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Reposition of intruded permanent incisor by a combination of surgical and orthodontic approach: a case report.

This report presents a case of a completely intrusive luxation of an immature permanent central incisor in a 7 years 9 months-old girl. Because there are severe intrusive trauma and cortical alveolar bone fracture, it was impossible to reposition with orthodontic or surgical method alone. The intruded tooth was repositioned to healthy alveolar bone level by using surgical extrusion and stabilization with sutures and periodontal pack. After healing of adjacent bone, the intruded maxillary central incisor erupted orthodontically by removable orthodontic appliance. It was moved from a high position to level of adjacent tooth in about 7 months. A radiograph was taken 6 months after ceasing forced eruption, which demonstrated minor root resorption, but the alveolar bone height had increased.

Alveolar Process↗

Nasopalatine duct cyst. An aggressive condition in adolescent Negroes from South Africa?

A retrospective study of the clinical and radiographic features of 51 nasopalatine duct cysts has been undertaken. Of these cysts 33 were in males (64.7%) and 18 in females (35.3%). The age range was 9--67 years (mean 32 years) with most cases being detected between the second and fourth decades. All of the subjects aged less than 20 years were South African Negroes and the lesions found in this group were invariably over 3.5 cm in diameter and rapidly growing. The average size for all of the cysts (after taking in 19% radiographic enlargment factor into account) was 3.5 cm in greatest diameter. The most common signs were: palatal swelling (88.2%), tooth displacement (78.4%) and sub-labial swelling (17.6%). Root resorption was found in only two of the 40 cysts which encroached upon lamina dura. No recurrences occurred following marsupialization or enucleation.

Adolescent↗

Tooth auto-transplantation with double periodontal ligament stimulation to replace periodontally compromised teeth.

BACKGROUND: The healing process of autotransplantation puts 2 different tissues in competition: the ligament on the root surface and the bone tissue of the alveolus. This study shows the effects of a protocol with 2 surgical stages, which promote ligament repair, inhibit adhesion between bone and dental root, and reduce the occurrence of the ankylosis-root resorption phenomenon. METHODS: Forty-three patients, 33 to 73 years old, received 47 transplantations of mature teeth (including retained teeth) during a 5-year period. During the first surgical step, the transplanted tooth is extracted, measured, immediately replaced in its origin site, and maintained with an original suture technique. The alveolus to which the tooth will be transplanted is adapted after extraction of the periodontally compromised tooth. The second surgery occurs at day 14, when regeneration of periodontal ligament (PDL) is at a maximum (first stimulation). The tooth is transplanted in its new alveolus and retained using the same suture technique to avoid a rigid splint and to create mechanical stimulation of the PDL (second stimulation). RESULTS: The results were 95.75% positive with normal PDL, with a 4.25% failure rate (transplant loss) and no ankylosis. Mean probing reduction was 8.37 +/- 3.0 mm. Mean radiographic bone gain was 7.73 +/- 4.32 mm. CONCLUSIONS: This study suggests that auto-transplantation with double PDL stimulation can be a viable treatment in clinical practice, especially to replace teeth with large periodontal lesions, deep furcation defects, and/or root fractures. This study shows the high potential of stimulated PDL to regenerate alveolar bone and periodontal structures in severe destruction sites.

Adult↗

Pulpal injury: pathology, diagnosis and periodontal reactions.

Diagnosis of pulpal disease can be difficult due to the lack of diagnostic signs and symptoms available to the practitioner. An understanding of the possible underlying pathological processes, combined with an exact assessment of the pain history, and appropriate clinical tests, should aid the practitioner in determining the nature of pulpal inflammation, and differentiating it from dentine sensitivity and cracked teeth. The responses of the pulp to traumatic injury to the periodontal membrane (PDM) require special consideration, particularly with respect to the assessment of pulp vitality, and the determination of cases requiring pulp extirpation in order to avoid inflammatory root resorption. Although the pulp is relatively isolated from the rest of the dentoalveolar complex by a dentine/cementum barrier, it is important to remember that it can communicate with the PDM through apical and lateral foramina, and areas of damaged cementum. Hence, it is a priority to both preserve the integrity of the cemental layer in cases of traumatic injury and periodontal disease, and to prevent the inflammation and resorption associated with periapical lesions by accurate diagnosis of irreversible pulpitis and pulp necrosis, followed by appropriate endodontic debridement procedures.

Cracked Tooth Syndrome↗

[The effects of orthodontic treatment on periodontal findings in adults].

After periodontal therapy 12 patients with advanced alveolar bone loss were orthodontically treated and recalled for approximately 51.1 months. Orthodontic tooth movement resulted in a mean overjet reduction of 1.7 mm, a mean overbite reduction of 1.3 mm and closure of the anterior spaces. No significant differences were observed in the probing depths and attachment levels between the test and control teeth. 31% of the treated teeth showed signs of root resorption. The results indicate that orthodontic therapy in patients with successfully treated advanced periodontal disease does not lead to further attachment loss if the patients are periodontally well maintained.

Adult↗

Postreplantation management of avulsed teeth: an endodontic literature review.

Today's dental treatment goals are directed at reducing the incidence of root resorption resulting from periodontal ligament devitalization or pulp necrosis. Although the American Association of Endodontists recommends the use of long-term therapy, short-term therapy may be utilized with confidence in well-defined clinical applications. Early final obturation with gutta-percha will increase the long-term prognosis in those cases where patient motivation is questionable or long-term follow-up prior to obturation is not possible. However, where inflammatory resorption is already present, long-term calcium hydroxide therapy is indicated. Long-term post treatment follow-up is imperative in both calcium hydroxide therapies.

Calcium Hydroxide↗

[Tissue lesions in dental displacement].

Following the observation of alveolar, periodontal and dental lesions following dental displacement, the authors performed histological examinations. Lacunae of root resorption were observed in the pressure zones. The ligamentous fibres were less organised and, when strong pressures were exerted, they became parallel to the tooth. Osteoclasts and bone resorption were observed in the alveolar bone. Osteoblasts and bone apposition were observed in areas of stretched ligaments. These tissue reactions were not always reversible; dental displacement should be considered to be a high risk procedure.

Alveolectomy↗

Clinical outcomes for permanent incisor luxations in a pediatric population. I. Intrusions.

A longitudinal outcome study was undertaken to identify variables that significantly influenced tooth survival as well as pulpal and periodontal outcomes for intruded permanent maxillary incisors of children and adolescents. All cases were treated between June 1988 and June 1998 in a teaching hospital clinic. Clinical and radiographic data were collected for 26 patients (19 males, 7 females) that represented 31 permanent maxillary incisors. Mean age at the time of injury was 9.3 years (range = 5.5-17.8 years). Mean time elapsed to follow up was 1380 days (range = 65-3394 days). Survival analysis was used to identify variables significantly related to the survival and pulp necrosis (PN) for these incisors. Proportional hazards regression yielded significant prognostic models for tooth survival and the diagnosis of PN (P < 0.05). Incisors intruded > 6 mm had significantly decreased survival compared with incisors intruded < 3 mm (5-year survival, 0.45 and 1.0, respectively, (P < 0.05)). Complex crown fractures were significantly related to the development of PN (P < 0.05). Logistic regression analysis showed that treatment method and severity of intrusion were related to the presence of replacement root resorption (P < 0.05). This study represents the largest sample of intruded permanent incisors examined in an outcome study of children and adolescents exclusively.

Adolescent↗

Mineralized tissue-formation in periodontal wound healing.

The purpose of the present study was to examine and compare the different mineralized tissues that are found on and around the dental root following treatment of different periodontal pathosis. The material has been compiled from previously published experimental studies on periodontal therapies and trauma treatments. 4 distinctly different appearances of the mineralized tissue layers on the marginal dentin surfaces were described; new cementum, non-attached bone-like tissue, partly attached bone-like tissue and ankylosis preceded by root resorption. It was concluded that, healing in the periodontal/root interface following periodontal therapy may yield different mineralized tissues, depending on a number of host-specific and external factors. The temporal pattern of such healing processes is schematically represented.

Alveolar Bone Loss↗

Periodontal repair in dogs: expanded polytetrafluoroethylene barrier membranes support wound stabilization and enhance bone regeneration.

A wound stabilizing effect of expanded polytetrafluoroethylene (ePTFE) membranes was evaluated in supra-alveolar periodontal defects in 5 beagle dogs. The defects, 5 to 6 mm in height, were surgically created around the 2nd, 3rd, and 4th mandibular premolar teeth in contralateral jaw quadrants. The root surfaces were conditioned with heparin, which, in this model, has been demonstrated to compromise periodontal healing and result in formation of a long junctional epithelium. Wound closure included application of ePTFE membranes around each premolar tooth in one jaw quadrant in each dog and flap positioning coronal to the cemento-enamel junction in both jaw quadrants. Healing progressed uneventfully except for 3 teeth in 2 dogs, which experienced membrane exposure. The dogs were sacrificed after a 4-week healing period and tissue blocks were prepared for histometric analysis. Connective tissue repair in heparin+membrane-treated teeth averaged 98% of the defect height compared to 84% in control heparin-treated teeth (P < or = 0.05). Junctional epithelium formation was smaller in membrane-treated teeth than in control teeth (P < or = 0.05) and was usually terminated coronal to the membrane. Bone regeneration was enhanced in membrane-treated teeth compared to controls (P < or = 0.01) and was strongly correlated to the area under the membrane in teeth without membrane exposure (r2 = 0.993; P = 0.002). This correlation was reduced when teeth with membrane exposure were included in the analysis (P < or = 0.05). Cementum regeneration was minimal under both treatment conditions. Root resorption was increased in membrane-treated compared to control teeth (P < or = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Alveolar Process↗

Calcium ion diffusion from calcium hydroxide-containing materials in endodontically-treated teeth: an in vitro study.

The aim of this in vitro study was to determine the amount and duration of diffusion of calcium ions from both a calcium hydroxide-containing root canal sealer and an intracanal medicament, through the apical foramen and the dentinal tubules of endodontically-treated teeth. The root canals of 88 freshly extracted single-rooted teeth were prepared using the modified double flared, balanced force technique with patency filing. The teeth were divided into four test groups of 20 teeth each and a control group of eight teeth. One group was dressed with a non-setting calcium hydroxide while the other was obturated using cold lateral condensation of gutta-percha with a calcium hydroxide-containing sealer. An artificial root defect was created in the apical third of the root of the teeth in the other two groups and the root canals were either dressed or obturated in the same way as the first two groups. All groups were incubated at 37 degrees C and were sampled for calcium diffusion after 1, 2 and 3 days and 1, 2, 3, 4 and 8 weeks. There was statistically significantly more calcium diffusion with the non-setting groups compared with the sealer groups (P < 0.05). There was more calcium ion diffusion from teeth with a patent apical foramen than those with an artificial resorptive root defect (P < 0.05).

Analysis of Variance↗

Clinical outcomes for permanent incisor luxations in a pediatric population. II. Extrusions.

A longitudinal outcome study was undertaken to identify variables that significantly influenced outcomes for extruded permanent maxillary incisors of children and adolescents. Clinical and radiographic data was available for 35 patients (18 males, 17 females) representing 55 incisors. Mean age at the time of injury was 10.6 years (range: 7.1-17.8 years). Mean time elapsed to follow up was 1320 days (range: 423-2887 days). Survival analysis was used to identify variables significantly related to the prognosis of these teeth. The loss of an incisor following extrusion was uncommon as only one tooth (1/55) required extraction. There was no statistically significant difference in survival between severely extruded teeth and avulsions that had been stored in physiological media (P > 0.10). Pulp necrosis (PN) was the most common complication following injury (43%) and it most often occurred during the first year. Although not statistically significant, a trend towards increased PN was found with more severely extruded teeth (P = 0.20, relative risk = 2.08). Pulp canal obliteration (PCO) was the second most common outcome (35%). The degree of extrusion was proven to be significantly associated with the development of PCO (P = 0.03, relative risk = 0.33). Root resorption was an uncommon outcome (3/55). This study represents the first outcome data on extrusions to permanent maxillary incisors in an exclusively pediatric population.

Adolescent↗

A long-term followup on the retention rate of zinc oxide eugenol filler after primary tooth pulpectomy.

A retrospective study of all the patients' records (> 6000) in a pediatric dental practice was done to assess ZOE retention after a pulpectomized primary tooth was lost and the succedaneous tooth erupted. There were 65 children with 81 ZOE pulpectomies done in 30 incisors and 51 molars. Pulpectomies were done at a mean chronologic age of 52.2 months and followed for a mean time of 90.8 months from time of placement. The initial radiograph after the pulpectomized tooth was lost, showed retained ZOE filler particles in 49.4% of the cases while 27.3% had retained ZOE a mean time of 40.2 months after pulpectomy tooth loss. Short-filled pulpectomies retained significantly less ZOE than long fills (P = 0.04). With time, retained ZOE particles either resorbed completely or showed reduction of filler size in 80% of the cases. No pathology was associated with the retained ZOE particles. Retention of ZOE was not related to pulpectomy success (P = 0.11), preoperative root resorption (P = 0.76), age of the patient (P = 0.24 incisors; P = 0.87 molars), extraction/exfoliation of the pulpectomy (P = 0.75), or timing of the pulpectomy's loss (P = 0.72).

Age Factors↗

Periapical lesions in rats with streptozotocin-induced diabetes.

The purpose of this study was to investigate histologically and histometrically the changes in pulpal periapical tissues after pulpal exposure in streptozotocin-induce diabetic rats. Control rats were injected with citrate buffer. Experimental rats were injected with streptozotocin dissolved in citrate buffer. All animals received a pulpal exposure in the left mandibular first molar. Blood glucose concentration was measured at, 0, 7, 14, 28, and 42 days. All animals were killed at 7, 14, 28, and 42 days after pulpal exposure, and their mandibles were evaluated histologically and histometrically. Blood glucose levels in the experimental rats were significantly higher than those in the control rats. In experimental rats, inflammation in the apical periodontal ligament and root resorption and alveolar bone resorption were more severe than that in control rats. This study also revealed histometrically that, in experimental rats, lesions in the periapical area were significantly larger than those in control rats.

Alveolar Bone Loss↗

[Iatrogenic effects of orthodontic therapy].

Iatrogenic effects of orthodontic treatment are root resorption, pulpal changes, decalcifications and white spots, gingival and periodontal changes, enamel surface changes, temporomandibular dysfunction, immunological reactions, pain and discomfort, and accidents. The authors discuss these items and give, if possible, tips to prevent or reduce these effects.

Accidents↗

[Clinical cases of teeth previously treated by endodontic restoration using intra-canal pins of gold-coated brass].

The authors, in previous studies, showed that morphological alterations on gold coated brass pins, extracted after some years of staying in dental roots, are the consequence of a localized corrosion attack, produced by anaerobic bacteria, whose presence is confirmed by the high concentration of sulphur on the most attacked spots. Since, by using a suitable technique of pin inserting, the corrosion should not occur, it was supposed that root resorption could lead to favourable conditions to create corrosion. In order to bear out this assumption, 10 meaningful clinical cases of teeth previously restored by gold coated radicular pins are critically evaluated.

Adult↗

The role of nitric oxide in orthodontic tooth movement in rats.

Nitric oxide (NO) is involved in second messenger formation, osteoblast and osteoclast function, and pulpal blood flow. This raises the question of whether or not altered NO production interferes with orthodontic tooth movement (OTM) by influencing the bone remodeling cycle. To investigate the role of NO in OTM, a rat model was established and 48 rats were divided into four study groups of 12 rats each. A 5 mm nickel-titanium closed-coil spring was ligated between the right maxillary incisor and first molar of each rat to deliver an initial force of 60 g. A saline group received subperiosteal injections of normal saline (50 microL/kg), an L-arginine (L-arg) group received L-arginine (NO precursor) injections (200 mg/kg), and a, L-NAME group received N(G)-nitro-L-arginine methyl ester (nitric oxide synthase inhibitor)(10 mg/kg) injections. All injections were given in the upper right first molar mucosa from the first through the 11th day of force application at 48-hour intervals. A control group received no injections. Tooth movement measurements were done at the time of injections. Animals were sacrificed 13 days after appliance insertion and final OTMs were measured at the time of sacrifice. From the third day till the end of the experiment, the L-arg group showed a significant increase in tooth movements, whereas the L-NAME group showed a significant decrease in tooth movements compared to the control and saline group (P < .001). Histopathologic studies revealed that the number of osteoclasts was significantly higher in the L-arg group smears, while the number of osteoclasts in the L-NAME group was significantly lower as compared to the control group (P < .001). Scanning electron microscope analysis showed that the force-induced root resorption in the L-arg group was less than the control group. This study suggests a role for NO in the bone remodeling cycle.

Animals↗