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The case reported here demonstrates an asymptomatic radiolucent lesion of plasma cell myeloma mimicking as a periapical cyst. The tooth involved was not carious, vital and did not show any root resorption.
The clinico-pathological records of 30 unicystic ameloblastomas collected over a period of 10 years were studied. The mean age at diagnosis was 18.0 years (SD +/- 8.1), most lesions were located in the mandible and were frequently associated with impacted teeth, root resorption and tooth displacement. The unicystic ameloblastomas in 11 patients (4 females and 7 males) exhibited invasion of the fibrous wall, 4 cases (1 female and 3 males) showed intra-luminal proliferation and the remaining 15 specimens (9 females and 6 males) were lined by non-proliferating ameloblastic epithelium. Two cases recurred 3 and 7 years after initial surgical removal. This study reveals the potential aggressive behaviour of unicystic ameloblastomas and underlines the importance of a thorough microscopic examination for sub-classification.
UNLABELLED: The therapy of deep infrabony defects in periodontal diseases has been a great problem for decades both for dentists and their patients, as well. After application of classic therapy in patients with serious stages of periodontal diseases (subgingival curettage, Modified Widmann flap surgery with and without implantation of implants) a significant strengthening of teeth in alveolus was observed, as well as alleviation of patient's discomfort, and decrease of the depth of periodontal pockets, bleeding, inflammation, etc. However, in spite of the application of this therapy a postoperative defect was sometimes filled with different low tissues of periodontium, in other words periodont reparation took place. For this reason, recidives could happen, as well as gingival recession, inflammation, root resorption. At the beginning of the nineties a new principal was introduced in the therapy of periodontal diseases: Guided Tissue Regeneration. This principal includes a controlled action between four different species of periodontal tissue: gingival epithelium, gingival connective tissue, alveolar bone, and periodontal ligament. This is achieved by surgical placement of non resorbale or bioresorbable periodontal membranes, which are placed during flap surgery above the previously treated infrabony defect. With membranes placed in that way the periodontal defect is for some time phisically separated from epithelium and gingival connective tissue and in that way alveolar bone is regenerated, as well as periodontal ligament in other words restitutio ad integram takes place. Nowadays, two concepts of guided tissue regeneration can be considered: a concept of isolation and a concept of integration. The first concept includes application of non resorbable, most frequently synthetic, membranes (so-called E-PTFE polyterafluorethylene) which replace the mucoperiosteal flap into its original position. After six weeks a patient is subjected to one more surgical intervention when flap is raised again and the non resorbable membrane is removed. The second operation diminishes the value and partially discredits the application of non resorbable membranes. For this reason, the concept of integration is today more frequently applied, that is to say the application of bioresorbable membranes is nowadays very frequent. They are by their chemical composition poly D,L lactides and they provide membranes with ideal resorption properties. Of great importance is their property to stay unchanged for six weeks, and then to be resorbed by geometrical progression. As the membrane is resorbed, it is not necessary to remove it, so there is no need for another surgery, and that enables the process of healing to proceed undisturbedly. For this reason, the concept of integration is also called a Single Step Method. CONCLUSION: On the basis of papers of the leading scientists from the field of guided tissue regeneration it can be concluded that by application of Single Step Method or in other words by application of bioresorbable membranes a tremendous progress was made in the therapy of infrabony periodontal defects. The application of these membranes is especially indicated in treating degree II furcation defects, then infrabony defects particularly with 2 and 3 walls and good results were also achieved in the therapy of a big problem in esthetic periodontology--gingival recession. A relatively low price, as well as simple application, biological compatibility and undisturbed process of healing of the wound are great advantages of the application of bioresorbable membranes, so in the near future their application on a large scale can be expected in the therapy of periodontal diseases, as well as further research work on their development, especially on their impregnation by growth factors, antibiotics, etc.
The resorption of the roots of deciduous teeth is a physiological phenomenon. Many morphological and histological investigations of the root resorption have been reported. However little biochemical data concerning systemic factors in it are available. In this study, cell culture derived from the root resorbing tissue of human deciduous teeth was tried and the effect of EGF on that cell was examined. The dissected root resorbing tissue from human deciduous teeth was cultured in a medium containing 10% fetal calf serum in a humidified incubator at an atmosphere of 5% CO2 in air at 37 degrees C. The outgrowing cells from root resorbing tissue were a mixed population of mesenchymal cells and epithelial cells during the early stage of cultivation, but at the later stage they changed to morphologically single population. The mesenchymal cells seemed to be derived from the dental sac and the epithelial cells from the enamel organ or the oral mucoepithelium. These cells seemed to be useful for analysis of the systemic factors in the root resorption. The effect of EGF on the proliferation of cells obtained as stated above was examined. EGF markedly stimulated DNA synthesis about by a factor of 6.9 for the mesenchymal cells and by a factor of 3.4 for the epithelial cells. These results suggested that EGF participates in the root resorption of human deciduous teeth.
This report describes root and alveolar bone resorption associated with a single tooth which had been subjected to occlusal trauma during bruxing activity. Management of this unusually severe case is described, including the provision of an occlusal splint, endodontic therapy and occlusal adjustment to the natural dentition.
BACKGROUND: There is some evidence that the epithelial cell rests of Malassez partition the root surface from the periodontal ligament blood vessels, and may protect the root from resorption. OBJECTIVE: The aim of the present study was to determine the distributions of the epithelial rests of Malassez (ERM) and blood vessels in the periodontal ligament (PDL) of the developing rat first molar before, during and after emergence. METHODS: Four Sprague-Dawley rats were sacrificed at two days, one week, two weeks, three weeks, four weeks and six weeks of age. After processing, the maxillae were embedded in paraffin, and sectioned longitudinally and transversely. The sections were stained with a double immuno-histochemical technique which utilised a keratin antibody AE1-AE3 (1:2,000) and an endothelial antibody Factor VIII (1:10,000) to enable simultaneous labelling of ERM and blood vessels. ERM and blood vessel counts were obtained from the mesio-buccal roots of three week, four week and six week-old rats, whilst qualitative observations were made for the earlier developmental stages. RESULTS: ERM cells and cell clusters were found in the tooth third of the PDL width at the three, four and six week stages. Cells and cell clusters increased in number with age, especially in the upper third of the mesio-buccal root. The largest numbers of cells and clusters were found on the distal surfaces of the roots in all age groups. Cells and clusters in all root surfaces increased from three to four weeks, but decreased from four to six weeks. The greatest number of blood vessels was found in the bone-side third of the PDL. The distal surface had the highest proportion of blood vessels, and the palatal surface the least proportion. The number of blood vessels in all surface quadrants did not vary much from three to four weeks of age, but increased from four to six weeks of age, possibly as a reaction to tooth emergence and occlusal function. Physiological root resorption was only observed after tooth emergence, and appeared to be related to loss of continuity of the ERM network and the incursion of blood vessels. CONCLUSIONS: Orthodontic root resorption can be regarded as an exaggerated response to loss of PDL homeostatic control, possibly mediated by the epithelial rests of Malassez.
As the average age of the population increases, we are seeing a significant rise in root caries and in the need for restorative procedures associated more often with an older population. This paper describes the subgingival placement of a resin-ionomer for several restorative procedures, including root caries, resorption, endodontic perforation and root fracture. After endodontic therapy, full thickness flaps may be used to gain access to the lesion or root defect. The defects may be prepared with ultrasonic instruments and the preparations treated with a dentin conditioner. The preparations are then washed and lightly air-dried and treated with a dentin bonding agent. A resin-ionomer may then be syringed into the preparations and either light-activated or allowed to undergo a chemical set. No untoward effect has been observed during the time frame of this project. The cases presented indicate that a resin-ionomer may be used as a subgingival restorative and may be placed in lesions originally thought to be unrestorable. Thus, teeth may be saved that were previously designated for extraction.
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The hyper-IgE syndrome (HIES) is a rare disorder characterized by pruritic dermatitis, recurrent Staphylococcus skin abscesses and extremely elevated levels of IgE in serum. In this report, an eleven-year-old-boy with hyper-IgE syndrome is presented. He had a coarse facial appearance, pruritic dermatitis, recurrent skin abscesses, pulmonary infection, a reduced rate of resorption of the roots of primary teeth and an elevated serum IgE concentration. The colonization of Candida albicans, Kiebsiella pneumoniae, Escherichia coli and Staphylococcus aureus were found as; (1x10(2) CFU), (2.2x10(4) CFU), (2.2x10(4) CFU) and (2.6x10(3) CFU) per ml saliva, respectively. Also the pulp of a deciduous molar was investigated with light and transmission electron microscope (TEM). As conclusion, treatment for this condition is lifelong administration of therapeutic doses of a penicillinase-resistant penicillin, with the addition of other antibiotics or anti-fungal agents as required for specific infections.
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In order to analyze the occurrence and character of ankylosis in primary molars in infraocclusion, 102 primary molars, 62 in infraocclusion and 40 in normal position, in children aged 3-17 yr, were studied histologically. Ankylosis was demonstrable in most of the infraoccluded teeth while ankylosis was not found in teeth with normal positions. The ankylosis was always located at the inner root surface. Progression of the resorption of the root with age was seen in both groups of teeth. In teeth of younger children, in contrast to teeth of older children, the ankylosis was never found in the cervical portion of the roots. In the mandible, a thicker buccal marginal bone crest could be found in infraoccluded teeth than in teeth in normal position. Bone biopsies revealed no pathologic changes. Pulps of infraoccluded teeth more often demonstrated degenerative changes like fibrosis and calcifications. It is suggested that ankylosis is a local phenomenon, most likely due to developmental disturbances of the periodontium, and that ankylosis in infraoccluded primary molars is not a static condition but part of an ongoing process during root resorption.
Previous studies have shown degeneration of nerve tissue as well as reorganization by periodontal tissue in dental pulp chambers following intentional vital root transection in Macaca mulatta. The supporting structures of the teeth, as well as the root itself, have not been fully studied following such surgery. The purpose of this study was to observe histopathologic changes in bone and root structure over a 1-year postoperative period. Three adult Macaca mulatta were evaluated for this study. Roots were transected within the apical one third and the areas were surgically closed. Following a postoperative soft diet for 7 days, the monkeys were allowed normal masticatory function. Maxillary and mandibular quadrants were removed following vascular perfusion of the animals at 1, 2, 3, 6, 24, and 52 weeks; quadrants were then demineralized, embedded, sectioned, and stained with Preece's trichrome. Resorption of cementum, dentin, and bone was independently evaluated on microslides for each tooth at consecutive intervals of approximately 70 microns. Resorption was rated as mild, moderate, or severe depending on the number of Howship's lacunae and the dimension of the resorptive area. Severe bone resorption was evident at 1 week, decreasing at 2 weeks, and then progressively decreasing up to 52 weeks. Most active inflammatory root resorption was noted on maxillary and mandibular premolars and molars on first-week specimens. Arrested resorptive areas were present in similar locations in second- and third-week specimens. New cementum was present along the cut surface on specimens from 2 to 52 weeks and within the pulp canal beginning at 2 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
Stenosis of the nerve root canal caused by isolated resorption of a lumbar disc is a frequently observed pathology, but one about which the orthopaedist still knows relatively little. Henry Crock was the first to reveal its principal pathogenetic factor, disc resorption, and to accurately describe the syndrome and its surgical treatment. A total of 22 patients operated according to Henry Crock's indications and followed-up after 2 years were reviewed. In 20 cases decompression alone was performed, while in 2 cases anterior fusion and MOSS instrumentation were associated. Of the 22 patients submitted to decompression 17 revealed complete regression of pain. Three cases failed: 1 patient had previously been treated with chymopapain, while 3 are awaiting anterior fusion to treat persistent lumbar pain. Follow-up is not sufficient for the two patients submitted to anterior fusion.
PURPOSE: The aim of this study was to determine the frequency and type of a group of radiographically detectable pathologic conditions around impacted mandibular third molars in Jordanians. PATIENTS AND METHODS: A retrospective study of patients referred to the Oral and Maxillofacial Surgery unit for surgical removal of impacted mandibular molars. The analysis outcome measures were the patients' age and gender, and any radiographic lesions associated with the impacted mandibular third molars. The following radiographic lesions were recorded in relation to the impacted third molar: caries, pericoronal radiolucent areas, and periapical radiolucent areas, in addition to odontomes, caries in the adjacent second molars, and external resorption of the roots of adjacent mandibular second molars. Bony radiolucent areas were all verified histopathologically. RESULTS: Impacted mandibular third molars (N = 2,432) from 1,398 patients were examined; 46.4% of third molars showed associated radiographically detected lesions. The most common lesion seen on panoramic radiographs was dental caries. Others included pericoronal radiolucent and periapical radiolucent areas. The majority of periapical radiolucent areas were histologically proven to be chronic periapical inflammation. All pericoronal radiolucent areas were histologically found to be either cysts or tumors. The most common cyst was dentigerous cyst; the most common tumor was ameloblastoma. CONCLUSION: A high ratio of impacted mandibular third molars in this group of Jordanians had an associated pathologic lesion.