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Intentional replantation - a 'last resort' treatment or a conventional treatment procedure? nine case reports.

Intentional replantation is an accepted endodontic treatment procedure in which a tooth is extracted and treated outside the oral cavity and then inserted into its socket to correct an obvious radiographic or clinical endodontic failure. This article reviews nine cases of intentional replantation (IR) that show the feasibility of the procedure in a variety of indications. Only one case of replantation showed evidence of pathosis that reflected root resorption or ankylosis. This report suggests that IR is a reliable and predictable procedure and should be more often considered as a treatment modality in our efforts to maintain the natural dentition.

Adult↗

Dentoalveolar distraction osteogenesis for rapid orthodontic canine retraction.

PURPOSE: We present a technique to reduce the overall orthodontic treatment time by means of dentoalveolar distraction osteogenesis. PATIENTS AND METHODS: Eleven patients who were planned to undergo orthodontic treatment with bilateral first premolar extractions and subsequent bilateral canine tooth distalization underwent osteotomy around the canine tooth. The first premolar was extracted, and the buccal bone was carefully removed. After wound closure, a special orthopedic device was mounted and cemented to the first molar and canine teeth. Distraction was started the same day at the rate of 0.4 mm twice a day and continued until adequate movement of the canine teeth was achieved. The device was then removed, and orthodontic therapy was continued with fixed appliances. RESULTS: The distraction rate and the device were well tolerated by all of patients. No anchorage loss in the second premolar and first molar teeth, root resorption, dental ankylosis, discoloration, or loss of vitality was detected. CONCLUSION: The concept of distraction osteogenesis for rapid orthodontic tooth movement is promising and feasible for clinical practice.

Adolescent↗

Transpalatal distraction as a method of maxillary expansion.

Conventional devices used for surgically assisted rapid palatal expansion are tooth-borne. Dental fixation entails a number of possible drawbacks such as loss of anchorage, skeletal relapse during and after the expansion period, cortical fenestration and buccal root resorption. A bone-borne titanium device with interchangeable expansion modules, used with a callous distraction policy, is presented.

Anesthesia, General↗

Hyper-IgE syndrome with recurrent infections--an autosomal dominant multisystem disorder.

BACKGROUND: The hyper-IgE syndrome with recurrent infections is a rare immunodeficiency characterized by recurrent skin and pulmonary abscesses and extremely elevated levels of IgE in serum. Associated facial and skeletal features have been recognized, but their frequency is unknown, and the genetic basis of the hyper-IgE syndrome is poorly understood. METHODS: We studied 30 patients with the hyper-IgE syndrome and 70 of their relatives. We took histories, reviewed records, performed physical and dental examinations, took anthropometric measurements, and conducted laboratory studies. RESULTS: Nonimmunologic features of the hyper-IgE syndrome were present in all patients older than eight years. Seventy-two percent had the previously unrecognized feature of failure or delay of shedding of the primary teeth owing to lack of root resorption. Common findings among patients were recurrent fractures (in 57 percent of patients), hyperextensible joints (in 68 percent), and scoliosis (in 76 percent of patients 16 years of age or older). The classic triad of abscesses, pneumonia, and an elevated IgE level was identified in 77 percent of all patients and in 85 percent of those older than eight. In 6 of 23 adults (26 percent), IgE levels declined over time and came closer to or fell within the normal range. Autosomal dominant transmission of the hyper-IgE syndrome was found, but with variable expressivity. Of the 27 relatives at risk for inheriting the hyper-IgE syndrome, 10 were fully affected, 11 were unaffected, and 6 had combinations of mild immunologic, dental, and skeletal features of the hyper-IgE syndrome. CONCLUSIONS: The hyper-IgE syndrome is a multisystem disorder that affects the dentition, the skeleton, connective tissue, and the immune system. It is inherited as a single-locus autosomal dominant trait with variable expressivity.

Abscess↗

Posterior transpalatal distraction with pterygoid disjunction: a short-term model study.

The transpalatal distractor (TPD) allows for maxillary expansion according to the concepts of distraction osteogenesis. Unlike tooth-borne, surgically assisted rapid palatal expansion devices, the bone-borne TPD is designed to avoid periodontal ligament compression, buccal root resorption, fenestration, tooth tipping, and orthodontic relapse during and after the expansion. When the distractor is placed on the palate at the level of the second premolar and pterygomaxillary disjunction is not performed, more expansion occurs in the anterior part of the maxilla than it does in the posterior. The aim of this investigation was to test the hypothesis that pterygomaxillary disjunction and placement of the TPD on the palate at the level of the first molars result in more parallel expansion of the maxillary segments. Twenty consecutive patients were included in a prospective way, and their predistraction and postdistraction models were electronically analyzed. The change in resistance and force application resulted, on average, in parallel segment expansion. The results showed that pterygomaxillary disjunction and posterior placement of the TPD are indicated for patients having transverse maxillary deficiency with lateroposterior crossbite.

Adolescent↗

Novel approach to regeneration of periodontal tissues based on in situ tissue engineering: effects of controlled release of basic fibroblast growth factor from a sandwich membrane.

To regenerate periodontal tissues, a sandwich membrane composed of a collagen sponge scaffold and gelatin microspheres containing basic fibroblast growth factor (bFGF) in a controlled-release system was developed according to the new concept of "in situ tissue engineering." A three-walled alveolar bone defect (3 x 4 x 4 mm) was made bilaterally in edentulous regions created mesially to the canines in both the maxilla and mandible of nine beagle dogs. A sandwich membrane with or without bFGF (100 microg) was implanted in each defect (each group, n = 18). During weeks 1, 2, and 4, histologic evaluation and histometric analyses were performed on three dogs. Throughout the 4 weeks, vascularization and osteogenesis were active only in the bFGF-treated group (p < 0.01). New cementum was formed (2.4 +/- 0.9 mm) on the exposed root surface at 4 weeks, and functional recovery of the periodontal ligament was indicated in part by the perpendicular orientation of regenerated collagen fibers. In the control group, epithelial downgrowth and root resorption occurred and the defects were filled with connective tissue. Thus, our sandwich membrane induced successful regeneration of the periodontal tissues in a short period of time.

Animals↗

Radiographic factors affecting the management of impacted upper permanent canines.

The aim of the investigation was to evaluate which radiographic factors influenced the orthodontists' decision whether to expose or remove an impacted upper permanent canine and was a retrospective, cross-sectional design. The sample consisted of all radiographic records of patients referred to the Orthodontic Department at Manchester University Dental Hospital with impacted upper permanent canines between 1994-1998 (n = 44). The following canine position measurements were made from the OPG: angulation to the midline, vertical height, antero-posterior position of the root, overlap of the adjacent incisor, and presence of root resorption of adjacent incisor(s). The labio-palatal position of the impacted canine was assessed from the lateral skull radiograph. Whether the impacted canine had been exposed and orthodontically aligned or removed was also recorded. Stepwise logistic regression analysis showed that the labio-palatal position of the crown influenced the treatment decision, with palatally positioned impacted canines more likely to be surgically exposed and those in the line of the arch, or labially situated, removed (P < 0.05). Additionally, as the canine angulation to the midline increased, the canine was more likely to be removed (P < 0.05). The orthodontists' decision to expose or remove an impacted upper permanent canine, based on radiographic information, seems to be primarily guided by two factors: labio-palatal crown position and angulation to the midline.

Adolescent↗

Cherubism: clinical evidence and therapy.

Cherubism is a hereditary childhood disease of autosomal dominant inheritance that is more common in the male sex. Some cases have also revealed a mutation of the gene FGF-RIII (fibroblast growth factor receptor III). The clinical picture of cherubism is characterized by painless symmetrical swelling of the mandible and polycystic destruction of the mandibular bone structure. Complications include delayed dentition, dental root resorption, malalignment of teeth, and impacted teeth. The disease progression comes to a halt of its own accord at the end of puberty. Spontaneous recoveries have been observed. Histologically, multinuclear giant cells with osteoclastic activity, which correspond to a giant cell granuloma, are found in fibrous stroma. It is generally agreed that decisions about surgical intervention should be considered carefully. A case report describes the course of the disease and therapy of a female patient with a periorbital manifestation of cherubism. The latero-orbital enlargement of the intraorbital and latero-orbital region of the zygomatic bone resulted in displacement of the orbital contents with a motility disorder of the eyes. The motility disorder was eliminated by reduction of the diseased hard tissue as well as by carrying out a modeling orbitotomy and by reconstructing an anatomically correct localized and irregular bilateral osseous structure of the zygomatic bone in the intraorbital and latero-orbital region.

Adult↗

The effect of calcitonin on osseous healing in guinea pig mandible.

Calcitonin (CT) is reported to be an effective medication for the treatment of inflammatory root resorption and to be capable of stimulating osteoblast proliferation in cell culture studies. In this study the effect of CT on the healing of osseous defects was evaluated in the mandibles of guinea pigs. After raising tissue flaps two experimental cavities were created on both sides of the corpus mandible of 33 guinea pigs. CT was applied into cavities either in hydroxypropyl methycellulose (HPMC) gel or gelatin as carrier. HPMC and gelatin alone and an empty cavity were also examined as control groups. Histopathological examinations under light microscopy were performed on weeks 1, 3, and 6. At week 1 in CT+gelatin and CT+HPMC groups, prominent osteoblastic activity was observed when compared with control groups. At week 3 the presence of woven bone in the experimental cavity areas reflected the increased osteoblastic activity in all groups. At the end of week 6 woven bone was gradually replaced by osteogenic tissue undergoing remodelization with Haversian systems in all groups. It is suggested that the osseous healing of the experimental cavity was enhanced by CT application in early stages (i.e. at week 1). However there was no significant difference of osteogenic activity between the control and CT-treated groups at the end of weeks 3 and 6.

Animals↗

A histological investigation of allografts of mature mouse molars to an intrabony and an extrabony site.

Fully developed mandibular third molar teeth, allografted across an H-2 plus multiple non-H-2 barrier to the tibial shaft medulla and renal subcapsular site in mice, were examined histologically over a 12-month period after transplantation. Cellular degeneration within the pulp chamber occurred in the immediate post-transplantation period and was followed by pulp chamber repopulation by a vascular fibrous connective tissue during the first 14 days after transplantation. Progressive regeneration of the grafts occurred and was characterized by irregular tubular dentine formation followed by more organized tubular dentine deposition on the pulp chamber walls. Allografts at both sites eventually underwent rejection, and it was apparent that grafts at the subcapsular kidney site were rejected in a shorter time (35 to 56 days) than those at the tibial shaft site (56 to 70 days). When mature teeth were allografted to the tibial shaft medulla across multiple minor (non-H-2) barriers alone, similar changes were observed with grafts undergoing rejection 56 to 70 days after transplantation. External root resorption and ankylosis were not prominent features and periodontal ligament reorganization was not observed in any of the grafts.

Animals↗

Emergency management of oral trauma in children.

Oral trauma continues to be a common pediatric emergency, accounting for 150 emergency room dental consultations per year at Children's Hospital in Boston. Children between the ages of 18 months and 2.5 years and between 8 and 11 years are most at risk. Recent advances in the management of these dental emergencies may help children and their families avoid the psychological and financial cost of infection or loss of primary and permanent teeth. Treatment of avulsions in the young permanent dentition remains a common problem, and a universally accepted approach to its management is still evolving. The use of a doxycycline immersion prior to reimplantation by the dentist may be helpful in preventing external root resorption. As always, the best therapy against dentofacial trauma is the pediatrician's support of preventive measures.

Child↗

Effects of Photobiomodulation Therapy in Lateral Luxation of Anterior Permanent Teeth: A Randomized, Double-Blind Clinical Trial.

BACKGROUND: Among the traumatic dental injuries (TDIs), lateral luxation may present poor prognosis due to frequent root resorption and consequent tooth loss. Photobiomodulation therapy (PBMT) modulates cellular activities (proliferation, differentiation, growth factor secretion) and may improve outcomes. OBJECTIVE: This randomized, double-blind, placebo-controlled trial evaluated PBMT (660 vs. 808&#x2009;nm) for post-operative pain and pulp sensitivity recovery in lateral luxation of permanent anterior teeth. METHODS: Initially, 41 patients were included, with a total of 63 teeth traumatized by lateral luxation and were allocated to G1 (n&#x2009;=&#x2009;21): Splinting&#x2009;+&#x2009;sham PBM (placebo), G2 (n&#x2009;=&#x2009;21): Splinting&#x2009;+&#x2009;808&#x2009;nm infrared PBM and G3 (n&#x2009;=&#x2009;21): Splinting&#x2009;+&#x2009;660&#x2009;nm red PBM. Four weekly sessions (3&#x2009;J/point, 3 points) were administered. Pain (by numeric rating scale) and pulp sensitivity (by cold test) were assessed weekly. Pain was analyzed using the Kruskal-Wallis test, followed by multiple comparisons using Dunn's method with Bonferroni correction, and pulp sensitivity by a logistic regression model (p&#x2009;<&#x2009;0.05). RESULTS: Three participants (total of 5 teeth) were excluded due to loss to follow-up. Fifty-eight teeth were analyzed (G1&#x2009;=&#x2009;21, G2&#x2009;=&#x2009;17, G3&#x2009;=&#x2009;20). Pain: All groups showed a significant reduction in pain over time (p&#x2009;<&#x2009;0.001). Both G2 and G3 demonstrated a significantly greater reduction in pain compared to G1 (p&#x2009;<&#x2009;0.001 and p&#x2009;=&#x2009;0.026, respectively). No significant difference in pain reduction was observed between G2 and G3. Pulp sensitivity: G2 showed a significant improvement over time (p&#x2009;<&#x2009;0.001), despite starting from a more unfavorable baseline. In contrast, no significant change in pulp sensitivity was observed for G1 or G3 between the initial and final assessments. CONCLUSION: Within the limitations of this clinical study, all intervention groups were effective in reducing pain in lateral luxation of permanent anterior teeth, with superior results for laser groups compared to the placebo. However, only the 808&#x2009;nm laser irradiation protocol demonstrated a significant improvement in pulp sensitivity, suggesting it may offer a more complete therapeutic response.

Humans↗

Bleaching of a discoloured non-vital tooth: use of a sodium perborate/water paste as the bleaching agent.

Bleaching materials containing hydrogen peroxide have been used successfully for the treatment of discoloured non-vital teeth; however, their use has occasionally been associated with external root resorption. Some evidence exists that sodium perborate mixed with water is as effective as sodium perborate mixed with hydrogen peroxide. A case is presented which supports this and a step-by-step technique is described.

Adolescent↗

Clear cell odontogenic tumor in the mandible: report of a case with an immunohistochemical study of epithelial cell markers.

A rare case of clear cell odontogenic tumor is presented with an immunohistochemical study using epithelial cell markers. A 35-year-old Japanese man was admitted with a complaint of painless swelling in the anterior region of his mandible. Radiological examination showed a relatively well-defined multilocular radiolucency with root resorption of the adjacent teeth. Despite a subtotal mandibulectomy, the tumor recurred three times. Histologically, the tumor was composed of proliferating clear cells and infiltrated through the cancellous bone. Histochemical and ultrastructural analyses detected cytoplasmic glycogen granules in the clear cells. They showed immunoreactivities for cytokeratin 8, 13 and 19, filaggrin and anti-ameloblastoma antibodies, suggesting an odontogenic epithelial origin.

Adenocarcinoma, Clear Cell↗

Gingivitis in the human deciduous dentition. A correlative clinical and block surface light microscopic (BSLM) study.

This study examined the relationship between clinical and histomorphometric parameters in the human deciduous dentition. Clinical parameters including plaque index, gingival swelling, gingival color, tooth mobility and degree of root resorption were determined prior to the extraction of teeth. The teeth were extracted with their surrounding gingiva in order to preserve the in situ relationship between the hard and soft tissues. Histomorphometric analysis was carried out on 55 sites, using block surface light microscopy (BSLM). Apical migration of the junctional epithelium was found at 53% (29) of the sites. The gingival sulcus was shallow (0.3 +/- 0.19 mm) and coronal to the cemento-enamel junction at 84% (46) of the sites. Junctional epithelium with retepegs was present at 89% (49) of the sites, whilst an inflammatory cell infiltrate (ICI) was present at all sites examined. The ICI was located opposite to the junctional epithelium and cementum at 80% (44) of the sites. The extent of ICI correlated positively with the patients' age and was significantly increased when clinical evidence of gingival swelling or redness was present.

Adolescent↗

The influence of anatomical, pathophysiological and other factors on periodontal healing after impacted lower third molar surgery. A multiple regression analysis.

A multifactorial approach has been used to identify some predictors of postoperative intrabony defects (IBD) on the distal surface of the adjacent second molar (M2) after impacted lower third molar (M3) surgery. The material consisted of 215 lower third molar removals, performed on 144 persons (age range 16-53 years; mean 27.2 years). The postoperative examination took place 2 years after impaction surgery and included both clinical and radiographic variables. Statistically significant (5% significance level) predictors of IBD found in stepwise multiple regression analyses were: (1) preoperative intrabony defect M2 distal; (2) age at the time of surgery; (3) size of contact-area M3/M2; (4) root resorption M2 distal; (5) probing dept distal surface of adjacent first molar postoperatively; (6) pathological follicle M3. The regression model with IBD as regressand produced a total R2 of 0.45. When the regressand was the difference between IBD and the preoperative intrabony defect, the regression analysis explained 62% of the variance (R2 = 0.62). These regression models explained the variance in terms of the size of the remaining postoperative intrabony defect as well as in terms of periodontal healing after impacted lower third molar surgery.

Adolescent↗

Adenomatoid odontogenic tumor: biologic profile based on 499 cases.

Topographically, the AOT occurs in peripheral and central variants, the latter further in follicular (with embedded tooth) and extrafollicular (no embedded tooth) types. The AOT is slow growing with few or no symptoms. Tumor growth may cause displacement of teeth rather than root resorption. The follicular AOT mimics a follicular cyst, the extrafollicular a residual or "globulo-maxillary" cyst and the peripheral a gingival fibroma. All variants of AOT show identical histologic features. The central variants account for 97.2%, 73.0% of which are follicular. The follicular variant (M:F ratio 1 to 1.9) is three times as frequent as the extrafollicular. The follicular variant is diagnosed earlier in life (mean age 17 yr) than the extrafollicular (mean age 24 yr). 53.1% of all variants occur within the teens (13-19 yr). Follicular AOT is associated with one embedded tooth in 93.2%. Maxillary permanent canines account for 41.7% and all four canines for 60.1% of AOT-associated embedded teeth. Ranking four among the odontogenic tumors the AOT is not a particularly rare tumor. Conservative surgical excision is the treatment of choice. Documented recurrences have not been reported.

Adolescent↗

Mitoses and microorganisms in the periodontal membrane after storage in milk or saliva.

Milk and saliva were tested in vitro as potential storage media for avulsed teeth. Developing monkey teeth were extracted and stored in milk or saliva for periods ranging from 1 to 6 h. The osmolality, pH, conductivity and number of viable bacteria in the media were determined after predetermined intervals during the storage periods. After the storage periods the teeth were either prepared for scanning electron microscopy or cultured for 24 h in Eagle's medium supplemented with 3H-thymidine. In the scanning electron microscope numerous adherent bacteria were seen covering the periodontal membrane after storage in saliva but none were found after storage in milk. The cultured teeth were sectioned and evaluated with autoradiography. Superficial parts of the periodontal membrane were rapidly injured by storage in saliva while the epithelial root sheath and the apical pulpal cells were affected at a later stage. Cells neighboring the cementoblasts incorporated 3H-thymidine after 6 h storage in milk but not after storage in saliva for the same length of time. It was concluded that the low osmolality in combination with bacteria which adhered to the periodontal membrane made saliva less suited than milk for long time storage of avulsed teeth. Furthermore, a viable layer of cells close to the root surface seemed to be a prerequisite for a successful healing without root resorption after replantation.

Animals↗