Delayed removal of a fully intruded tooth in the nasal cavity after facial trauma: a case report.
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Although intrusion of natural tooth abutments in tooth-implant connected fixed prostheses has been reported, it can also occur to a free-standing natural tooth bounded by implant prostheses. For the patient described in this article, intrusion was noted with a natural tooth bounded by 2 implant-supported prostheses 5 months after insertion of the prostheses. The intrusion was reversed completely after 5 months with appropriate management. The course of treatment and possible mechanisms of intrusion are provided.
Lack of posterior support can result in adverse occlusal forces being placed on anterior teeth. These forces may cause fremitus, splaying of the anterior teeth, and even accelerated wear. When implant-supported restorations are used, a common indicator of overload is screw loosening. This clinical report demonstrated conservative management of a patient who presented with multiple episodes of screw loosening of an implant-supported restoration replacing the maxillary left incisor secondary to developing reduced posterior support. Ideal treatment would be to re-establish posterior support by means of implant-supported restorations; however, this option was constrained by finances.
STATEMENT OF PROBLEM: The clinical outcome of complete-arch fixed prostheses supported by implants and natural tooth abutments in patients with normal or reduced periodontal support has been reported by few studies, with controversial results. PURPOSE: The purpose of this study was to report on the implant success rate, prosthetic complications, and the occurrence of tooth intrusion, when complete-arch fixed prostheses, supported by a combination of implants and teeth, were fabricated for patients with normal and reduced periodontal support. MATERIAL AND METHODS: Nineteen patients with residual teeth that served as abutments were consecutively treated with combined tooth- and implant-supported complete-arch fixed prostheses and were retrospectively evaluated after a period varying from 24 to 94 months. Nine patients showed reduced periodontal support as a result of periodontal disease and treatment (RPS group), and 10 patients had normal periodontal support of the abutment teeth (more than 2/3 of periodontal support [NPS group]). Ninety implants and 72 tooth abutments were used to support 19 fixed partial dentures. Screw- and cement-retained metal-ceramic and metal-resin prostheses were fabricated with rigid and nonrigid connectors. Implant survival and success rates, occurrence of caries and tooth intrusion, and prosthetic complications were recorded. The number of teeth, implants, prosthetic units, fixed partial dentures, and nonrigid connectors were compared with a t test to assess differences between the 2 groups, while data for the occurrence of intrusions and prosthetic complications were compared with the Fisher exact test (alpha=.05). RESULTS: One of the 90 implants was lost (99% survival rate) over 24 to 94 months, while 3 implants showed more than 2 mm of crestal bone loss (96% success rate) over the same period. No caries were detected, but 5.6% (4/72) of the abutment teeth exhibited intrusion. Intrusion of abutment teeth was noted in 3 patients who had normal periodontal support (13% of teeth in NPS group) of the abutment teeth and was associated with nonrigid connectors. No intrusion of teeth was noted in the patients exhibiting reduced periodontal support regardless of the type of connector or when a rigid connector was used for either group. The number of intruded teeth was significantly greater in patients with intact periodontal support (P=.03). CONCLUSIONS: Complete-arch fixed prosthesis supported by implant and tooth abutments may be associated with intrusion of teeth with intact periodontal support when nonrigid connectors are used to join the implant- and tooth-supported sections of the prostheses. However, fixed partial dentures supported by implants and teeth with reduced periodontal support were not associated with tooth intrusion, regardless of the type of connectors used.
This clinical report describes the use of an all-ceramic system to restore periodontally compromised teeth. A metal-free post-and-core system and all-ceramic crowns were used to splint the teeth and fulfill the esthetic demands.
Little information exists regarding the surgical and oral reconstructive options for the patient with idiopathic gingival hyperplasia, especially with regard to endosseous implant placement and recurrence of the disease. The authors report a case of severe gingival enlargement and bone resorption involving the maxillary and mandibular arches in a 21-year-old female causing distortion of facial features. The etiology could not be established but the condition was exacerbated during pregnancy, causing chewing, speaking, and esthetic problems. The hyperplastic tissue and all the teeth were removed surgically, followed by immediate placement of 2 endosseous implants. Restoration of esthetics and function with a maxillary denture and mandibular overdenture were completed 3 months later. No disease recurrence was noted at the 6-month postoperative interval.
OBJECTIVES: Autotransplantation is a viable option for treating missing teeth when a donor tooth is available. The aim of this study was to evaluate the prognosis in addition to the causes of failure in 182 autotransplanted teeth. STUDY DESIGN: A total of 182 cases of autotransplantation were analyzed. All the transplants were performed according to a computer-aided rapid prototyping technique with an average extraoral time of 7.58 minutes. These cases were followed for 2 to 60 months after surgery. The prognosis was divided into 4 groups, complete healing, incomplete healing, uncertain healing, and failure. The initial stability, root resorption, and ankylosis were also analyzed. RESULTS: Most transplanted teeth showed complete healing between postoperative 2 months and 8 months. The transplanted teeth with a good initial stability showed better initial healing than those with a poor initial stability. The average extraoral time was 7.58 min (range: immediately after extraction up to 25 min). There was no relationship (P > .05) between the extraoral time and either root resorption (4 cases, 2.4%) or ankylosis (18 cases, 10.7%) within this experimental time period. Nine cases (4.5%) failed. CONCLUSION: This study showed a 4.5% failure rate during the short to intermediate observation period. Autotransplantation is a very useful method for replacing missing teeth, provided that the extraoral time and other factors are well controlled.
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Axial movements of impeded and unimpeded rat mandibular incisors were measured following application and removal of intrusive loads of 1, 2, 5, 10 and 20 mN in a stepwise order at intervals of 1h on erupting teeth. The tooth movements were recorded by a displacement detector under artificial respiration with halothane anaesthesia. The loading and unloading procedures brought about the tooth movements in two steps: an initial rapid movement immediately after application or removal of the load and a subsequent slow and gradual movement. The initial rapid intrusive or extrusive tooth movements were significantly greater in the unimpeded than in the impeded teeth at the same load. The forces to stop extrusive tooth movements, estimated from the formula of regression lines showing correlations between the intrusive loads from 0 to 5 mN and tooth movements (microm/30 min), were 4.2 mN in the impeded and 2.9 mN in the unimpeded incisors. We suggest that repeated shortenings of the rat incisor did not cause an increase in the eruptive force and that changes in the resistance of the periodontal ligament predominantly regulate the axial movement of the rat incisor.
Axial tooth movements and arterial blood pressure were measured following the intravenous injection of 0, 0.01, 0.1, 1, or 10 micrograms/kg of adrenaline, noradrenaline or isoprenaline. Adrenaline caused a dose-dependent, rapid, extrusive tooth movement with a nearly simultaneous increase in blood pressure, followed by a marked intrusive tooth movement and a decrease in blood pressure. Noradrenaline caused a dose-dependent, rapid, extrusive tooth movement and an increase in blood pressure, but a subsequent intrusive tooth movement and decrease in blood pressure were not so marked. Isoprenaline caused a marked intrusive tooth movement and a decrease in blood pressure, without an extrusive tooth movement and increase in blood pressure. The time required to reach the maximum intrusive tooth movement was delayed after that to reach the maximum decrease in blood pressure. The recovery time of the intrusive tooth movement was much more delayed than that of blood pressure. These results suggest that the extrusive movement of the rat incisor was primarily related to the rise of arterial blood pressure due to stimulation of vascular alpha-receptors. It is also suggested that stimulation of beta-receptors would probably cause vasodilatation of arteries that would make the pressure in the small vessels in the microcirculation of the socket fall, so reducing the volume of blood and interstitial fluid in the socket followed by a marked and continuing intrusive tooth movement.
The present study was undertaken to disclose temporal changes in the distribution of Fos-like immunoreactive (-IR) neurons in the trigeminal subnucleus caudalis (SpVc), one of the important relay nuclei for processing the nociceptive information from the oro-facial regions, following induction of experimental tooth movement in rat upper molars. Furthermore, the effect of morphine and naloxone on the levels of Fos-IR neurons in the SpVc was examined. The experimental tooth movement was induced by insertion of an elastic rubber between the first and second upper molars. In normal animals, Fos-IR neurons were rarely observed in the SpVc. Immediately after insertion of the elastic band, the distribution of Fos-IR neurons was comparable to that observed in normal animals. The number of Fos-IR neurons increased significantly from 1 to 4 h following the induction of experimental tooth movement, reaching a maximum at 2 h, and then decreasing gradually. Most of the neurons were localized in the dorsomedial portion of the superficial layers of the ipsilateral SpVc near the obex, but a few were observed at the ventral portion of the SpVc. The neurons at the superficial layers and ventral portion of the contralateral SpVc also showed Fos-like immunoreactivity, but their numbers were significantly smaller than those on the ipsilateral side. Pretreatment with morphine (3 and 10 mg/kg, i.p.) significantly reduced the induction of Fos-IR neurons at the superficial layers of the ipsilateral SpVc in a dose-dependent manner, and its effect was antagonized by the subsequent treatment of naloxone (2 mg/kg, i.p.). Naloxone pretreatment enhanced the expression of Fos-IR neurons on the ipsilateral SpVc. The present results of a reduction of Fos-IR neurons by morphine pretreatment suggest that the induction of Fos-IR neurons may be due to the noxious stimulation caused by induction of experimental tooth movement.