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PubMed1982

Histologic and clinical assessment of long-term pulpal-periodontal therapy.

A 20-year follow-up of cases published in 1959 involving the treatment of pulpal-periodontal disease suggests the following: 1. The periodontal results have been stable except for one case of root resorption and one case in which there was gingival recession with no pocket formation. 2. The histologic evidence in the resorbed case would suggest that repair had occurred with the formation of new bone, ligament, and cementum. 3. There was also evidence from the histologic sections that the inflammatory response was localized to the region of the apical foramen. 4. There was secondary osteocementum on the dentin surface inside the root canal which had narrowed the width of the apical foramen. 5. There was x-ray and histologic evidence that previously well-condensed gutta-percha had been resorbed during a 20-year period in all of the four treated root canals.

Dental Pulp Diseases↗

PubMed1996

Diagnosis and management of root fractures and periodontal ligament injury.

Although root fractures are among the less common oral injuries (6 percent), a careful diagnostic evaluation of such injuries is required to arrive at an appropriate treatment plan. The position of the fracture in the root will determine the proper management. The problem of luxation due to trauma often involves the use of dental splints, which, if not properly designed, may cause root resorption, loss of alveolar bone, pulpal necrosis and pulp canal obliteration. The guidelines for the type of splint to use and conditions under which it should be placed are presented.

Dental Pulp↗

PubMed2006

Characteristics and prevalence of non-syndrome multiple supernumerary teeth: a retrospective study.

OBJECTIVE: The goal of this study was to evaluate the radiological and clinical findings of non-syndromic multiple (five or more) supernumerary teeth in patients radiographically examined between 1999 and 2004. METHODS: Among 9550 patients, 251 cases of supernumerary teeth were found, including six cases of multiple supernumerary teeth. Patients with multiple supernumerary teeth were evaluated for age, sex, unilateral or bilateral distribution of the teeth, localization, morphology and complications or associated pathologies such as dentigerous cysts, eruption anomalies, resorption of adjacent teeth, displacement of tooth germ, malformation, migration, neurological symptoms, and secondary and periapical infections. RESULTS: All patients were male and most of the multiple supernumerary teeth were seen in the premolar region. The prevalence of multiple supernumerary teeth was 0.06%. Out of 37 multiple supernumerary teeth examined, 30 were impacted. Various associated anomalies were seen in 21.6% of cases. Although the mean age was high (23.1 years), no pathologies such as root resorption on adjacent teeth or cystic formation were observed, in contradiction of previous studies. CONCLUSION: In agreement with previous studies, the majority of supernumerary teeth were seen in the lower premolar region. That all patients with multiple supernumerary teeth were male and that most of these teeth were impacted was also in agreement with previous studies. The order of location frequency in previous studies has been premolar-molar-anterior; we found the order to be premolar-anterior with no supernumerary molar teeth observed. It was also interesting that no serious pathological findings were recorded.

Adolescent↗

PubMed1978

Autologous tooth transplantation to replace molars lost in patients with juvenile periodontitis.

A method is described to replace perodontally destroyed first molars in patients with juvenile periodontitis by auto-transplantation of third molars. Fifteen molars which had been extracted due to periodontal destruction were replaced by autologous third molars with incomplete root formation. The patients were then observed for a period up to 7 years. In all cases complete regeneration of the alveolar bone took place and radiographically a normal periodontal membrane was extablished. All of the transplanted teeth continued their root formation and there was no radiographic evidence for root resorption, ankylosis or necrosis of the pulp. None of the transplanted teeth displayed pocket depths over 3 mm and no abnormal mobility was detectable.

Adolescent↗

PubMed2006

Long-term clinical and radiological outcomes of surgical management of central giant cell granuloma of the maxilla.

The aim of this study was to report the results of long-term clinical and radiological follow up of the surgical management of central giant cell granuloma of the maxilla. A retrospective analysis was conducted on 12 patients--5 male and 7 female whose ages ranged from 9 to 41 years, with central giant cell granuloma of the maxilla treated between 1991 and 2000. The anterior maxilla was involved in five cases, seven cases were in the posterior region, and none crossed the midline. Four patients were asymptomatic and eight patients presented with pain, mobility of teeth, and rapidly enlarging facial swelling. Radiographically, all lesions were radiolucent; 58.3% were unilocular, and the borders were well-defined in 33.3%. Roots were commonly displaced by the lesion, but no root resorption was observed. Cortical perforation was seen clinically and on CT scan in four patients. All cases were treated with thorough curettage until healthy bone was encountered. In cases with cortical perforation the affected buccal and/or palatal mucosa was excised. When the maxillary sinus was affected or the lesion was bulging into the nose, the nasal mucosa was also removed. All patients were reviewed annually for a follow-up period of 2-9 years; the condition recurred in two patients. It is concluded that thorough curettage is a satisfactory method for the treatment of non-aggressive and aggressive central giant cell granuloma of the maxilla, with a low recurrence rate and favorable postoperative outcome.

Adolescent↗

PubMed1993

Normal histologic features of domestic ferret periodontium.

The normal histologic features of the periodontal tissues in 17 domestic ferrets (10 male and 7 female) are described. The following teeth were histologically evaluated: canines, the maxillary third premolar (P3), the mandibular fourth premolar (P4), the carnassial teeth (P4 in the maxilla and the first molar, M1, in the mandible) and the next molar after the carnassials (M1 in the maxilla and M2 in the mandible). After histologic preparation for light microscopy, the sections were analyzed at magnifications of x 20 and x 100. The histometric measurements performed were 1) distance between the cementoenamel junction (CEJ) and the alveolar bone crest, 2) distance between CEJ and the most coronal connective tissue, 3) root length, 4) width of the periodontal ligament at three different locations along the root surface, and 5) cementum layer thickness at the most apical portion of the root. The number of sections exhibiting root resorption was counted. The results gave the normal values of some common periodontal variables and suggested a possible future use of the domestic ferret as an alternative experimental animal in periodontology.

Animals↗

PubMed2005

Comprehensive therapy of a fusion between a mandibular lateral incisor and supernumerary tooth: case report.

The term fusion is used to define a developmental anomaly characterised by the union of two adjacent teeth. In the case reported here, clinical and radiographic examinations suggested a unilateral fusion between the mandibular left permanent incisor and a super-numerary tooth. Radiographs showed that the fused teeth had two distinct pulp chambers and canals. A diagnosis of chronic periapical abscess of the supernumerary tooth was made. Before root canal therapy, a periodontal surgical procedure was performed to section the central incisor and its fused supernumerary. Also, odontoplasty was performed on the roots, to establish an anatomy consistent with a normal central incisor. Later, the chronic apical abscess on the supernumerary tooth was instrumented chemo-mechanically, root canal filling was performed and an anterior composite resin restoration was placed. The patient was evaluated for one year after root canal therapy. The tooth was asymptomatic, not exhibiting any pathological root resorption or alveolar resorption, and the anterior composite restoration was intact. Instead of extracting the supernumerary tooth, the application of endodontic, periodontal, and restorative procedures proved to be an alternative treatment.

Child↗

PubMed2006

Evaluation of the formocresol versus mineral trioxide aggregate primary molar pulpotomy: a meta-analysis.

OBJECTIVE: To apply meta-analysis to compare the clinical and radiographic effects of mineral trioxide aggregate (MTA) with formocresol (FC) when used as wound dressing for pulpotomy of primary molars. STUDY DESIGN: The study list was obtained by searching MEDLINE, The Cochrane Library, EMBASE, and SCI. Only those papers that met the inclusion criteria were analyzed. RESULTS: Six studies met the inclusion criteria. There was significant difference between the success rates of FC- and MTA-treated pulpotomized primary molars (P < .05). Clinical assessments and radiographic findings of the MTA versus FC pulpotomy suggested that MTA was superior to FC in pulpotomy resulting in a lower failure rate, with the RR (Relative Risk) being 0.32 (95% confidence interval [CI] 0.11 to 0.90) and 0.31 (95% CI 0.13 to 0.74), respectively. Internal root resorption happened less in the MTA group with RR 0.29, 95% CI 0.11 to 0.77. CONCLUSION: MTA induces less undesirable responses and might be FC's suitable replacement.

Aluminum Compounds↗

PubMed1993

A follow-up study of incisor teeth which had been treated by apical closure and root filling.

A follow-up study was conducted of 93 non-vital immature incisor teeth treated by apical closure and root filling. Only six teeth had been lost and these losses were due to trauma, failed restorative treatment or root resorption. Life table analysis suggested that 86% of teeth would still be present after 5 years. The number of teeth at risk was too small after 5 years to provide precise enough estimates of the percentage of survivors.

Adolescent↗

PubMed1985

Effect of implants on healing of experimental furcation defects in dogs.

The present study was performed to find out whether implants placed around periodontally involved teeth during reconstructive surgery would support replaced flaps and prolong gingival coverage of the treated root surfaces facilitating new attachment. Through-and-through furcation defects were made in the mandibular second, third, and fourth premolars of 10 beagle dogs. Bone was surgically removed from the furcation and from the circumference of each tooth to a level 3 to 4 mm apical to the cementoenamel junction. Steel wires were passed through the furcations and ligated to enhance plaque formation. At 6 weeks, the wires were removed. At 12 weeks, during reconstructive surgery, 4 dogs received implants of autogenous intraoral cancellous bone, 2 of autogenous iliac cancellous bone and marrow, 2 of Proplast, and 2 of Avitene. The results demonstrated that none of 12 teeth implanted with Avitene or Proplast showed new attachment. Only 2 of 6 teeth implanted with autogenous iliac bone showed new attachment, combined with extensive root resorption and ankylosis. Of 12 teeth implanted with autogenous intraoral bone, 6 showed new attachment. Our findings suggest that flap support by intraoral cancellous bone implants may facilitate new attachment. A more predictable technique, however, needs to be developed.

Animals↗

PubMed1992

Periodontal repair in dogs: effect of a composite graft protocol on healing in supraalveolar periodontal defects.

This study evaluated the effect of a composite graft as an adjunct to gingival flap surgery in induced chronic supraalveolar periodontal defects in the mandibular premolar region in beagle dogs. The vertical dimension of the defects, measured from the cemento-enamel junction to the alveolar bone, approximated 5 mm. Root surface treatment in quadrants receiving the graft protocol included conditioning with both critic acid and tetracycline. The composite graft (including: hydroxyapatite, freeze-dried decalcified bone, tetracycline, and fibronectin) was then fitted to the defects. Flaps were placed and sutured to cover most of the crowns of the teeth but the tips of the cusps. The root surfaces in contralateral jaw quadrants were conditioned with critic acid and the flaps similarly placed and sutured. Dogs were sacrificed 6 weeks after surgery and tissue blocks including teeth and surrounding structures processed for histometric analysis. Connective tissue repair to the root surface in teeth treated with the graft protocol approximated 60% of the defect height. Connective tissue repair in teeth treated with citric acid only was significantly greater and averaged 98% of the defect height (P less than or equal to 0.01). Cementum formation was limited following both treatments (approximately 6% of the defect height). Bone regeneration was significantly smaller in grafted sites than in sites treated with citric acid only (approximately 2% and 10% of the defect height, respectively; P less than or equal to 0.05). Root resorption was observed in almost all teeth. Ankylosis was present in two citric acid-treated specimens, both from the same dog.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Etching, Dental↗

PubMed1998

Nature and attachment of cementum formed under guided conditions in human teeth. An electron microscopic study.

In an attempt at characterizing the nature and attachment of cementum formed under conditions of guided tissue regeneration (GTR) in humans, front teeth from 4 patients aged 42 to 72 years were examined at the electron microscopic level. All teeth were affected by complex periodontitis associated with advanced loss of periodontal support. Roots were surgically planed and notched, but not chemically conditioned. Either the mesial or distal surface of each tooth represented the experimental site and was covered with a biodegradable polyglactin 910 barrier, while the opposite approximal surface served as control. Following 3 months of healing, teeth were removed together with surrounding periodontal tissues including some alveolar bone. These blocks were fixed histologically, decalcified, embedded in epoxy, and sectioned for examination in the scanning (backscatter mode) and transmission electron microscope. Both experimental and control sites disclosed 2 types of regenerative cementum that seemed to be formed by cells resembling cementoblasts. The first type was characterized by a thin fringe of collagen fibrils which were arranged perpendicular to the root surface and appeared mineralized in a zone extending about 1 to 3 microm from the dentin. The second type occurred as thick patches which revealed scattered cementocytes and sheets of collagen fibrils oriented mainly parallel to the root surface, running both circularly and axially. In both situations, a continuous, thin, electrondense layer was interposed between newly formed cementum and preexisting radicular hard tissues. Interdigitation of collagen fibrils from cementum and dentin, such as observed along the natural cemento-dentinal junction, did not occur. Thus, regenerative cementum laid down in humans under guided conditions on previously diseased and planed, but not otherwise treated root surfaces shares some morphologic features with cementum formed during spontaneous repair of root resorptions. However, unlike in the course of such repair, a fibrous attachment of new cementum resembling the natural cemento-dentinal junction does not seem to be regenerated under guided conditions.

Absorbable Implants↗

PubMedDate not supplied

A multidisciplinary approach to the treatment of an intruded maxillary permanent incisor complicated by the presence of two mesiodentes.

Treatment of a traumatically intruded maxillary incisor with an immature apex remains controversial. Treatment options include observation, surgical repositioning, or orthodontic forced eruption. Likewise, the ideal timing of surgical removal of a mesiodens is highly controversial: immediate versus delayed intervention. The complications associated with untreated supernumerary teeth include: overretention of primary teeth, delayed eruption of permanent incisors, rotations, impaction, diastema, pulp necrosis and root resorption. Less common sequelae include enlarged follicular sacs, cystic degeneration and nasal eruption. This paper describes another risk factor associated with delayed removal of a mesiodens previously not mentioned in the dental literature, namely potential complications arising from a traumatic injury, in particular intrusion, of the maxillary permanent incisors.

Child↗

PubMed2003

Dentin-induced in vivo inflammatory response and in vitro activation of murine macrophages.

The activation of inflammatory cells and consequent release of mediators play an important role in the resorption of mineralized tissues. In the present study, we examined the ability of dentin extracts to induce inflammatory cell recruitment and activation. We showed here that dentin extracts triggered an intense cell migration and progressive cell maturation, in a time- and dose-dependent manner. Expression of interleukin-1 beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha), nitric oxide (NO), and hydrogen peroxide (H(2)O(2)) was also up-regulated by dentin extracts. These results show that inflammatory events can be elicited in response to dentin, which may suggest a possible involvement of dentin molecules in the inflammatory events, coupled with their release at the root resorption sites.

Analysis of Variance↗

PubMed2003

Intentional replantation for periodontally involved hopeless teeth.

The aim of this study was to evaluate the clinical and radiographic results of intentional replantation of periodontally involved teeth after conditioning of root surfaces with tetracycline-HCl. Thirteen patients (seven female, six male; age range: 35-52 years) with 15 periodontally involved hopeless teeth were included in this study. During the replantation procedure, the affected teeth were gently extracted, then the granulation tissues, calculus, remaining periodontal ligament and necrotic cementum on the root surfaces were removed. Tetracycline-HCl, at a concentration of 100 mg ml(-1), was applied for 5 min to the root surfaces. The teeth were then replaced into the socket and splinted. Patients were clinically and radiographically evaluated at baseline (time of surgery) and 6 months after the surgery. The following measurements were recorded: probing depth (PD), gingival recession (R), the amount of bone loss (BL) and bone gain (BG). Results indicated a reduction in PD and in the amount of bone loss and healthy gingiva. Mean PD was decreased from 5.25 to 2.36 mm, gingival recession was increased from 3.73 to 4.0 mm, and BL was reduced from 73.20 to 56.86%. At the end of 6 months, no root resorption or ankylosis was observed radiographically. Even during the short period of evaluation, it may be suggested that intentional replantation can be an alternative approach to extraction in cases where advanced periodontal destruction is present and no other treatments could be considered.

Adult↗

PubMed1993

The prevalence and distribution of rests of Malassez in the mouse molar and their possible role in repair and maintenance of the periodontal ligament.

This study sought to determine the prevalence and distribution of these rests under normal conditions and after giving 1-hydroxyethylidene-1,1-bisphosphonate (HEBP), a drug that interferes with homeostasis in the periodontal ligament. Normally the rests of Malassez were equally distributed on all root aspects with the exception of the mesial of the mesial root of the first mandibular molar. With increasing age their number decreased. A similar distribution was seen in the animals treated with the bisphosphonate, in which there was a severe reduction in width of the periodontal ligament, at several sites resulting in ankylosis. After discontinuing HEBP the normal width of the periodontal ligament space was restored. Repair was characterized by root resorption, elimination of ankylosis, cementum formation and regeneration of ligament. These processes seemed to have no connection with the prevalence and distribution of rests of Malassez. It is concluded that rests of Malassez are unlikely to play an important part in the homeostasis of periodontal ligament and do not seem to be a prerequisite for its repair and maintenance.

Animals↗

PubMed2004

Effect of enamel matrix proteins on the periodontal connective tissue-material interface after wound healing.

The periodontal ligament has the potential to regenerate a complete periodontal connective tissue attachment, starting with the deposition of cementum, on pathologically exposed root surfaces as well as several materials including titanium oxide. However, most commonly used dental materials result in a fibrous encapsulation or a chronic inflammatory response after periodontal wound healing rather than the formation of a periodontal connective tissue attachment. Recently, an extract of porcine enamel matrix (Emdogain(R), EMD) has been reported inductive of cementum formation in both in vivo and in vitro studies. The aim of this study was to determine the effect of EMD, when applied to materials previously reported not supportive of periodontal connective tissue formation, on the periodontal connective tissue-material interface obtained with these materials in vivo. Bilateral osteotomies were performed on the mandible of a Yucatan minipig exposing the buccal root surface of four premolars. A series of four preparations were placed in each root surface that were subsequently filled with calcium hydroxide, gutta percha, mineral trioxide aggregate (MTA), or left unfilled. One side, in addition, received an application of EMD prior to surgical closure. A bioabsorbable surgical barrier membrane was placed over the osteotomy sites to exclude gingival connective tissue from the wound-healing environment. The mucoperiosteal flaps were then readapted and sutured in position. The animal was euthanized 10 weeks after the procedure, block sections obtained and prepared for light microscopy. Results demonstrated complete regeneration of alveolar bone and periodontal ligament in all four teeth from the EMD-treated side. Fibers from the periodontal ligament were observed to insert into a mineralized matrix consistent with cementum on all four root preparations. In contrast, massive root resorption without regeneration of alveolar bone was found on all teeth from the side not treated with EMD. The results of this pilot study suggest that the application of EMD to material surfaces that normally do not support periodontal connective tissue attachment formation can alter the type of periodontal connective tissue interface obtained with these materials.

Animals↗

PubMed2001

Histology of connective tissue graft. A case report.

BACKGROUND: Few investigations can be found in the literature on the histological nature of the attachment of connective tissue grafts to root surfaces previously exposed by recession. METHODS: In this case report, a 24-year-old patient was treated with a connective tissue graft combined with a partial-thickness coronally positioned flap for root coverage of Class I Miller recessions at the maxillary right and left canines and first premolars. The treated sites exhibited 83% and 100% root coverage on the right and left sides, respectively. Twelve months later, the case required extraction of all 4 first premolars for orthodontic reasons. Two conservative block sections including the maxillary first premolars with the buccal soft tissues were obtained and processed histologically in a bucco-palatal plane. RESULTS: Histological analysis showed that healing occurred via a long junctional epithelium throughout the major portion of the previous recession site. Only minimal signs of new cementum-like tissue formation could be seen in the apical portion of the recession area coronal to the base of the instrumented root surface. No root resorption or ankylosis could be detected in any of the serial sections. CONCLUSIONS: The findings of this case report outline the possible variations in the histological outcome of connective tissue grafts. These variations can be attributed to differences in size and shape of the recession defects and flap positioning at the end of surgery.

Adult↗