no apical closure), II (few apical delta), IIIA (low apical delta) and IIIB (high apical delta). In the 6-month-old beagles, more than half the tooth roots were classified as type I. In the 7-month-old beagles, type IIIB apical delta was the most predominant and types I, II and IIIA apical delta were occassionally seen. Apical closure and delta were observed in all beagles at 8 months of age histologically. In the 8- and 9-month-old beagles, all root apexes observed were type IIIB. Most of the 314 tooth roots extracted from 33 adult dogs were type IIIB, but a few were type IIIA.

Animals↗

Immediate implantation in fresh extraction sockets. A controlled clinical and histological study in man.

BACKGROUND: Early implantation may preserve the alveolar anatomy, and the placement of a fixture in a fresh extraction socket helps to maintain the bony crest. Although a number of clinical studies exist, no histological reports show the outcome of implantation in fresh extraction sockets without the use of membranes in humans compared to implants placed in mature bone. METHODS: Forty-eight healthy patients, receiving at least 4 fixtures in each of 2 symmetrical quadrants, underwent placement of 1 experimental fixture placed in a fresh extraction socket (TI) and 1 contralateral fixture in mature bone (CI). TI were placed after atraumatical tooth extraction, with a surgical site at the apex of the socket and a tight contact between the fixture and the socket's walls, but without the use of filling materials or membranes. The flap was coronally repositioned to obtain primary wound closure. Immediately after surgical intervention, a standardized periapical radiograph was taken. Second-stage surgery was done after 6 months. Six months after the second surgery, a second standardized periapical radiograph was taken and clinical parameters (bleeding and plaque index) recorded. Marginal bone loss (MBL) from the time of implant placement to the time of fixture removal was calculated by comparing periapical radiographs. TI and CI were then removed by a hollow drill to obtain histological specimens. Non-demineralized sections were stained by acid fuchsin and toluidine blue, and by von Kossa to evaluate the degree of bone mineralization. The percentage of direct implant-bone contact (DBC) was calculated by a computerized microscopic digitizer. RESULTS: No significant differences in the clinical and radiographic parameters were observed between the 2 experimental categories. There was no statistically significant difference between TI and CI for DBC either in the maxilla or in the mandible. No connective or fibrous tissues were present around TI or CI. Bone resorption was not present in any of the histological sections. CONCLUSIONS: The present study shows that when a screw-type dental implant is placed without the use of barrier membranes or other regenerative materials into a fresh extraction socket with a bone-to-implant gap of 2 mm or less, the clinical outcome and degree of osteointegration does not differ from implants placed in healed, mature bone.

Adult↗

Unusual healing of apical root fracture.

A 23-yr-old woman received a blow to the symphysis region of the mandible. She sustained several injuries including a root fracture of the mandibular left lateral incisor. The pulp in the coronal root portion of that tooth became necrotic. A radiolucent lesion developed at the apex of the coronal root portion, and the apical root fragment was displaced 2 1/2 mm. Following endodontic treatment of the coronal segment, the apical fragment returned to its original position.

Adult↗

Failure of endodontic treatment due to a palatal gingival groove in a maxillary lateral incisor with talon cusp and two root canals.

A case is presented in which endodontic treatment of a maxillary lateral incisor with a talon cusp and two root canals failed following a mistaken diagnosis. What was first diagnosed as an endodontic lesion was, in all probability, a primary periodontal lesion caused by the advance of bacteria from the gingival crevice to the apex along the radicular groove between the main tooth and the talon cusp.

Adult↗