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PubMed1987

Autotransplantation of teeth (I). Indications for transplantation with a follow-up of 51 cases.

The indications for autotransplantation of teeth in 45 patients have been analysed together with a follow-up of the success rate of surgery. Most of the transplants were mature teeth, 37 out of 51, with closed apex. The majority of transplantations were carried out in order to replace single tooth losses (40) but in 11 cases, the teeth were used as an abutment in prosthetic rehabilitation. In 14 cases, an impacted tooth was transplanted to its normal position. The follow-up ranged from 3 months up to 10 years. No progressive root resorption has been observed so far; only 6 cases with slight surface resorption. Clinical signs of anchylosis were noticed in 4 teeth and shallow bone defects in 6 patients. Small- or medium-sized periapical destructions were observed in 4 cases. Mature transplanted teeth were always subjected to endodontic therapy within a month; the immobilisation varied between 2-4 weeks, while trying to keep it as short as possible with maintained stability. The experiences so far achieved do encourage a more comprehensive use of the method to solve problems associated with oral rehabilitation, from both prosthodontic and orthodontic points of view.

Adolescent↗

PubMed1995

Evaluation of the effect of delayed management of traumatized permanent teeth.

This investigation studied the complication that could arise from delayed management of traumatized permanent teeth. Patients reported to the primary care clinic at the College of Dentistry, King Saud University, seeking treatment of traumatized anterior teeth were evaluated. Esthetic consideration (64 patients) and pain, swelling, or discomforts (50 patients) were the main reasons the patients came to the clinic. Clinical and radiographic examinations, as well as history of the trauma, were recorded. It was found that most of the patients had a treatment delay exceeding 1 month. Initial pulp exposure resulted in 100% pulp necrosis. When a fracture involved both enamel and dentin, the frequency of pulp necrosis was 53%. External root resorption and pulp calcification were seen in few teeth. It was concluded that the figures for pulp necrosis could be misleading, because there might have been a bias when only patients with problems sought treatment. In addition, a trauma awareness educational program should be developed to encourage parents and the public to seek immediate dental treatment. Furthermore, a proper diagnostic test for pulp and periodontal complication should be done in patients with initially nontreated dental injuries.

Accidental Falls↗

PubMed1996

Pathoses associated with mandibular third molars subjected to removal.

OBJECTIVES: To measure the prevalence of disease of mandibular third molars referred for removal and to estimate the risk for development of pathoses for two cues. STUDY DESIGN: A prospective cohort study on molars subjected to removal was performed. The prevalence of different diseases and the patient's age, angular position, and degree of impaction of the molars were registered. Odds ratio for molars with different positions and impaction states were estimated. RESULTS: Pericoronitis was found in 64% of cases, caries in the third molar in 31%, periodontitis in association with 8%, caries in the second molar in 5%, and root resorption of the second molar with 1% of the molars with pathoses. Odds ratio was highest for distoangular molars (5.8) and for molars partially covered by soft tissue (6.7). CONCLUSIONS: The odds ratio is about 22 and 34 times higher for molars partially covered by soft tissue than for molars completely covered by soft or bone tissue. For distoangular molars the odds ratio is 5 to 12 times higher than for molars in other positions.

Adolescent↗

PubMed1990

Endocytosis in odontoclasts and osteoclasts using microperoxidase as a tracer.

Microperoxidase (MP, a peptide tracer) was intravenously injected into rats after six days of tooth movement by the Waldo method. Bone resorption was seen along the distal bone surface of the inter-radicular septum of the upper first molar, and tooth root resorption occurred along the mesial and distal surfaces of the distal root of the same molar. Odontoclasts were smaller in size and numbers than osteoclasts, but had the same organelles [multiple nuclei, ruffled borders (RB), clear zones, vacuoles, mitochondria, and specific granules] as osteoclasts. MP was deposited on the resorbed area through the clear zone and was transported into the vacuoles along the channels of the RB. The uptake of MP by odontoclasts was small, compared with that by osteoclasts. Collagen fibrils were found in the channels of the RB but were not detected in the vacuoles. Instead, filament-like structures were seen in the vacuoles and were located very near the collagen fibrils in the channels. Fibroblasts outside the resorbed lacunae had endocytosed collagen. In contrast, some cells close to odontoclasts (osteoclasts) in the dentin (bone)-resorbed lacunae had not endocytosed any collagen fibrils. These findings suggest (1) that odontoclasts resorb the dentin or cementum just as osteoclasts do in bone resorption, (2) that the resorbed area connects with the extracellular spaces of the odontoclasts or osteoclasts, and (3) that the organic components (e.g., collagen fibrils) of dentin or cementum are endocytosed through the channels of the RB in the same manner as that for MP. However, the endocytotic ability of odontoclasts appears inferior to that of osteoclasts.

Animals↗

PubMed1996

Management of intrusive luxation injuries.

Traumatic intrusion of permanent teeth is a relatively infrequent but serious type of dental injury, due to the complicated picture it involves. Various treatment approaches have been suggested, so far, regarding management of intrusive luxation. Techniques aiming to reposition the intruded tooth include observation for spontaneous reeruption, surgical as well as orthodontic repositioning. However, development of complications such as pulp necrosis, inflammatory root resorption, replacement resorption and ankylosis and loss of marginal bone support makes selection of the most favorable technique controversial. In this paper, a critical review of the existing treatment modalities is attempted and treatment approaches based on diagnostic parameters that are indicative of the severity of an intrusive injury are presented. Recommendations are made after taking into consideration experimental and clinical study findings and observations from other author's and our own clinical experience. Two cases of intrusive luxation in children are presented and management of the dental injuries as well as the complications which occurred are being discussed.

Alveolar Process↗

PubMed1989

Panoramic screening for dental anomalies assessed by professionals with identical and different backgrounds.

The aim of the present study was to evaluate how dental professionals with identical and different backgrounds assess dental anomalies viewed on panoramic radiographs. 101 panoramic radiographs performed of 9-to-10-yr-old children were examined independently by three orthodontists and two radiologists. All observers agreed on the recording of number and identification of congenitally missing permanent teeth. The observers' assessments of malpositioned teeth, teeth in infraocclusion, and primary teeth with atypical/non root resorption varied, however, to a great extent. Two of the orthodontists seemed to report only major deviations from normality (in 38 and 51 of the children respectively) while one reported several more findings (in 85 children). The radiologists reported abnormal findings in 80 and 88 children respectively. In only three children were no dental anomalies reported by any observer. The inconsistent reporting of the majority of dental anomalies (except for agenesis) in children, even among members of subgroups with a similar educational background (e.g. orthodontists), substantiates the need for an evaluation of the expedience of panoramic screening.

Anodontia↗

PubMed1997

Nonsurgical rapid maxillary alveolar expansion in adults: a clinical evaluation.

Palatal expansion in adults has traditionally been performed on a very limited basis. The expansion has been thought to be limited in scope and stability and to be associated with unacceptable complications. Instead, surgically assisted rapid maxillary expansion (SA-RME) has been advocated. Five adults with transverse arch deficiency are presented to illustrate the feasibility of nonsurgical expansion using the Haas appliance. Transmolar expansions of 3.9 to 7.5 mm, sufficient to correct the malocclusions, were achieved. Limiting the rate of appliance activation is thought to be important to avoid pain, swelling, and ulceration. Measurements of molar axial angulation, facial divergence, and clinical crown heights demonstrated modest molar tipping, stable mandibular divergence, and only minimal gingival recession. Radiographs revealed minimal observable root resorption of the maxillary molars and premolars. Contour tracings of the palate indicated that most of the correction of the maxillary transarch deficiency occurred at the level of the lateral walls of the palate (the alveolar process) rather than in the skeletal base of the maxilla. For this reason the technique is defined as rapid maxillary alveolar expansion (RMAE). RMAE is an acceptable alternative to SA-RME in adults for most cases of maxillary transarch deficiency. This article is followed by a commentary by Robert L. Vanarsdall Jr., and by an author's response.

Adult↗

PubMed1984

The effect of orthodontic extrusion on traumatically intruded teeth.

The management of traumatically intruded permanent incisors is controversial. Some authors suggest a decreased incidence of ankylosis in cases treated with orthodontic extrusion. The purpose of this study was to examine two common management techniques for traumatic intrusion, orthodontic extrusion, and observation for re-eruption. The four first premolars of three shepherd dogs were traumatically intruded with a mallet while a holding device was used to prevent tooth fracture. Five to 7 days following the injury, orthodontic force was applied unilaterally while the contralateral tooth served as the untreated control. To facilitate serial periapical radiography, x-ray jigs were fabricated for each animal and tantalum implants were placed in the bone distal to the permanent canine and first and second premolars. Observations included radiographic measurement of tooth movement, clinical estimates of tooth mobility, and radiographic and histologic assessment of root resorption, ankylosis, and periapical pathosis. The amount of traumatic intrusion varied from less than 0.5 to 4.1 mm. Following 11 to 13 weeks of force activation, 10 of 12 traumatized teeth showed clinical, radiographic, and histologic evidence of ankylosis irrespective of orthodontic treatment. Whereas the ankylosed teeth did not move with orthodontic forces, the teeth used for force application were orthodontically intruded 1.7 to 6.5 mm. When the injury to the tooth was severe, orthodontic extrusion had little effect on repositioning of the injured tooth but resulted in undesirable movement of the anchorage teeth. When the injury was less severe, orthodontic forces facilitated repositioning of the affected tooth.

Animals↗

PubMed2001

Tooth movement and changes in periodontal tissue in response to orthodontic force in rats vary depending on the time of day the force is applied.

The purpose of this study was to investigate whether there are any differences in tooth movement or in the response of periodontal tissue to orthodontic force when the force is applied at different times of the day. One hundred 6-week-old male Wistar rats were divided into one control group without force application and three experimental groups based on the time of day the force was applied to the upper first molars. Animals in the whole-day group received force continuously throughout the experimental period, while animals in the light- and dark-period groups received force only during the light (07:00-19:00) or dark period (19:00-07:00), respectively. Tooth movement was measured using the occlusal view of a precise plaster model with a profile projector. Periodontal tissues were evaluated histologically. The time course of tooth movement varied among the groups. Tooth movement over 21 days in the whole-day and light-period groups was about twice that as in the dark-period group. The formation of new bone on the tension side in the whole-day and light-period groups was more than twice that as in the dark-period group. On the pressure side, more osteoclasts appeared on the alveolar bone in the whole-day and light-period groups than in the dark-period group. The light-period group showed less extensive hyalinization of the periodontal ligament (PDL) than the whole-day group. The area of root resorption on day 21 also varied among the groups. Interference by masticatory forces did not seem to be a principal cause of the decreased tooth movement in the dark-period group. These results indicate that there are considerable variations in tooth movement and in the response of periodontal tissue to orthodontic force when the force is applied at different times of the day in rats. The results suggest that diurnal rhythms in bone metabolism have important implications in orthodontic treatment.

Alveolar Process↗

PubMed2000

Tissue engineering in periodontics using rhBMP-2.

The results of these studies show that rhBMP-2 clearly enhances regeneration in periodontal defects (Figures 2&3). The extent of regeneration appears to be significantly influenced by the nature of the carrier material used to deliver the rhBMP-2 to the periodontal wound. While the positive effects of rhBMP-2 on osteogenesis are well established, less is known about the way in which rhBMP-2 effects cementogenesis, or its role in the formation of a new periodontal ligament. From the studies reviewed, it would appear that rhBMP-2 facilitate in the formation of cellular cementum on previously denuded root surfaces. This newly formed cementum has also been shown to support an organised periodontal ligament attachment. Mechanisms related to the possible role of rhBMP-2 in ankylosis are presently unclear and will require further investigation as such sequelle may complicate the clinical utility of rhBMP-2 in periodontal regeneration. Root resorption has also been reported in the above mentioned studies and appears to be related to the concentration of rhBMP-2. Further research directed at understanding how different carriers influence the way in which the rhBMP-2 is released during wound healing should assist researchers with how to best apply these bioengineered proteins to ultimately achieve a more predictable regeneration of the periodontal attachment apparatus. Moreover, additional research into the differing biologic effects of other members of the BMP family of proteins may also hold further promise in the application of this technology to periodontal regeneration.

Animals↗

PubMed2004

Orthodontic and periodontal considerations in managing teeth exhibiting significant delay in eruption.

AIM: Significant delay in tooth eruption may be observed in many orthodontic patients. This delay may lead to complications, such as devitalization, ankylosis, external root resorption, injury to the adjacent teeth, and mucogingival problems. These complications may result in prolonged treatment time, esthetic deformities, damage to the periodontal tissues, and tooth loss. This report investigates the special considerations needed in treating such cases. METHODS: Combined orthodontic and surgical treatment can be used in managing teeth exhibiting significant delay in eruption. RESULTS: A high rate of success can be achieved in terms of esthetics, occlusion, and periodontal health. CONCLUSION: Nontraumatic surgery, adequate control of gingival inflammation, and use of minimal orthodontic forces may ensure a higher percentage of success and prevention of problems associated with teeth exhibiting significant delay in eruption.

Dental Occlusion↗

PubMed1994

Treatment of intruded permanent incisors: a multidisciplinary approach.

The case presented is a report of a healthy 11-year-old boy, who fell down and traumatized his four maxillary incisors. Both central incisors were deeply intruded with concomitant uncomplicated crown fractures, and both lateral incisors suffered concussion. The intruded teeth were repositioned using a removable orthodontic appliance and were endodontically treated 3 weeks after trauma. Tooth 11 became ankylosed 3 months post trauma, and tooth 21 was extruded to its original position after 5 months. Five months post-trauma, teeth 12 and 22 underwent necrosis and were endodontically treated. In addition, tooth 22 presented an external inflammatory root resorption that was arrested by calcium hydroxide paste after 3 months. A crown-lengthening procedure was performed on tooth 11 10 months post-trauma, exposing the clinical crown to a better condition for restoration. All 4 incisors were restored with a composite material, and the incisal edges of the central incisors were shaped at the same level. Two months after the crown lengthening procedure, spontaneous eruption occurred on tooth 11, that had been ankylosed. The restored incisal edge of tooth 11 was reduced to the same level of tooth 21. The patient is under periodical examination till a definitive orthodontic treatment can be performed.

Ankylosis↗

PubMed2004

Periodontal repair in dogs: examiner reproducibility in the supraalveolar periodontal defect model.

BACKGROUND: Histometric assessments are routinely used to evaluate biologic events ascertained in histologic sections acquired from animal and human studies. The objective of this study was to evaluate the intra- and inter-examiner reproducibility of histometric assessments in the supraalveolar periodontal defect model. METHODS: Histometric analysis using incandescent and polarized light microscopy, an attached digital camera system, and a PC-based image analysis system including a custom program for the supraalveolar periodontal defect model was performed on histologic sections acquired from one jaw quadrant in each of 12 dogs. The animals had received an experimental protocol including implantation of a coral biomaterial and guided tissue regeneration (GTR) barrier devices, and were evaluated following a 4-week healing interval. Histometric parameters were recorded and repeated within a 3-month interval by two examiners following brief training. Intra- and inter-examiner reproducibility was assessed using the intra-class correlation coefficient (ICC). RESULTS: Most parameters showed high intra-examiner ICCs. Parameters including defect height, connective tissue repair, bone regeneration (height/area), formation of a junctional epithelium, positioning of the GTR device, ankylosis, root resorption, and defect area yielded an ICC> or 0..9. The ICCs for bone density and biomaterial density were somewhat lower (0.8 and 0.7, respectively). The inter-examiner reproducibility was somewhat lower compared to the intra-examiner reproducibility. Nevertheless, the ICCs were generally high (ICC range: 0.6-0.9). CONCLUSIONS: Histometric evaluations in the supraalveolar periodontal defect model yield highly reproducible results, in particular when a single examiner performs the histometric measurements, even when the examiner was exposed to limited training.

Animals↗

PubMed2005

Clinical and radiological features of central giant-cell lesions of the jaw.

OBJECTIVE: The purpose of this study was to evaluate the clinical and radiological features of central giant-cell lesions that were diagnosed in The Netherlands between January 1, 1990, and January 1, 1995. STUDY DESIGN: A population-based retrospective study was carried out, examining all patients with a central giant-cell lesion from this period. RESULTS: In 83 patients there was a central giant-cell granuloma (89 lesions). Aggressive signs and symptoms (pain, paresthesia, or root resorption) were found in 16 (19.3%) patients. Multiple lesions occurred in 3 (3.6%) patients. The overall recurrence rate was 26.3%, and there was a higher recurrence rate in patients who exhibited aggressive signs and symptoms than in patients without these features (RR 1.6). In 5 patients a clinical diagnosis of cherubism or concomitant neurofibromatosis type 1 was made (14 lesions). CONCLUSION: In a general population, large and aggressive lesions are less common than suggested by the literature. Multiple lesions, however, occur more frequently than previously assumed. In patients with aggressive signs and symptoms, surgical curettage is not an effective therapy.

Adolescent↗

PubMed1992

Effect of trichloracetic acid on the microhardness and surface morphology of human dentin and enamel.

Trichloracetic acid is recommended for the treatment of external cervical root resorption. The present study examined the effect of 90% trichloracetic acid on the microhardness and surface morphology of human dentin and enamel. Intact extracted human teeth were sectioned and embedded in acrylic resin. Each tooth was grinded and highly polished exposing a flat surface of dentin and enamel. The teeth were treated with 90% trichloracetic acid for 30, 60 and 90 s. Vicker's microhardness of the dentin and enamel was assessed for each tooth before and after each treatment. In addition the surface morphology of a trichloracetic acid treated tooth was examined via SEM. The results showed that 90% trichloracetic acid caused a second order type reduction of the microhardness, as well as structural changes in both dentin and enamel.

Acid Etching, Dental↗

PubMed2003

Long-term results of guided tissue regeneration therapy in the treatment of class II furcation defects: a randomized clinical trial.

BACKGROUND: The purpose of this study was to evaluate the results after guided tissue regeneration (GTR) using a bioabsorbable membrane in Class II furcation defects in mandibular molars over a 24-month period. METHODS: Nine patients with 2 comparable Class II furcation defects were included. The defects in each patient were randomly assigned to either test (GTR) or control (open flap debridement) group. Clinical measurements and standardized radiographs were taken at baseline, and at 6, 12, 18, and 24 months. The radiographs were analyzed by subtraction radiography. RESULTS: There were significant probing depth reductions for both test and control groups (P < 0.007, P < 0.0005, respectively); however the differences between groups were not significant at any examination. The intra-group and inter-group differences in the vertical clinical attachment level gain were not significant (P > 0.05). Over 24 months, a significant horizontal clinical attachment level gain was observed in the test group compared to control (P<0.03). In the test group, 2 sites showed complete closure, one was converted to Class I, and one tooth was lost due to root resorption. In the control group, 2 defects progressed to Class III over 24 months. At 6 months, the test group showed 0.14 mm of bone loss while the control group showed 0.86 mm of bone gain (P = 0.035). The inter-group differences were not significant at 12, 18, and 24 months. A significant bone height gain was observed in the test group at 24 months when compared to the values obtained after 6 months (P = 0.015). CONCLUSION: GTR may provide a greater horizontal clinical attachment level gain with the possibility of complete closure of some defects and stability over time.

Absorbable Implants↗

PubMed2002

[Medical treatment of central giant cell granuloma of the jaws].

Central giant cell granuloma (CGCG) is a benign intraosseous lesion of the jaws that is found predominantly in children and young adults. The lesion appears mostly in the mandible and presents as a unilocular or multilocular radiolucent defect. Although it is benign, it may be locally aggressive, causing extensive bone destruction, tooth displacement and root resorption. Two variants of the lesion, non-aggressive and aggressive, have been described. Traditionally, CGCG was treated surgically with aggressive curettage and peripheral ostectomy. The more aggressive type or recurrent lesions require wide resection, that lead to major defects in the jaws. This form of surgical treatment could be particularly disfiguring for a child or young adult. An alternative, non-surgical approach, was developed during the past several years. The present review describes several medical treatments available for CGCG that have been reported in the literature, such as corticosteroids, calcitonin and Interferon Alfa-2a. These alternatives are advantageous for large aggressive lesions in order to cure, or reduce the size of the lesion and thus minimize the need for extensive surgical resection that could result in functional and esthetic deficits.

Adrenal Cortex Hormones↗

PubMed2003

Long-term results of orthodontic treatment of impacted maxillary canines.

A total of 61 children who had 83 maxillary canines impacted were followed up for a mean of 3.5 years (range 1.1-10.9 years) after treatment to evaluate the long-term results of the treatments. In most of the children, the impacted maxillary canines had been surgically exposed and treated with fixed orthodontic appliances. In 11 cases, lateral incisors had been extracted because of extensive root resorption. The esthetic results as well as functional and periodontal conditions were evaluated. Only four of the 61 children were not satisfied with the esthetic result, whereas orthodontists judged only 56% of the results as esthetically acceptable on clinical evaluation and 57% as esthetically acceptable on color slides. The periodontal conditions and the occlusal function on sides with previously impacted canines and on sides with normally erupted canines, on the whole, were similar. Exceptions were pocket depths of the left lateral incisors and left canines, but these variables were significantly different mainly because of one patient. In lateral movements of the mandible, however, significant differences in contact pattern were found between sides with normally erupted canines and sides with impacted canines. Canine rise occurred more often on working sides with normally erupted canines than with impacted canines.

Adolescent↗