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Pathologic tooth migration.

Pathologic tooth migration (PTM) is a common complication of moderate to severe periodontitis and is often the motivation for patients to seek periodontal therapy. In this review of the literature, available information concerning prevalence, etiology, treatment, and prevention of pathologic tooth migration is summarized. Prevalence of PTM among periodontal patients has been reported to range from 30.03% to 55.8%. A survey of the literature regarding chief complaints of periodontal patients support these high prevalence findings. The etiology of PTM appears to be multifactorial. Periodontal bone loss appears to be a major factor in the etiology of PTM. Many aspects of occlusion can contribute to abnormal migration of teeth, and more than one of those factors may be present in an individual patient. Soft tissue forces of the tongue, cheeks, and lips are known to cause tooth movement and in some situations can cause PTM. Also considered important in the etiology of PTM is pressure produced from inflammatory tissues within periodontal pockets. Because extrusion is a common form of PTM, clinical observations support the theory that eruption forces sometimes play a role in the etiology of PTM. Many oral habits have been associated with PTM which are often difficult for the therapist to detect. Most cases of severe PTM require a team approach to achieve success. Periodontal, orthodontic, and prosthodontic treatment are often required. Many patient variables enter into the selection of treatment for PTM. In early stages of PTM, spontaneous correction of migrated teeth sometimes occurs after periodontal therapy. Light intrusive forces are used successfully to treat extrusion and flaring forms of PTM. Based on the literature reviewed, it appears that many cases of PTM could be prevented through the early diagnosis and treatment of periodontal disease, occlusal contributing factors, gingival enlargement, and oral habits.

Bite Force↗

Bizarre pathologic tooth migration.

An extreme example of pathologic tooth migration associated with bruxism and severe periodontitis is presented. The prognosis of the tooth was deemed hopeless; it subsequently was extracted. Various etiological factors of abnormal tooth displacement are discussed.

Bruxism↗

Tooth migration during the transitional dentition.

Posteruptive tooth migration between 6 and 14 years involves both total arch displacement and intra-alveolar tooth movement. Central incisors, canines, and permanent first molars all drift forward within the alveolar bone. The molars, and to a lesser extent the incisors, drift occlusally. With respect to lingual arch contour, lateral movement of molars and canines is negligible.

Adolescent↗

[Physiological tooth migration in hydroxyapatite grafts with bony regeneration. Animal study].

Tooth migration into jaw segments where granular hydroxy apatite had been implanted was studied in rats. To prevent premature contact with the ceramic granules, tooth germs were completely removed in the animals at the age of 10 days. Tooth root contact with the ceramo-osseous complex as a result of physiological tooth migration had deleterious effects. In the light of these findings the implantation of granular hydroxy apatite in the vicinity of tooth roots is not advisable.

Animals↗

Spontaneous correction of pathologic tooth migration and reduced infrabony pockets following nonsurgical periodontal therapy: a case report.

This case report describes the spontaneous correction of pathologic tooth migration and reduced infrabony pockets after nonsurgical periodontal therapy. A 3-mm diastema between the maxillary incisors was closed completely, and the mandibular teeth, which had migrated pathologically, returned to the optimal position. Clinical evaluation showed a significant reduction in probing depth, with increased clinical attachment and bone deposition demonstrated radiologically.

Alveolar Bone Loss↗

A biometric analysis in the rat of the horizontal component of physiological tooth migration and its response to altered occlusal function.

The direction and amplitude of physiological tooth migration, as well as the influence of occlusal force on this movement, were evaluated macroscopically in the rat by biometric means. The first experiment, which compared the position of the teeth in the anteroposterior plane of the maxilla between two groups of 20 and 28 rats killed at age 15 and 52 weeks, respectively, confirmed the distal direction of this drift. In a second experiment, after suppression of the antagonist occlusal contacts of the maxillary left dental hemiarch in nine rats, the migration of this hemiarch was compared to that of the hyperfunctional contralateral hemiarch and to that of the molars in a control group of 20 rats. A statistically significant (t-test) reduction of the physiological migration in the absence of occlusion, was revealed.

Animals↗

[The design of removable appliances for tooth movement and tooth migration].

Removable/functional appliance therapy can still be further expanded and developed. Retentive elements in the anterior region increase anchorage. Thereby, active forces can be utilised without anchorage loss. Functional appliances are indicated following extraction, to maximise on tooth migration. In first molar extraction cases, treatment with activators is relatively straightforward. When considering premolar extraction cases with possible need for extraction later of the third molars as well, then one should consider extraction of the first permanent molars. With correct use of the appliance, it is possible to optimally align the second molar teeth as well as favourably influencing the soft tissue profile.

Activator Appliances↗

A study on factors associated with pathologic tooth migration.

The purpose of this cross-sectional epidemiological study was to determine the prevalence of pathologic tooth migration (PTM) among periodontal patients and to investigate the relationship and degree of association between PTM and the following factors: bone loss, tooth loss, gingival inflammation according to the gingival index, age, lingual interposition, parafunctions and oral habits. 852 periodontal patients (36.7% male, 63.3% female) whose ages ranged from 19 to 72 years (mean 42.5 +/- 9.9) were studied. PTM was defined as the presence of a developing diastema in the upper anterior sextant, which was not present in the past or already existed but increased. Statistical analysis was performed using the Wald test and the Mantel-Haenszel test. Estimates odds ratio were also calculated to assess increased PTM probability as a function of a single variable, or a combination of several. PTM prevalence of 55.8% was found, and it was statistically associated with bone loss (p<0.001), tooth loss (p<0.001) and gingival inflammation (p<0.001), while no association was observed with the remaining variables. The odds ratio indicated that PTM probability increased between 2.95 to 7.97 times as bone loss increased. For tooth loss this probability increased 2.76 times when no tooth loss was compared to 4 or more teeth lost. Likewise the probability increased 2.23 times when the gingival index was above 2. According to the single effect as well as the combined effect of these 3 main factors, it was concluded that: (1) no single factor by itself is clearly associated with PTM: (2) the factor mainly related to PTM is bone loss, followed by tooth loss and gingival inflammation: (3) as bone loss increases, the association of additional factors with PTM, such as tooth loss and gingival inflammation, increases.

Adult↗

Effects of essential fatty acid deficiency on periodontal tissue adaptation to spontaneous tooth migration.

Essential fatty acids (EFAs) play a significant role in bone metabolism. Herein we studied the adaptation of alveolar bone to physiologic tooth drift in young rats deprived of essential fatty acids from birth. Reductions in femur size and trabecular bone volume reflected body growth impairment. Along the alveolar wall, osteoclastic resorption and bone formation were depressed, disrupting the adaptive deformation of the tooth socket to ongoing migration. As a result, the periodontal ligament narrowed considerably, and further adaptation was achieved through root resorption. Essential fatty acid deficiency (EFAD), did not affect precursor recruitment or differentiation in the periodontal ligament (PDL), but caused redistribution of nonspecific-esterase (NSE)-positive osteoclast precursors and tartrate-resistant acid phosphatase (TRAP)-positive pre-osteoclasts between the bone compartment (which was depleted) and the root compartment (which was enriched). EFAD had also a marked effect on the PDL vasculature; the number of vessels was reduced, whereas their size was markedly increased. As a whole, our results show that EFAD disturbs alveolar bone adaptation to drift, but that a reaction (detrimental to root integrity) prevents root collision with the bone surface, thereby preserving the PDL as a source of precursor cells for bone and cementum homeostasis. Moreover, our results confirm that although alveolar bone resorption is arachidonic acid-dependent, the factors activating root resorption are different.

Animals↗