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Ankylosis of primary molars--a future periodontal threat to the first permanent molars?

Most infra-occluded and ankylosed primary molars with a permanent successor will exfoliate normally. Continuous supervision of occlusal development and radiographic control of normal root resorption have been recommended. The decreased height of the alveolar bone level at the site of the infra-occluded primary molar has been reported to normalize after the eruption of the permanent successor. However, opinions that infra-occlusion of primary molars entails a risk of future periodontal damage to the first permanent molars have been presented. The aim of this study was to perform a long-term follow-up of the alveolar bone level mesial to the first permanent molars after spontaneous exfoliation or necessary extraction of the infra-occluded second primary molars. The material consisted of 143 permanent molars adjacent to 119 infra-occluded primary molars and 24 normal contralateral primary molars in 68 individuals. The subjects were re-examined about 8 years after the exfoliation or extraction of the infra-occluded second primary molars. The subjects were examined both clinically and radiographically. Alveolar bone level mesial to the first permanent molars was measured in bite-wing radiographs. All but two permanent first molars showed a normal alveolar bone level mesially. In two first permanent molars where the primary molar was extracted, mesial approximal bone loss amounted to 4 and 3 mm, respectively, but no pocket formation was found. Infra-occlusion and ankylosis of primary molars does not constitute a general risk of future alveolar bone loss mesial to the first permanent molars. The general treatment recommendation to await normal exfoliation and eruption of successors remains valid.

Adolescent↗

Generalized odontodysplasia concomitant with mild hypophosphatasia--a case report.

An abnormal exfoliation pattern of the primary teeth is a sign of a systemic abnormality affecting more than just the oral structures. A prompt investigation of the cause of this condition is mandatory to identify any disease process and to initiate the required treatment. This article presents a case of mild hypophosphatasia concomitant with odontodysplasia in a 4 1/2-year-old female. The child's condition was first detected due to the early exfoliation of her primary teeth. This article also discusses the two different disease entities and the reasoning that led to the final diagnosis.

Child, Preschool↗

The effect of extraction of infraoccluded deciduous molars: A longitudinal study.

Infraocclusion of deciduous molars is often associated with ankylosis. Such teeth are believed to be potential sites of malocclusion, with a risk of tipping of neighboring teeth and loss of space. Extraction has therefore been the most widely recommended treatment. The aim of this study was to follow longitudinally the effect of extraction versus nonextraction treatment in twenty-three homologous pairs of mandibular deciduous molars with infraocclusion when unilateral extraction was performed. The study comprised fifteen children with a mean age at the start of 10.1 years. Recordings were made at the start of the study and every 6 months thereafter until eruption of permanent successors. Periodic identical periapical radiographs and study models were taken every 6 months. Ten of the twenty-three mandibular deciduous molars on the nonextraction side showed progression of the degree of infraocclusion. All infraoccluded deciduous molars exfoliated within the normal time. There was a normal alveolar bone height on both sides after eruption of the successors. Extraction resulted in a gradually increasing space loss in fourteen of the fifteen children. In two cases a definite space deficiency at the time of eruption of the successors was registered. It has been possible to confirm very few of the previously reported negative effects following nontreatment of infraoccluded deciduous molars on exfoliation, eruption, and occlusal development in this study. The results favor a more conservative approach to extraction therapy of infraoccluded deciduous molars.

Adolescent↗

Developmental absence of the premolar teeth: dental management.

A boy aged 11 years presented with dental pain, several carious teeth and a localized area of acute necrotizing ulcerative gingivitis (ANUG). Developmental absence of the premolar teeth was notable and additional anomalies included mid-facial hypoplasia, mandibular prognathism, transposed teeth and delayed exfoliation of the deciduous teeth. These abnormalities have significant oral, dental, orthodontic and orthognathic implications.

Anodontia↗

Eight-year study on conventional glass ionomer and amalgam restorations in primary teeth.

The aim of this randomized clinical study was to compare the longevity and the cariostatic effects of conventional glass ionomer and amalgam restorations in primary teeth placed in everyday practice in the Danish Public Dental Health Service. All restorations inserted during a 7-month period by 14 clinicians in 2 municipalities were included in the study. The sample consisted of 515 conventional glass ionomer restorations and 543 amalgam restorations in 666 children aged between 2.8 and 13.5 years. The restorations were in contact with 592 unrestored surfaces in primary and permanent teeth. The study was terminated after 8 years, with 2% of the restorations in function and 7% patient dropouts. Fifty percent of the teeth restored with glass ionomer and 63% of those with amalgam were exfoliated with the restoration in situ, while 42% of the glass ionomer and 20% of the amalgam restorations had been repaired or replaced. Fracture of restoration, endodontic complication, and loss of retention were the major reasons for failure. The 50% survival time for glass ionomer restorations in all cavity types was 42 months, while the median survival time for amalgam restorations could not be estimated but exceeded 7.8 years (P < 0.001). Progression of caries lesions on tooth surfaces adjacent to amalgam restorations required operative treatment on 30% of the teeth, while only on 16% of teeth adjacent to glass ionomer restorations. The 75% survival time was 40 months for surfaces in contact with glass ionomer compared to 25 months for surfaces in contact with amalgam (P = 0.005). Multivariate analyses were performed in order to assess the influence of a number of factors on the longevity of restorations, occurrence of prevalent failures, and caries treatment of surfaces in contact with the restorations. Owing to the high frequency of failures of the conventional glass ionomer restorations, it was concluded that they are not an appropriate, universal alternative to amalgam for restorations in primary teeth, although they reduce caries progression and the need for operative treatment of adjacent surfaces.

Adolescent↗

A case of Coffin-Lowry syndrome with premature exfoliation of primary teeth.

We present a case of a 5-year-old boy with premature exfoliation of primary teeth. All eight primary incisors had exfoliated by the age of 3 years, and three canines and one primary first molar were subsequently lost when he was 4 years old. None of the exfoliated teeth exhibited caries. The boy also showed characteristic facial changes, tapering of the fingers, and mental and motor retardation. Based on these findings, he was diagnosed as having Coffin-Lowry syndrome. Premature exfoliation of primary teeth in Coffin-Lowry syndrome has been described in a few reports. This manifestation of the disease would be helpful for diagnosis at an early stage as those previous reports suggested.

Child, Preschool↗

Dental eruption and exfoliation chronology in the ferret (Mustela putorius furo).

Substituting ferrets for rats and dogs as animal models for craniofacial research is favourable because of the similarity of many of the ferret's anatomical, metabolic and physiological features to those of man. Other advantages are cost-effectiveness and possibly less ethical controversy. However, information on the dental chronology of ferrets needs to be supplemented if this animal is to be promoted as an alternative model. Dental development was here examined in 16 ferrets (eight males, eight females) from three litters at between 12 and 90 days of age. Dental eruption and exfoliation were assessed and recorded every second day. The sequence of eruption of deciduous and permanent teeth was determined and data were analysed statistically. Also, any sex-related differences in eruption and exfoliation ages were defined. No deciduous incisors were observed to erupt in this group of animals. Other deciduous teeth erupted between the 19th and 31st postnatal days, and exfoliated between days 51 and 76. The time of eruption of the permanent teeth ranged from 42 to 77 days, in accordance with the stage of the mixed dentition. The female ferrets were generally ahead of the males in the exfoliation age of their deciduous teeth and the eruption age of their permanent teeth, but this, a sex difference did not apply to the eruption age of the deciduous teeth. These extended basic data might facilitate the introduction of this alternative experimental animal into craniofacial research.

Aging↗

Cementum-like tissue deposition on the resorbed pulp chamber wall of human deciduous teeth prior to shedding.

In the later stage of exfoliation in human deciduous teeth, odontoclastic resorption takes place at the pulpal surface of the coronal dentin. However, this resorption does not continue until the teeth are shed, and the resorbed pulp chamber wall is usually repaired by cementum-like tissue deposition. In this study, we examined the formation and characteristics of the cementum-like hard tissue on the resorbed dentin surface in the pulp chamber of deciduous teeth prior to shedding. The site and degree of deposition of newly formed cementum-like tissue on the resorbed pulp chamber wall varied from tooth to tooth. Furthermore, they also showed compositional and structural variations. Generally, however, the matrix of the cementum-like tissue was composed of intrinsic collagen fibers, acellular or cellular. There was a tendency for acellular cementum-like tissue to be deposited on small and shallow resorption bays, whereas the cellular type was found on larger and deeper ones. In both cases, the surface of the deposited cementum-like tissue on the resorbed dentin surface usually became flat. However, unlike the cementum repair of resorbed areas on the root surface, no acellular extrinsic fiber cementum-like tissue was found on the resorption pulp chamber wall. Although the role of the repair of the resorbed pulp chamber wall with cementum-like tissue deposition just before shedding is unknown, it might play some role in the retention of deciduous teeth until shedding.

Dental Pulp↗

Caries control and other variables associated with success of primary molar vital pulp therapy.

PURPOSE: This research evaluated initial treatment of deep dental caries with caries control (CC) procedure and the effect of other factors on the success of indirect pulp therapy (IPT) and formocresol pulpotomy (FP). METHODS: Retrospective chart audits were performed on 226 primary molars with deep caries approaching the pulp that were treated using IPT and FP. Mean follow-up was 3.4 years. CC with glass ionomer cement (GIC) was performed on 50 of the 226 teeth 1 to 3 months before pulp therapy. RESULTS: IPT therapy was successful 94% of the time, whereas FP was successful 70% of the time. The initial use of CC increased the IPT/FP success rate to 92% vs a 79% success rate in teeth without CC. Primary molar FP success on primary first molars was 61% vs 83% in second molars. IPT therapy was successful 92% of the time for first molars vs 98% of the time for second molars. Thirty-six percent of the FP-treated teeth exfoliated early vs 2% of the IPT-treated teeth. Primary first molars with reversible pulpitis had a higher success with IPT (85%) vs FP (53%). The type of final restoration did not affect IPT or FP success, except that FPs restored with an immediate IRM (Dentsply/Caulk, Milford, Del) restoration decreased success to 39%. CONCLUSIONS: IPT for the treatment of deep dental caries lesions produced greater long-term success than FP. FP success in primary first molars was lower compared to IPT success, especially in teeth with reversible pulpitis. Also FP-treated teeth showed significantly earlier exfoliation patterns. The prior treatment of deep dental caries lesions with CC procedures improved the subsequent IPT or FP success.

Child↗

Is it better to leave or restore carious deciduous molar teeth? A preliminary study.

INTRODUCTION: The objective of this study was to compare the extraction and exfoliation experience of filled and unfilled carious deciduous molar teeth. METHOD: The study was carried out in 1997 in four general dental practices in south Cheshire, UK and involved a longitudinal retrospective review of case notes. A quota sample of 20 case notes of children from each practice was selected according to strict criteria. Subjects had to: Have had experience of approximal caries in one or more of the deciduous molar teeth. Have a date of birth between 1st January 1984 and 31st December 1985. Be a regular attender and in continuous contact with the practice. Data were collected on a common data abstraction form. Variables measured included: Base-line dmft. Site and number of filled teeth. Site and number of unfilled carious teeth. Number of courses of antibiotics. Site and number of pulp therapies. Site, number, method (local or general anaesthetic) of extractions. Reasons for extraction. All teeth not recorded as being extracted were assumed to have exfoliated. In addition, information was collected on the dentists' treatment philosophies. A series of group discussions revealed that the four dentists fitted into two groups according to treatment philosophies; two dentists shared a philosophy of minimal intervention, the other two shared the same views of treating more radically. RESULTS: There was no significant difference between the proportion of filled teeth and the proportion of carious unfilled teeth that were extracted (chi-square 0.05 P = 0.83). A logistic regression showed that for each course of antibiotics administered the odds of having an extraction was multiplied by 5.5 and children who were patients of the interventionist dentists were five times more likely to have an extraction than patients of non-interventionist dentists. CONCLUSION: Although the study was preliminary in nature no clear benefit could be found in filling deciduous molar teeth against leaving carious teeth unfilled, if avoidance of extraction was the desired outcome. The treatment philosophy of dentists was a major factor in determining extraction or exfoliation outcomes. This issue is complex with many interacting factors to be accounted for and will require multiple well-designed studies to provide an answer.

Anti-Bacterial Agents↗

Orthodontic-prosthetic treatment to replace maxillary incisors exfoliated because of improper use of orthodontic elastics: a case report.

This article describes the iatrogenic exfoliation of maxillary central incisors following the improper use of orthodontic elastic bands. The unsecured rubber band had migrated apically and caused an almost "bloodless extraction" of both maxillary central incisors. A combined orthodontic-prosthetic solution was used to replace the lost incisors.

Adolescent↗

Effects of removing inferior alveolar neurovascular structures on mandibular growth and the eruption of permanent dentition in puppies.

Investigation was performed on the effects of removing the inferior alveolar neurovascular structures on the permanent dentition and mandibular growth. Five puppies with erupted deciduous teeth had the inferior alveolar neurovascular structures removed unilaterally. When the test animals were 28 weeks old, examination revealed that the deciduous teeth on the side operated had exfoliated but permanent teeth did not replace them. On the other hand, the permanent teeth on the side not operated on replaced the exfoliated deciduous teeth. After a second period of 28 weeks, the germs of the permanent teeth on the side operated on were still buried in the mandibular bone, and the permanent teeth on the side not operated on erupted normally. Mandibular measurements demonstrated that translative and transformative growth and developmental processes were normal in both the sides operated on and the sides not operated on.

Animals↗

Histological study on the postnatal development and sequence of eruption of the mandibular cheek-teeth of rabbits (Oryctolagus cuniculus).

The postnatal development and sequence of eruption of mandibular cheek teeth of rabbits were studied by histological methods. Hemi-mandibles were dissected and sectioned in longitudinal sections of 7 mu and stained with hematoxylin-eosin and Masson's trichrome. The presence of two mandibular deciduous molars which are replaced by corresponding premolars and of three mandibular permanent monofisary molars was confirmed. Eruption of deciduous molars of the mandible begins at 4 days after birth and of the mandibular permanent molars at 9 days, while that of mandibular premolars occurs at 23 days, replacing the mandibular deciduous molars which have exfoliated. At 32 days all the mandibular permanent cheek-teeth are erupted. At birth the mandibular deciduous molars are completely developed and at 4 days their root resorption is initiated. At the first day P3 is in the bell stage and the P4 has begun dentinogenesis. In M1 and M2 amelogenesis is observed.

Amelogenesis↗

Iatrogenic exfoliation of teeth by the incorrect use of orthodontic elastic bands.

Four cases of improper use of elastic bands for minor orthodontic treatment are described. For all the patients, the treated teeth were damaged and local surgical intervention was necessary. To prevent complications when elastic bands are being used, the dentist must provide stabilization of the elastic bands by brackets, bands, or bonded attachments, inform the patient about the possibility of losing the rubber elastic band, and mark the elastic rubber by radiopaque material. Every effort must be made to preserve the damaged anterior teeth by fixation and surgical treatment.

Child↗

Dentinal dysplasia type I: review of the literature and report of a family.

A family is reported with dentinal dysplasia type I affecting both dentitions. Presenting features included unusual mobility of the teeth, followed by early exfoliation; normal clinical shape of the crowns of the teeth, but with an amber color without any sign of attrition or abnormal loss of enamel. Radiographic findings showed pulp-chamber and root-canal obliteration, poor root formation, radiolucent linear appearance of the pulp chamber parallel to the cementoenamel junction and frequent periapical radiolucencies. Histological studies have reported large masses of calcified tubular dentin, atypical osteodentin, and also true denticle.

Adult↗

Premature or delayed exfoliation of deciduous teeth and root resorption and formation.

The present cross-sectional study was based on orthopantomograms of 1245 Greek children (590 males and 655 females), whose ages ranged from 6 years 10 months to 14 years. Three orthodontic practices were the source of these orthopantomograms which were taken before the start of orthodontic treatment. The resorption process of the deciduous mandibular canine and molar roots was divided into five stages and the root formation process of their permanent successors into eight stages. The percentage distribution of the deciduous root resorption stages for each root formation stage of the corresponding permanent teeth was then recorded. Exfoliation of these three deciduous teeth occurred when the root formation of their successors had reached the R2/3, R3/4 or the beginning of the Rc stage. As far as the effect of local factors on root resorption and formation process our findings indicated that decay, pulp necrosis and pulpotomy hastened the rate of root resorption of the deciduous molars, while they did not influence the rate of root formation of the corresponding permanent teeth.

Adolescent↗

Early-onset periodontitis associated with Weary-Kindler syndrome: a case report.

Weary-Kindler syndrome is a rare and poorly understood genetic disorder that has manifestations of both epidermolysis bullosa and poikiloderma congenitale. There are approximately 70 cases documented in the past 40 years but no cases appear in the dental literature, although dental findings have been discussed superficially in dermatological and pediatric publications. This case reports on the periodontal findings and treatment for a 16-year-old female diagnosed with the syndrome. Early exfoliation of deciduous teeth, severe periodontal bone loss around many permanent teeth, and fragile bleeding gingiva were key features. Microbiological testing revealed an absence of Actinobacillus actinomycetemcomitans and low levels of other commonly accepted periodontal pathogens. Tests for inflammation, including AST and elastase, were positive prior to therapy and greatly decreased after mechanical root instrumentation. A beneficial effect of non-surgical periodontal therapy was observed in the short-term follow-up.

Adolescent↗