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PubMed2003

Treatment of a non-vital immature incisor with mineral trioxide aggregate (MTA).

- A case of severe crown fracture and luxation in the upper permanent incisors of a 9-year-old boy is reported. The treatment of one of the injured teeth included apexification with calcium hydroxide and endodontic treatment with gutta-percha obturation. The other incisor was also treated with calcium hydroxide, but as there was no apical stop after 3 years of treatment, it was decided to use a new root-end filling material: mineral trioxide aggregate (MTA). At follow-up 12 months later, the tooth was asymptomatic and radiographically showed the initial repair of the radiolucent apical lesion.

Aluminum Compounds↗
PubMed2003

Single-tooth implant treatment in the anterior region of the maxilla for treatment of tooth loss after trauma: a retrospective clinical and interview study.

The aim of this study was to evaluate the results of single-tooth implant treatment in patients where teeth have been lost as a result of trauma. Also, the patients' and professionals' opinions regarding the final outcome of treatment were assessed. Thirty-four patients with 42 lost teeth were evaluated by clinical and radiographic examinations and interviews 2-5 years after treatment. A professional who had not taken part in the treatment evaluated the implant crowns. Central maxillary incisors were the most frequently lost and replaced teeth after trauma (75%) followed by lateral incisors (21%). In patients with incomplete growth, implant treatment was generally postponed until completion of growth. Lack of space was treated by presurgical orthodontics (7%) or by selecting an implant with a reduced diameter (5%). Deficiency of bone was seen in 17% and was treated by bone grafting or local augmentation prior to implant surgery. Patients who had lost two or more teeth after trauma were all subjected to bone grafting. Preservation of roots in the alveolar process seemed to maintain the bone volume enabling better conditions for later implant placement. Forty-one implants (97.6%) were integrated successfully. Complications were few and of minor importance (9.5% before and 12% after cementation of crowns) and could all be managed. No or minimal bone loss was seen. In general, the patients felt that they received good care and that they were well informed about their treatment. Some patients reported that the local anesthesia procedure was not pain-free, but 71% of the patients experienced the treatment as pain-free. For each of the variables (color, shape, height, and size of the crowns), the highest degree of satisfaction was noted in 93-98% of the patients and 91-95% of the single evaluating professional. Given that the patients have finished growth and a careful treatment planning and timing are performed, the functional and esthetical outcome of single-tooth implant treatment today is excellent and can be recommended for replacing tooth losses after trauma in the anterior region of the maxilla.

Adolescent↗
PubMed1997

Use of calcium hydroxide for apical barrier formation and healing in non-vital immature permanent teeth: a review.

OBJECTIVE: To review the use of calcium hydroxide for induction of apical barrier formation and healing in immature permanent teeth. INTRODUCTION: Pulp necrosis is a frequent complication of dental trauma in immature permanent teeth. Endodontic treatment of these teeth is often complicated. The walls of the root canals are frequently divergent and the apices immature, making debridement and obturation difficult. The aim of treatment is induction of apical healing which may be defined as apical closure through formation of mineralised tissue and repair of the periapical tissues. Calcium hydroxide is the material of choice for apical barrier formation and healing. RESULTS: The use of calcium hydroxide for apical barrier formation is successful in 74-100% of cases irrespective of the proprietary brand used. The average length of time for apical barrier formation is approximately 5 to 20 months. Control of infection and adequate cleaning of the root canal are very important for apical healing. CONCLUSIONS: While the success rate of apical barrier formation using calcium hydroxide is high, long-term follow-up of these teeth is necessary. Problems such as failure to control infection, recurrence of infection and cervical root fracture may occur. The latter is more frequent in immature luxated teeth with the least root development.

Bacterial Infections↗
PubMed1997

Treatment of root perforations with calcium hydroxide and SuperEBA cement: a clinical report.

Iatrogenic root perforations sometimes occur during root canal treatment or when preparing the root canal for a post. The inflammation in the periradicular tissues caused by root perforation reduces the prognosis of the involved tooth. The situation may be further complicated if by coronal leakage, microorganisms are allowed to infect the canal and the periradicular region. This clinical report presents a nonsurgical technique, based on the internal matrix concept, using both calcium hydroxide and SuperEBA together to repair root perforations. The author has experienced good clinical results with this perforation repair technique.

Adult↗
PubMed1998

Sealing ability of composite resin placed over calcium hydroxide and calcium sulphate plugs in the repair of furcation perforations in mandibular molars: a study in vitro.

The purpose of this study was to evaluate in vitro the sealing ability of various materials in the repair of furcation perforations in mandibular molars by measuring coronal microleakage with Indian ink. Ninety extracted mandibular molars were embedded individually into a plaster of Paris block, with the roots surrounded by a simulated periodontal ligament of silicone. Subsequently, a standard coronal access opening was prepared, the root canal orifices were located and a perforation was made with a size 012 round bur in a water-cooled high-speed handpiece directly into the centre of the floor of the pulp chamber. The perforations were repaired with amalgam, composite resin, calcium sulphate under composite resin and calcium hydroxide under composite resin. The teeth were coated with two layers of nail polish, leaving the access opening area uncovered, and immersed in Indian ink for 4 days at 37 degrees C. The teeth were sectioned longitudinally and dye penetration measured from the coronal level of the repair material to the apical end of the perforation. All experimental groups revealed dye penetration in varying degrees, but there was no significant difference amongst them (Kruskal-Wallis test P < 0.05). Calcium sulphate and calcium hydroxide prevented overextrusion of composite resin when used under this repair material.

Analysis of Variance↗
PubMed1999

Endodontic-orthodontic relationships: a review of integrated treatment planning challenges.

Literature review There is a paucity of information on the concise relationship between endodontics and orthodontics during treatment planning decisions. This relationship ranges from effects on the pulp from orthodontic treatment and the potential for resorption during tooth movement, to the clinical management of teeth requiring integrated endodontic and orthodontic treatment. This paper reviews the literature based on the definition of endodontics and the scope of endodontic practice as they relate to common orthodontic-endodontic treatment planning challenges. Literature data bases were accessed with a focus on orthodontic tooth movement and its impact on the viability of the dental pulp; its impact on root resorption in teeth with vital pulps and teeth with previous root canal treatment; the ability to move orthodontically teeth that were endodontically treated versus nonendodontically treated; the role of previous tooth trauma; the ability to move teeth orthodontically that have been subjected to endodontic surgery; the role of orthodontic treatment in the provision for and prognosis of endodontic treatment; and, the integrated role of orthodontics and endodontics in treatment planning tooth retention. Orthodontic tooth movement can cause degenerative and/or inflammatory responses in the dental pulp of teeth with completed apical formation. The impact of the tooth movement on the pulp is focused primarily on the neurovascular system, in which the release of specific neurotransmitters (neuropeptides) can influence both blood flow and cellular metabolism. The responses induced in these pulps may impact on the initiation and perpetuation of apical root remodelling or resorption during tooth movement. The incidence and severity of these changes may be influenced by previous or ongoing insults to the dental pulp, such as trauma or caries. Pulps in teeth with incomplete apical foramen, whilst not immune to adverse sequelae during tooth movement, have a reduced risk for these responses. Teeth with previous root canal treatment exhibit less propensity for apical root resorption during orthodontic tooth movement. Minimal resorptive/remodelling changes occur apically in teeth that are being moved orthodontically and that are well cleaned, shaped, and three-dimensionally obturated. This outcome would depend on the absence of coronal leakage or other avenues for bacterial ingress. A traumatized tooth can be moved orthodontically with minimal risk of resorption, provided the pulp has not been severely compromised (infected or necrotic). If there is evidence of pulpal demise, appropriate endodontic management is necessary prior to orthodontic treatment. If a previously traumatized tooth exhibits resorption, there is a greater chance that orthodontic tooth movement will enhance the resorptive process. If a tooth has been severely traumatized (intrusive luxation/avulsion) there may be a greater incidence of resorption with tooth movement. This can occur with or without previous endodontic treatment. Very little is known about the ability to move successfully teeth that have undergone periradicular surgical procedures. Likewise, little is known about the potential risks or sequelae involved in moving teeth that have had previous surgical intervention. Especially absent is the long-term prognosis of this type of treatment. During orthodontic tooth movement, the provision of endodontic treatment may be influenced by a number of factors, including but not limited to radiographic interpretation, accuracy of pulp testing, patient signs and symptoms, tooth isolation, access to the root canal, working length determination, and apical position of the canal obturation. Adjunctive orthodontic root extrusion and root separation are essential clinical procedures that will enhance the integrated treatment planning process of tooth retention in endodontic-orthodontic related cases.

Dental Pulp↗
PubMed2001

Traditional tooth bud gouging in a Ugandan family: a report involving three sisters.

It has been reported in the literature that some rural populations of Sub-Saharan and Eastern Africa and other isolated areas around the world, practise gouging or enucleation of primary tooth buds to cure childhood illnesses. The unerupted primary canine tooth bud is believed to be the cause of febrile illness, diarrhoea, and vomiting; prevalent in infants in these areas of the world. Tooth bud gouging has implications for the developing dentition, and is a potential risk to the health and life of the child. Reported prevalence ranges from 22%-90%. From the information in this case report, the practise of tooth bud gouging is no longer confined to rural areas and may well be performed by communities that have emigrated to the UK. The three sisters described, now resident in the UK, suffered tooth gouging in a city clinic in Uganda. The damage caused to the primary and permanent dentition is described and treatment planning and options are suggested for each case to restore structure and function. Appropriate provision of healthcare and education could avoid the potential long-term damage to the health of the child and their developing dentition by the practise of tooth bud gouging, whether it occurs in the developing or developed world.

Child↗
PubMed2000

Maxillofacial injuries in the pediatric patient.

Approximately 22 million children are injured in the United States annually. Children are uniquely susceptible to craniofacial trauma because of their greater cranial-mass-to-body ratio. The pediatric population sustains 1% to 14.7% of all facial fractures. The majority of these injuries are encountered by boys (53.7% - 80%) who are involved in motor vehicle accidents (up to 80.2%). The incidence of other systemic injury concomitant to facial trauma is significant (10.4% - 88%). The management of the pediatric patient with maxillofacial injury should take into consideration the differences in anatomy and physiology between children and adults, the presence of concomitant injury, the particular stage in growth and development (anatomic, physiologic, and psychologic), and the specific injuries and anatomic sites that the injuries affect. This comprehensive review, based on the last 25 years of the world's English-speaking surgical literature, presents current thoughts on the anatomic and physiologic differences between adults and children, a synopsis of childhood growth and development, and an overview of state-of-the-art management of the pediatric patient who has sustained maxillofacial injury.

Accidents, Traffic↗
PubMed2000

A radiographic comparison of apical root resorption after orthodontic treatment with a standard edgewise and a straight-wire edgewise technique.

The purpose of this study was to compare the severity of apical root resorption occurring in patients treated with a standard edgewise and a straight-wire edgewise technique, and to assess the influence of known risk factors on root resorption incident to orthodontic treatment. The sample consisted of 80 patients with Angle Class II division 1 malocclusions, treated with extraction of at least two maxillary first premolars. Variables recorded for each patient included gender, age, ANB angle, overjet, overbite, trauma, habits, invagination, agenesis, tooth shedding, treatment duration, use of Class II elastics, body-build, general factors, impacted canines, and root form deviation. Forty patients were treated with a standard edgewise and 40 with a straight-wire edgewise technique, both with 0.018-inch slot brackets. Crown and root lengths of the maxillary incisors were measured on pre- and post-treatment periapical radiographs corrected for image distortion. Percentage of root shortening and root length loss in millimetres were then calculated. There was significantly more apical root resorption (P < 0.05) of both central incisors in the standard than in the straight-wire edgewise group. No significant difference was found for the lateral incisors. Root shortening of the lateral incisors was significantly associated with age, agenesis, duration of contraction period (distalization of incisors), and invagination, while root shortening of the central incisors was related to treatment group and trauma.

Adolescent↗
PubMed2006

Surgical repositioning of a developing maxillary permanent central incisor in a horizontal position: spontaneous eruption and root formation.

This report describes the surgical repositioning of a developing maxillary permanent central incisor in a horizontal position, followed by spontaneous eruption and root formation without orthodontic traction. Surgical exposure of the right central incisor was achieved. A 7-year-old boy referred for orthodontic consultation. Radiographic examination showed the crown of a maxillary right central incisor to be positioned horizontally with root formation at the initial stage. The surgically repositioned incisor (by a close-eruption surgical flap technique) spontaneously erupted into correct alignment after 2 years 3 months. The erupted incisor remained vital and responded normally to percussion, mobility and sensitivity testing. The soft tissue, periodontal attachment, gingival contour and probing depths were normal. Follow-up radiographs confirmed the continued development of the root, with revascularization of the pulp and a normal appearance of the periodontal space and lamina dura. There was, however, shorter root formation and a narrower root cavity compared with the contralateral incisor. As a result, no orthodontic traction and alignment were required. This method of surgical repositioning is a viable alternative to the traditional approach of extraction or surgical exposure followed by orthodontic traction for a developing maxillary permanent central incisor in a horizontal position.

Child↗
PubMed1998

Applications of Scanora multimodal maxillofacial imaging in orthodontics.

The principles of the Scanora multimodal radiography system are described. This self-contained unit of X-ray generator, patient chair, and imaging elements incorporates the two basic principles of narrow beam radiography and spiral tomography. Conventional panoramic images or magnified images of the dentition can be produced. In orthodontics, the application of spiral tomography in order to obtain cross sectional images has proved helpful in the assessment of a number of patients. Four cases are reported in which the images obtained using this system has substantially contributed to their management.

Adolescent↗
PubMed2000

Sealing furcation perforations with silver glass ionomer cement: an in vitro evaluation.

Furcation perforations sealed with silver glass ionomer cement (Chelon Silver) were evaluated in vitro compared with amalgam. Access cavities were prepared in 25 extracted human molar teeth. The coronal orifices of the root canals were sealed with amalgam and varnish. Naturally occurring coronal leakage through the intact pulp chamber floor was determined quantitatively for each tooth, using a modified fluid transport model, under pressure of 1.2 Atm. Each tooth was then disconnected from the system, perforated at the furcation, and the perforation sealed with either Chelon Silver (10 teeth) or amalgam (10 teeth); five remaining teeth served as a negative control. After incubation for 24 h at 37 degrees C in 100% humidity, teeth were reconnected to the modified fluid transport system, and coronal leakage under pressure was evaluated at 1, 2, 6, 15, and 24 h. Leakage through each tooth was compared with that of its own intact pulp chamber floor before perforation and the groups compared with each other. No significant difference was found between the mean leakage of the intact pulp chamber floors of the two groups. Chelon Silver had a significantly better sealing ability than amalgam (p < 0.01): leakage rate of 0.007 and 0.017 microliter/min, respectively. It is concluded that Chelon Silver could be an adequate sealer for furcation perforations.

Cermet Cements↗
PubMed2000

Stress analysis of human tooth root using various root canal instruments.

This study compared external root stresses from instrumentation by several motor-driven nickel-titanium instruments to stresses developed by hand files. Twelve curved first molar mesial roots were invested in PLM-9 photoelastic material to disclose net stress transmitted from the canal through the dentin. Minimal fringe patterns were observed during instrumentation with all techniques. Light-speed yielded the least change. In no case was a complete 60 psi fringe change noted.

Birefringence↗
PubMed2001

Conservative management of an accidentally resected root: a 3-year follow-up.

Despite all the effort by dentists to provide high levels of dental care in clinical practice, there is always the possibility of accidents occurring. This report describes a referred case that presented with irreversible pulpitis in tooth #19. The situation developed after accidental resectioning of the distal root of tooth #19 during the surgical extraction of tooth #18 by another dentist. The resultant open apex in the distal root of tooth #19 was managed conservatively. A positive apical stop was prepared at the root end of the distal root and sterile calcium hydroxide powder was used to create an apical barrier against which a gutta-percha filling was condensed. The treatment appeared successful at 3-year follow-up.

Calcium Hydroxide↗