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Amelogenesis imperfecta: enamel ultra structure and molecular studies.

Amelogenesis imperfecta (AI) is a hereditary disorder resulting in generalized defects in the enamel. The case reported here is of a seven-year-old male child with yellow color of all his teeth. Two of his primary molars were extracted due to dental abscess with advanced root resorption. Histologically hypoplastic enamel layer, positively birefringent, generalized pitting, roughness with irregular general cracked borders were observed. Scanning electron microscope, revealed extensive irregular, disorganized rough superficial enamel layer. The enamel was irregularly decussate with filamentous prisms accompanied by small rounded formations. The morphological and histological examination of the tooth revealed that this patient has the features of AI. For genetic study blood sample were collected from the patient and PCR analysis revealed that there is no mutation in exons 1-7 of AMELX gene on the X chromosome of the patient. Hence, it is probable that the AI of this patient is not X-linked. It is more likely to be an autosomal mutation.

Amelogenesis Imperfecta↗

Preserved scleral allografts in periodontal defects in man. II. Histological evaluation.

1. The scleral grafts appeared to be well accepted as there were no signs of antigenicity or untoward reactions. 2. The gingival connective tissue, periodontal ligament and the periosteum were observed intertwined with sclera at the interface. 3. Sclera was invaded by host fibroblasts, capillaries, and appeared in some areas to be raplaced by a dense connective tissue. 4. Areas of cementogenesis could be observed in all specimens. 5. There were no signs of osteogenesis within the scleral grafts. 6. The alveolar crest appeared relatively nonreactive to sclera. 7. There were no signs of external root resorption or ankylosis. 8. Sclera may be able to be used to fill in osseous craters, other periodontal defects and as a scaffolding in conjunction with osseous grafts. This requires further investigation. 9. Sclera may possibly be used in areas where there was loss of gingival contour or need for ridge augmentation.

Alveolar Process↗

A clinical and histometric study of gingivitis associated with the human deciduous dentition.

This study examined the relationship between clinical indices and the histologic parameters associated with the gingiva of the human deciduous dentition. The plaque index, gingival swelling and color, probing depth, bleeding on probing, contact with adjacent teeth and the degree of root resorption of 58 deciduous teeth were recorded. The teeth were extracted with their surrounding gingiva and prepared for histologic examination. The area of epithelium and connective tissue with and without inflammatory cells was measured as well as the epithelial length from the gingival margin including the junctional epithelium. When these measurements were grouped according to the values of the clinical indices, nonmobile teeth were found to have less epithelium than those with mobility and gingiva with a healthy color had a significantly smaller inflammatory cell infiltrate than red gingiva. Bleeding and increased probing depth were not associated with the other clinical signs of inflammation. The amount of plaque did not correlate with the measures of clinical inflammation. The inflammatory cell infiltrate was present irrespective of whether the gingiva was clinically normal or not and the inflammation did not correlate with the amount of plaque.

Adolescent↗

Healing of spontaneous periodontal defects in dogs treated with xenogeneic demineralized bone.

This study was undertaken to histologically, clinically and radiographically evaluate the sequence of healing following implantation of bovine demineralized bone powder (DBP) into severe, spontaneous periodontal defects in beagle dogs. Eight dogs with documented severe periodontitis were treated surgically following initial debridement. One quadrant in each arch was treated with conventional flap surgery and the others were treated with surgery followed by DBP implantation. Animals received postoperative debridement and clinical and radiographic evaluation. Two dogs were sacrificed at 1, 3, 6 or 12 months postoperatively, and the jaws were evaluated histologically. Clinically, DBP was well tolerated by recipients. No evidence of localized inflammatory response or delayed hypersensitivity reaction was noted. Significant reductions in gingival inflammation were noted in both experimental and control sites at 1 month postoperatively compared to preoperative scores. Equivalent periodontal pocket reduction was noted between test and experimental sites and remained significant at 12 months. Radiographically, no differences were noted in the rate of bone loss between control and test sites. Histologic evaluation demonstrated the presence of DBP at 1 month following implantation, but the material was replaced with new bone by the next sacrifice period. Periodontal ligament fibers of standard orientation were seen extending from DBP-induced bone to the root surface by 1 month after implantation. An intact epithelial attachment appeared to be present 1 month after the implantation of DBP. No differences in root surfaces were detected between test and control groups. Ankylosis was a rare finding, noted equally between test and control sites. DBP did not appear to predispose to external root resorption. In later stages, histologic evidence of advancing periodontitis was noted equally in both control and experimental groups. While DBP successfully induced new bone formation, the inability to adequately maintain the periodontal tissues due to bacterial accumulation in this model combined with recurrent pocket formation, precluded any conclusion regarding long-term advantage. Based on these findings, clinical trials of this or similar materials are recommended.

Alveolar Process↗

Effect of a collagen matrix on healing in periodontal fenestration defects in dogs.

Contralateral periodontal fenestration defects in seven beagle dogs were used to evaluate influence of a collagen matrix on periodontal wound healing. The defects (6 x 4 mm) were created through the buccal cortical plates of the maxillary canine teeth following elevation of mucoperiosteal flaps. The collagen was fitted to the defects on one side. Contralateral defects served as controls. Flaps were repositioned and sutured. Dogs were sacrificed 4 weeks after surgery and block sections including teeth and surrounding structures were prepared for histometric analysis. No meaningful differences in cementum and bone regeneration were observed between treatments. There was seemingly more bone regeneration in the apical than in the coronal aspect of the defects and significantly more cementum regeneration. Root resorption was observed in one collagen and one control defect. Ankylosis was not observed. The results suggest that the maxillary canine periodontal fenestration defect can be used as a model to evaluate factors that may enhance cementum and bone regeneration. The collagen matrix neither enhanced nor inhibited periodontal wound healing in this model.

Alveolar Bone Loss↗

Papillon-Lefèvre syndrome: a review of the literature and report of 4 cases.

This report describes 4 cases of Papillon-Lefèvre syndrome (PLS) affecting 2 Jordanian families with a total of 8 children. In family A, 3 girls out of 6 siblings were affected; and in family B, the eldest of 2 brothers. The patients were between 4 1/2 and 12 years old, and their parents, who are first cousins, were not affected. Diagnosis was determined by history, and clinical, laboratory, and radiographic examinations. All present cases exhibited the typical clinical features of PLS: hyperkeratosis of the palms and soles and the presence of advanced destructive periodontitis resulting in early loss of both the primary and permanent dentitions. In Case 4, cutaneous lesions were noticed at age 6 months and the child was edentulous by the age of 12 years. In all cases, there was a relationship between increased severity of skin lesions and seasonal variations and intensified periodontal destruction. There was an early eruption of the permanent teeth. The teeth were caries-free with no sign of root resorption. Dentists play a significant role in the diagnosis and management of PLS patients.

Child↗

The effect of safflower seed extract on periodontal healing of 1-wall intrabony defects in beagle dogs.

BACKGROUND: Recent interest in naturally based products has increased. Various herbal extracts are known to have a variety of medicinal properties. Among the various natural medicines, safflower seeds have beneficial effects on various bone diseases such as bone fracture, osteoporosis, and osteodysplasia. In addition, they are known to have anti-inflammatory effects. The objective of this study was to evaluate the effect of a safflower seed extract (SSE) on the regeneration of periodontal tissue in a preclinical 1-wall model in dogs. METHODS: Preclinical 1-wall periodontal defects were surgically created in the mesial aspect of the maxillary third and mandibular fourth premolar and in the distal aspect of the maxillary first and mandibular second premolar, and were randomly assigned to receive SSE/collagen (SSE/Col), phosphate-buffered saline/collagen (buffer control), or root planing only (surgical control). The created 1-wall defect configuration was 4 mm in depth by 4 mm in width. We selected the segment showing the best activity to the osteoblast cells that was sensitive to the formation of calcified nodules among the SSE fractions extracted from various organic solvents. The animals were euthanized at 8 weeks postsurgery, and block sections of the defects were collected for histologic and histometric analysis. RESULTS: The junctional epithelium migration did not show any statistically significant differences among the treatments. In connective tissue adhesion, the SSE/Col group and the buffer control group showed significant differences compared to the surgical control group. New cementum averaged 3.84 +/- 0.57 mm, 3.75 +/- 0.24 mm, and 1.53 +/- 1.22 mm for the SSE/Col group, the buffer control group, and the surgical control group, respectively, with the SSE/Col and buffer control groups significantly different from the surgical control group (P < 0.05). The amount of intrabony cementum in the SSE/Col group was significantly different (P < 0.01) from the surgical control group, but the amount of suprabony cementum did not demonstrate any statistical difference between the different treatments. The amount of new alveolar bone averaged 2.93 +/- 0.70 mm, 2.10 +/- 0.63 mm, and 1.20 +/- 0.65 mm for the SSE/Col group, the buffer control group, and the surgical control group, respectively. The difference in alveolar bone regeneration between the SSE/Col group and the surgical control group was significantly different (P < 0.01). Root resorption was often observed, but no ankylosis was present. CONCLUSION: Wound conditioning with safflower seed extracts may contribute to bone formation but appears to have unpredictable potential for stimulating periodontal regeneration including new cementum.

Alveolar Bone Loss↗

The role of parathyroid hormone-related protein in the regulation of osteoclastogenesis by cementoblasts.

BACKGROUND: Parathyroid hormone-related protein (PTHrP) promotes osteoclastogenesis by inhibiting expression of osteoprotegerin (OPG), a decoy receptor for the receptor activator of nuclear factor kappa B (RANK), and by enhancing production of RANK ligand (RANKL) by osteoblasts. However, little is known regarding the role of PTHrP in regulating cementoblast-mediated osteoclastogenesis. METHODS: This study determined the impact of PTHrP on osteoclastogenesis using: 1) OCCM-30 (immortalized murine cementoblasts), 2) RAW 264.7 cells (murine myeloid cells), or 3) OCCM-30 plus RAW 264.7 cells. Cells were treated with PTHrP (1-34), RANKL, or PTHrP and RANKL combined. Enzyme-linked immunosorbent assays (ELISAs) for OPG and RANKL were performed on media and cell lysates, and tartrate-resistant acid phosphatase (TRAP) and mRNA detection for the osteoclast associated receptor (OSCAR) were performed. RESULTS: The highest numbers of TRAP-positive cells and cells expressing OSCAR were found in the RAW cell group treated with either RANKL alone or RANKL and PTHrP. TRAP-positive cells were fewer when OCCM cells were co-cultured with RAW, but the greatest numbers were still with both PTHrP and RANKL. OPG levels were highest from OCCM cells and PTHrP decreased these levels. In contrast, RANKL levels were low in OCCM cell lysates and PTHrP increased RANKL. In vivo studies also revealed high osteoclastic activity surrounding developing teeth in mice administered PTH. CONCLUSIONS: These results demonstrate that PTHrP influences the balance of OPG and RANKL production by cementoblasts, and further indicate that this effect, in the context of surrounding cells, might have a significant impact on osteoclastogenesis, root resorption, and tooth eruption.

Acid Phosphatase↗

The effects of a bioabsorbable barrier membrane containing safflower seed extracts on periodontal healing of 1-wall intrabony defects in beagle dogs.

BACKGROUND: Recently, there has been much research done into the regenerative potential of materials used in oriental medicine. In several studies, evidence was found that these materials have an effect on bone regeneration. Among these materials, safflower seeds are of particular interest as they have been used for the treatment of blood stasis, bone fracture, and osteoporosis in traditional Korean medicine. In addition, they are known to have anti-inflammatory effects. The objective of this study is to evaluate the periodontal tissue regenerative effects of a bioabsorbable barrier membrane (polylactide glycolic acid electro-spun non-woven membrane) containing safflower seed extracts applied to surgically created 1-wall intrabony defects in beagle dogs. METHODS: One-wall intrabony defects were surgically created bilaterally at the mesial and distal sides of the mandibular second premolars and mesial side of the fourth premolars. These defects were randomly assigned either to the surgical control group which received a flap operation only or to one of two experimental groups consisting of defects which received a guided tissue regenerative procedure with either a bioabsorbable membrane (PLGA) or a bioabsorbable membrane containing safflower seed extracts (SSE/PLGA). The dogs were sacrificed 8 weeks after the operation, and a comparative histological examination was done. RESULTS: The new cementum formation was 2.49+/-0.41 mm in the surgical control group, 3.22+/-0.35 mm in the PLGA group, and 3.67+/-0.82 mm in the SSE/PLGA group. The extent of new cementum formation in barrier groups was significantly different from the surgical control group (P <0.05). The amount of intrabony cementum was 1.75+/-0.06 mm, 2.40+/-0.33 mm, and 2.70+/-0.81 mm for the surgical control group, the PLGA group, and the SSE/PLGA group, respectively; the amount of infrabony cementum in the barrier groups was significantly different from the surgical control group (P<0.05). The value of the suprabony cementum was 0.73+/-0.48 mm, 0.82+/-0.21 mm, and 0.97+/-0.09 mm for the surgical control group, the PLGA group, and the SSE/PLGA group, respectively, with no significant differences being observed among the treatments. The amount of new alveolar bone formation was 1.74+/-0.25 mm, 2.36+/-0.30 mm, and 2.64+/-0.74 mm for the surgical control group, the PLGA group, and the SSE/PLGA group, respectively, with a significant difference exhibited between the surgical control group and other groups (P <0.05). Superficial root resorption was often observed, but ankylosis was not present. CONCLUSION: Our results suggest that surgical application of polylactide glycolic acid non-woven membrane with or without safflower seed extract could promote the regeneration of alveolar bone and cementum in intrabony periodontal defects.

Absorbable Implants↗

Effects of gradually increasing force generated by permanent rare earth magnets for orthodontic tooth movement.

OBJECTIVE: To examine the effects of gradually increasing force generated by permanent rare earth magnets for orthodontic tooth movement by using a novel experimental rat model and computer simulation. MATERIALS AND METHODS: Fifty-five male rats (age 18 weeks) were used as animal experiments. Magnetic (experimental groups) or titanium (control group) cuboids (1.5 x 1.5 x 0.7 mm) were bonded to the lingual surface of the maxillary first molars. The initial distance between materials was 1.0 mm, generating 4.96 gf (experimental group I), or 1.5 mm, generating 2.26 gf (experimental group II). Tooth movement was measured and periodontal structures were observed with microfocus x-ray computed tomography radiographs. RESULTS: The distance between the magnets decreased with time in experimental groups I and II (P < .001), whereas there was no tooth displacement in the control group. Experimental group I showed rapid tooth movement in the initial phase followed by slower tooth movement. Experimental group II showed gradual tooth movement. Horizontal sections on microfocus computed tomgraphy radiographs revealed no pathological changes, such as root resorption, on the compressed side in the experimental groups. CONCLUSIONS: The initial light force and gradual increasing force in magnetic attractive force induced effective tooth movement in rats without inducing any pathological changes.

Analysis of Variance↗

An adult bimaxillary protrusion treated with corticotomy-facilitated orthodontics and titanium miniplates.

We performed an orthodontic treatment combined with corticotomy and the placement of titanium miniplates in an adult patient who desired a shortened treatment period. The patient had an Angle Class I malocclusion with flaring of the maxillary and mandibular incisors. First, titanium miniplates were placed into the buccal alveolar bone of the maxilla for absolute orthodontic anchorage. Second, an edgewise appliance was applied to the maxillary and mandibular teeth. Then, the maxillary first premolars and mandibular second premolars were extracted. At the same time, a corticotomy was performed on the cortical bone of the lingual and buccal sides in the maxillary anterior as well as the mandibular anterior and posterior regions. Leveling was initiated immediately after the corticotomy. The extraction spaces were closed with conventional orthodontic force (approximately 1 N per side). The edgewise appliance was adjusted once every 2 weeks. The total treatment time was 1 year. Cephalometric superimpositions showed no anchorage loss, and panoramic radiographs showed neither significant reduction in the crest bone height nor marked apical root resorption. A corticotomy-facilitated orthodontic treatment with titanium miniplates might shorten an orthodontic treatment period without any anchorage loss or adverse effects.

Adult↗

[Experimental study of periodontal tissue regeneration. Changes in the periodontium after tooth implantation with and without periodontal ligament].

The role of the periodontal ligament in periodontal tissue regeneration was evaluated. The materials included bilateral upper 1st premolars and lower 2nd, 3rd, and 4th premolars of 11 adult Beagle dogs, aged from 3 to 6 years. Before implantation, the right teeth were extracted and kept for a period of more than 3 months in "a solution for reserving teeth". The left teeth on the other hand, were extracted and soon implanted thus retaining the periodontal ligament into the newly created bone cavities prepared in the right edentulous areas. At the same time, the right reserved teeth were implanted into the left tooth sockets. Implanted teeth were periodically observed macroscopically, radiographically, and histologically for a 6-month period. Macroscopical observation showed good clinical repair in the bilateral sides of the tooth implantation with and without a periodontal ligament. After a 6-week experimental period, radiographic observations of the implanted lower right teeth having a periodontal ligament revealed lamina dura-like findings. Histopathological investigation revealed ankylosis and root resorption on the left side, where the reserved teeth without a periodontal ligament were implanted. But regeneration of the periodontal tissue complex, which consisted of the gingiva, alveolar bone, cementum, and periodontal ligament, was generally observed in the implanted right teeth having a periodontal ligament. These results suggest that the periodontal ligament cells play a significant role in periodontal tissue regeneration.

Animals↗

[The histopathological study of periodontal tissue regeneration using atelocollagen membranes].

In an attempt to promote periodontal tissue regeneration following periodontal surgery, an experimental study was conducted by applying the guided tissue regeneration (GTR) technique to a cross-linked atelocollagen membrane. The palatal gingiva of maxillary first molars of rats were dissected and the cementum was removed by curettage. An atelocollagen membrane was implanted into the site of dissection in the experimental group, while the control group received no implant. The wound healing processes in two groups were examined by histopathological methods, including histometric analysis of the cells and histological measurement of the regenerated periodontal tissue, 1, 3, 5, 7, 14 and 21 days, and 1, 2, 3 and 4 months after the implantation. The results were as follows. 1) Implantation of the atelocollagen membrane did not enhance or prolong the inflammatory reaction, indicating possible involvement of inflammatory cells and macrophages in the membrane absorption. 2) In the experimental group, epithelial downgrowth was markedly inhibited and fiber bundles of the gingival connective tissue were clearly arranged vertical to the root surface. 3) The experimental group showed a significant increase in new cementum formation 2 months after surgery compared with the control group. Root resorption was seldom observed in either group during the study period. The above results indicate that the GTR technique using an atelocollagen membrane may provide an effective method to promote periodontal tissue regeneration after periodontal surgery.

Animals↗

Occurrence and appearance of cementum hypoplasias in localized and generalized juvenile periodontitis.

The occurrence and appearance of cementum hypoplasias have been studied on teeth affected by juvenile periodontitis. Scanning electron microscopy showed the presence of cementum hypoplasias on the root surface of all extracted first molars and one incisor from nine patients with localized juvenile periodontitis and on most extracted teeth from two patients with generalized juvenile periodontitis. No hypoplasias were found on the extracted third molars. The alveolar bone loss in these patients seemed to be correlated to the frequency and extension of the hypoplastic areas in the associated teeth. The distribution of the teeth affected by localized juvenile periodontitis showed a symmetric distribution in the jaws. The patients with generalized juvenile periodontitis showed considerable deposits of dental calculus and wide areas of root resorption. The disturbance of cementum formation may have been caused by hereditary systemic factors, which subside with increasing age of the patient. The clinical appearance of juvenile periodontitis may therefore be influenced by the age at onset, the duration, and the frequency of such systemic factors, giving rise to a localized form and a more generalized form. One such factor may be a varying degree of hypophosphatasia.

Adolescent↗

Experimental transplantation of teeth to simulated maxillary alveolar clefts.

A total of 14 teeth were transplanted to simulated alveolar clefts in 5 monkeys. Autogenous cancellous bone was grafted to the cleft together with the tooth in ten instances. Healing processes were observed 216 or 271 days postoperatively. Another group of four teeth were transplanted in the cleft areas 133 days after bone grafting. These teeth were observed for 138 days before sacrifice. Radiological and histological findings support previous reports on adverse effects to dental tissues when placed in direct contact with fresh transplanted bone. Root resorption and ankylosis occurred to a large extent. Establishment of a normal periodontal membrane could, however, be observed when the tooth was transplanted to an area grafted 4 months previously. An interval before tooth transplantation allowing the cancellous graft to organize and bone to remodel seems to be indicated.

Alveolar Process↗

Multiple supernumerary teeth in association with malocclusion: report of two cases.

Although multiple supernumerary teeth without any associated syndromes are rare, their occurrence can create a variety of clinical problems such as derangement of the occlusion, prevention of eruption of permanent teeth, damage to adjacent teeth, cystic degeneration and root resorption. Hence, clinical and radiographic evaluation of patients should always be thorough in order to detect their presence. Furthermore, because the clinical management of multiple supernumerary teeth poses a great challenge to clinicians, timely, appropriate consultation and interdisciplinary approach to treatment is extremely important. We report two cases, a 14 year-old boy with eight and a 13-year-old girl with seven supernumerary teeth not associated with syndromes. In the boy, the teeth were bilaterally distributed in all quadrants in the premolar regions, and in the girl they were distributed bilaterally in the premolar regions in the mandible and bilaterally distal to the upper third molars. The clinical implications and management are discussed.

Adolescent↗

The use of anorganic bovine bone to correct a residual osseous defect after tooth extrusion: report of case.

This report deals with the clinical treatment of an osseous defect resulting from the extrusion of an impacted canine in a twelve-year-old girl. An apical horizontal root resorption of the adjacent lateral incisor was a related condition to this impaction, influencing the choice of treatment. The bone defect, caused by a guided canine extrusion, was restored by an anorganic bovine bone mineral (Bio-Oss). After a one-year follow-up, the lateral incisor responded vital and showed no discoloration; no progress of the resorption was found. Furthermore, by improving the conduction of new bone formation from the defect walls, the osteoconductive potential of this anorganic bovine bone became obvious. This case report illustrates a new indication area for its use in pediatric dentistry.

Animals↗

Conservative treatment of severely luxated maxillary primary central incisors: case report.

The treatment and follow-up evaluation of two orally luxated maxillary primary central incisors in a three-year-old girl is described. The injured teeth were displaced into a cross-bite with their mandibular opposing teeth. They were repositioned shortly after the injury and splinted with composite resin for two weeks. Oral hygiene instructions and antibiotic therapy were prescribed. Two weeks after the injury a necrotic pulp was removed and the root canals filled with a resorbable paste. Thirty months after the injury, the teeth and the surrounding tissues were clinically and radiographically asymptomatic and physiologic root resorption could be noted. The permanent successors erupted soon after natural exfoliation of the injured primary teeth. Only mild hypocalcified defects were observed on the permanent incisors.

Acute Disease↗