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Splinting periodontally involved teeth is a technique that has been in use for centuries. This article gives a brief history and review of the literature concerning periodontal splinting and outlines the rationale and indications for the correct application of periodontal splinting in modern dental practice. The common types of splint and clinical techniques involved are described, addressing some of the clinical problems.
UNLABELLED: A case of localized anterior tooth surface loss (TSL) with an unusual aetiology is reported. Whilst suffering from a bout of acute depression and anxiety, a 29-year-old female caused significant trauma to her anterior dentition with a pair of fabric scissors. The presentation and management of this case is described. CLINICAL RELEVANCE: Although tooth surface loss is a common clinical finding in many patient groups, practitioners should be aware of possible unusual aetiologies which may be involved.
UNLABELLED: The strength of the evidence linking some common malocclusion traits (which are used as the basis for IOTN classification) with dental disease is reviewed. It is concluded that IOTN is not a reliable predictor of the potential impact of malocclusion on future dental health, and that alternative indices, which place greater emphasis on the aesthetic impairment and take account of patient perceptions, are more appropriate for assessing an individual's orthodontic treatment need. CLINICAL RELEVANCE: IOTN is likely to assume greater significance with the advent of the new GDS/PDS regulations pertaining to orthodontics. However, all practitioners, including those who commission specialist services, should be aware of its limitations, especially in relation to the Dental Health Component.
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Fifteen hours after the patient's tooth was avulsed in a bicycle accident, replantation procedures began. This case presents a process of replantation and its success. An avulsed tooth is a traumatic experience. Replantation is often of psychological value. Although the possibility of the eventual loss of the tooth should be explained to the patient, replantation reduces the traumatic effect of the accident. It also has clinical value. Successful replantation results in prolonged retention which will improve esthetic appearance, arch form, chewing, enunciation, and integrity of the arch. Use of calcium hydroxide in avulsed teeth has allowed the rate of replantation success to increase greatly. It is a practical technique that is scientifically sound, has many positive indications, and has provided an invaluable service to patients.
The authors used combined reconstructive and regenerative therapy to treat a patient who had a surgically created osseous defect that also was associated with a perforated root canal. The defect involved a maxillary canine that exhibited 10 millimeters of attachment loss on its mesial surface. Tetracycline root surface conditioning, glass ionomer cement, a decalcified freeze-dried bone allograft and an expanded-polytetrafluorethylene membrane were used to achieve a 7- to 8-mm gain in clinical attachment level two years after the initial surgery. This case illustrates the use of glass ionomer cement, in conjunction with regenerative therapy, to effectively treat a root perforation adjacent to a periodontal osseous defect.
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BACKGROUND: This report reviews the available literature on the types and properties of athletic mouthguards, current fabrication methods and the role of mouth protectors in reducing the incidence and severity of sports-related oral injuries. OVERVIEW: For more than 50 years, the American Dental Association has promoted the protective value of wearing properly fitted mouthguards while participating in athletic or recreational activities that carry a risk of dental injury. Safety is essential to maintaining oral health, and a properly fitted mouthguard can minimize the risks of sustaining oral injuries during participation in sports. CONCLUSIONS: The dental literature supports the use and protective value of mouthguards in reducing sports-related injuries to the teeth and soft tissues. Dentists are encouraged to educate patients regarding the risks of oral injury in sports, fabricate properly fitted mouthguards, and provide appropriate guidance on mouthguard types and their protective properties, costs and benefits. Further studies addressing the effectiveness of currently available mouthguard types and population-based interventions for reducing oral injuries are recommended. CLINICAL IMPLICATIONS: Participants in sporting and recreational activities are often susceptible to oral injury. To reduce the incidence and severity of sports-related oral trauma, the use of a properly fitted mouthguard is recommended in any athletic or recreational activity that carries a risk of injury.
Distributions of growth-associated protein-43 (GAP-43) in the periodontal ligament and dental pulp of adult rats were studied by light and electron microscopy. The mature periodontal ligament and dental pulp contained numerous GAP-43-positive neural elements, comprising periodontal Ruffini endings and thin nerve fibers, but expression patterns differed among the kinds of nerves. In the periodontal ligament of rat molars, immunoelectron microscopy revealed that GAP-43 like immunoreactivity in the Ruffini ending, an essential mechanoreceptor, was confined to the Schwann sheaths around the axon terminals and was not in the axon terminals themselves, unlike free endings that revealed axonal GAP-43. However, the lamellar Schwann cells associated with the cutaneous receptors did not exhibit any GAP-43 like immunoreactivity though they were intensely reactive for low affinity nerve growth factor receptor (p75-NGFR), a marker for lamellar Schwann cells in mechanoreceptors. The characteristically uniform expression of GAP-43 in the Schwann lamellae that surround the Ruffini mechanoreceptors of rat molar ligament suggests that Schwann cells are involved in the GAP-43 mediated plasticity of these receptors. On the other hand, the pulpal nerves were filled with the reaction products in their axonal spaces, suggesting the potential for neuronal plasticity during normal function and after tooth injury.
Traumas to deciduous teeth may have severe consequences. This article addresses a dentigerous cyst case report associated with an upper permanent incisor, unusual site of occurrence, which was impacted and dislodged from its natural site of eruption after trauma at the deciduous predecessor. The main aspects of etiopathology and its clinical characteristics are also discussed, with special focus on the radiographic features of the diagnosis in order to allow for an accurate surgical planning.
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This case report describes the treatment of a perforation on the facial surface of the maxillary right central incisor made during endodontic therapy. Treatment of this highly visible area required a creative approach to therapy. The perforation was repaired with an amalgam restoration. A connective tissue with partial thickness double pedicle graft was used to replace missing periodontal structures, cover the exposed root surface, and obscure from view, as much as possible, the amalgam restoration placed in the perforation. This unconventional therapy is offered as a possible treatment option when few or no other acceptable options exist.
BACKGROUND: Intraligamentary (periodontal ligament) injection has been used to locally control pain with minimal anesthetic dose. The purpose of the present study was to determine the histologic effect of using a computer-controlled local anesthesia delivery system (CCLADS) for the administration of a periodontal ligament injection in the mini-swine model system. METHODS: Thirty-two sites in 3 mini-swine pigs with healthy periodontium were selected. Each site was notched on the mesial-lingual line angle of the tooth to allow a reference for needle placement and provide a histologic marker. An anesthetic cartridge was used with a 30-gauge needle attached to the handpiece of the CCLADS. This provided a controlled flow rate for 2 minutes. The control sites were treated with the same needle in place for 20 seconds. The animals were sacrificed and provided observation periods of 1 hour, 1, 4, 7, 21, and 49 days. Specimens were stained with hematoxylin and eosin and trichrome. RESULTS: Twenty-four hours after injection, limited localized inflammation was present. By 7 days, the ligament appeared within normal limits. Apical migration of the junctional epithelium extended to the apical limit of the notch and was similar in test and control specimens. CONCLUSIONS: Within the limits of this study, the histologic results showed that tissue responses following intraligament injections using a CCLADS demonstrated limited inflammatory responses within the first 24 hours, which abated by 7 days postinjection. Similar migration of the junctional epithelium was seen in test and control specimens and was probably related to tooth injury rather than anesthetic injections. Further investigations are warranted using CCLADS to determine whether clinical benefits will translate in the human model system.
This survey was conducted to clarify which dental treatments in children are regarded as difficult by general dentistry practitioners. The subjects were 615 children who first visited Tokyo Dental College Chiba Hospital from January 1995 to August 1999 with reference letters. There were 615 children in the study; 571 (92.8%) came from Chiba City where our hospital is located and the 11 regions surrounding Chiba City. The prime reasons for referral in the order of frequency were treatments of dental caries, malalignment/malocclusion, traumatized teeth, supernumerary teeth, retarded eruption/impacted teeth, abnormal direction of erupted teeth, congenitally missing teeth, prolonged retention of deciduous teeth, and abnormal frenulum. Patients with dental caries or traumatized teeth in the deciduous dentition period and those with malalignment/malocclusion, supernumerary teeth, or retarded eruption/impacted teeth in the mixed dentition period were often referred to medical organizations specializing in pediatric dentistry because of the difficulties in controlling the patients' behavior and in providing adequate treatment. The information about pediatric dental treatments considered difficult by general dentists revealed by this survey appears to be useful and needs to be incorporated in the programs for clinical training of undergraduate students and education of postgraduate students.
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Dilaceration of permanent successors is one of the most common complications of trauma to the deciduous teeth. It is advisable to keep these patients under observation post-trauma and to consult an orthodontist at an early stage to prevent unfavorable sequelae. Presented here is a typical case of dilaceration.
OBJECTIVE: To determine the causes and pattern of missing permanent teeth among Kenyans. DESIGN: A descriptive cross-sectional study. SETTING: Five districts in Kenya. SUBJECTS: Seven hundred and twenty two persons aged 6-85 years (346 males and 376 females). METHODS: This study was undertaken in October 2001 during the National Dental Health Action Month organised by the Kenya Dental Association. Six centres in five districts were identified and subjects randomly selected. Intra- oral examination was done visually and results were recorded on specially designed clinical examination forms. RESULTS: The mean number of missing teeth in the population was 1.60. Among those with missing teeth, the mean number of missing teeth was 3.35. The most commonly missing teeth were lower molars followed by upper molars. No record of complete edentulousness in both jaws was encountered. Dental caries was the commonest cause of tooth loss (52.6%), followed by periodontal disease (27.6%). Extractions, as a form of traditional practice, accounted for 12.3% of total tooth loss. Orthodontic treatment and trauma accounted for 2.2% and 2.0% respectively of total tooth loss. The upper and lower posteriors were the commonest teeth lost due to dental caries and periodontal disease. Teeth lost due to trauma were mostly upper anteriors, whereas those extracted due to traditional practices were exclusively lower anteriors. CONCLUSION: The findings of this study show that the commonly lost teeth are molars and the principal cause of tooth loss is dental caries followed by periodontal disease. Overall, very few extractions had been done for orthodontic reasons.
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