[HYPOPHOSPHATASEMIA].
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Alkaline Phosphatase↗
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[Possibilities and limits in the early diagnosis of peridontal insufficiency].
Up to now, the early detection and the discriminating evaluation of periodontal insufficiency are not feasible due to the variety of conditions provoking a pathological response of the tissues. In general, the defence may be regarded as sufficient. Exceptions to this rule are periodontal changes existent already in adolescence and therapy-resistant gingivitides in which endogenous causal factors obviously predominate. A disproportion of tooth mobility to bone reduction and a tendency to abscess-formation, tooth migrations and recurrences after periodontal therapy are indicative of insufficiency. The development of a progressive course is to be compared with the breakdown of the barrier of defence. The reduction or elimination of provoking and conditioning factors prior to prosthetic therapy is considered to be the way to maintain the "stability" of the periodontal tissues.
Adult↗
Periodontal status in two siblings with severe congenital neutropenia: diagnosis and mutational analysis of the cases.
BACKGROUND: Severe congenital neutropenia (SCN), also known as Kostmann syndrome, was originally reported as an autosomal recessive disease of neutrophil production. The disease is characterized by a maturation arrest of neutrophil precursors at the promyelocytic stage of differentiation and by extremely low levels of mature neutrophils in peripheral blood. METHODS: A 6-year-old male presented with a complaint of gingival swelling and bleeding, and swelling at the left side of his face. Upon clinical examination, severe inflammation of all gingival tissues was apparent, and a periapical abscess with mobility was noted on the left mandibular second molar. Medical and dental histories revealed numerous recurrent bacterial infections associated with oral and non-oral tissues. His medical history with recurrent infections led us to evaluate his 3-year-old sister to determine the status of her oral health. Inflammation of her oral tissues and recurrent bacterial infections were apparent. Their consanguineous parents were in good health. To assist in identifying possible systemic diseases underlying the inflammatory situation in the siblings, consultations were requested from the Pediatric Hematology Department at Selcuk University and Pediatric Oncology Department at Gulhane Military Medical Academy. RESULTS: Based on absolute neutrophil count (< or =200/mm(3)) and bone marrow aspiration findings consistent with early maturation arrest in myelopoiesis, the cases were diagnosed as SCN. No chromosomal abnormality was detected upon cytogenetic examination. Sequencing analysis also revealed no mutation in the neutrophil elastase or growth factor independent-1 (GFI-1) genes in these patients. Severe periodontal disease, attachment loss, and mobility for over 50% of the deciduous teeth were noted. Within 6 months, the male sibling lost all of his deciduous teeth due to periapical and periodontal infections. His sister presented with tooth mobility for all mandibular incisors. Monthly visits, including scaling, polishing, and 0.2% chlorhexidine digluconate irrigation were performed to support their oral hygiene and to avoid recurrent oral infections. We have been able to stabilize these patients' periodontal conditions during a 2-year follow-up period. CONCLUSION: This case report emphasizes the role of periodontists and pediatric dentists in the diagnosis of diseases linked with neutrophil and other systemic disorders and highlights the need to optimize the health of oral tissues with regular appointments.
Bacterial Infections↗
A four-year clinical follow-up of nonvital root resection in maxillary molar teeth.
The aim of the study was to evaluate the success of non-vital root resected maxillary molar teeth over a period of four years. Fourteen root resected maxillary molar teeth were evaluated for mobility and probing depth in the area of root resection. Only one failure was observed over a period of four years follow-up. It was observed that removal of one root neither increase the tooth mobility nor the probing depth in most of the cases. It is concluded that non-vital root resection should be considered before molar extraction, because this treatment can provide good results with long term success, provided appropriate patient selection. This procedure can be practised by general dentists with little effort.
Adult↗
Alveolar bone loss in two children with short-bowel syndrome receiving total parenteral nutrition.
Two preschool children who were receiving total parenteral nutrition (TPN) for short-bowel syndrome (SBS) were noted to have radiographic evidence of alveolar bone loss in their primary dentition. Tooth mobility, gingival recession, and premature tooth loss were clinical findings in these children. Both had a 2-year history of recurrent infections and fluctuating serum electrolytes prior to identification of their dental problems.
Alveolar Bone Loss↗
A case-control study of differences between regular and causal adult attenders in general dental practice.
OBJECTIVES: To assess whether adults attending a dental practice for regular dental care have better oral health than adults attending casually in response to a dental problem, and to explore the barriers to asymptomatic attendance. METHODS: An observational case-control study comparing the characteristics of 100 regular attenders with 100 causal attenders in one general dental practice in North Staffordshire. All study subjects were aged 18 years or over. Sociodemographic characteristics of the two groups were collated, including age, gender, social class, marital status, employment status and smoking status. The primary outcome measure was the observed number of teeth with dentinal caries diagnosed using bitewing radiographs. RESULTS: Regular attenders were observed to have better oral health with respect to dental caries and tooth mobility (p < 0.05). This was not explained by the observation that causal attenders were more likely than regular attenders to be male, aged 18-44 years, in social class III or IV. Secondary outcomes, including number of subjects with mobile teeth and teeth with > 30% bone-loss, were also significantly worse in the casual attenders. However, the median number of teeth present in both groups was 27. In regular attenders, the most common reason for attending was to 'keep the teeth' (96%). In casual attenders, 'fear/dislike of dental treatment' was the most frequent indicator of non-attendance (56%). CONCLUSIONS: In our study, adults who regularly attended general dental practice were shown to have better oral health, including less overall tooth decay, mobility and bone-loss, compared with adults who did not attend on a regular basis. Assuming this result to be externally valid, a challenge for the dental profession in the future will be to develop effective oral health promotion initiatives.
Adolescent↗
A 10-year study of the progression of destructive periodontal disease in adult and elderly Chinese.
This study describes the progression of destructive periodontal disease among Chinese aged 20 to 80 with limited access to dental health facilities and minimal traditions for oral hygiene procedures. These individuals were followed for 10 years to determine whether the rates for progression of periodontal disease were markedly different than for populations with more access to oral health care. At baseline, participants had been examined for tooth mobility, plaque, calculus, gingival conditions, attachment levels, and probing depths on 4 sites of each tooth present. These probing depth and attachment level recordings were repeated at follow-up, although third molars were excluded from examination. A total of 398 persons remained dentate at follow-up. The analysis demonstrated that virtually all subjects experienced > or = 2 mm attachment loss over the 10-year period, and frequently in a large proportion of the sites present. Attachment loss > or = 3 mm was also widespread, but the distribution of persons according to the extent of > or = 3 mm attachment loss was positively skewed in all age groups. Positive skewness was even more pronounced when attachment loss of > or = 4 mm was considered. Some types of teeth, such as mandibular incisors and maxillary molars, had higher progression rates than did, for example, maxillary incisors. The mean individual attachment loss rates did not differ significantly between age groups, and were remarkably similar to those reported for populations whose access to and tradition for oral health care is widespread.
Adult↗
Determination of the centre of resistance in an upper human canine and idealized tooth model.
The purpose of this investigation was to analyse the influence of geometric and material parameters of a human canine on initial tooth mobility, and the stress and strain profiles in the periodontal ligament. While the material parameters of tooth and bony structures are known within an uncertain limit of approximately a factor of 10, values reported for the elasticity parameters of the periodontal ligament differ significantly. In the course of this study, bilinear behaviour was assumed for the mechanical property of the periodontium. The finite element model of an elliptical paraboloid was created as an approximation to the geometry of a human canine to reduce calculation time and to determine influences of the geometry on numerical results. The results were compared with those obtained for a realistic human canine model. The root length of both models was 19.5 mm. By calculating pure rotational and pure tipping movements, the centre of resistance (CR) was determined for both models. They were located on the long axis of the tooth approximately 7.2 mm below the alveolar crest for the idealized model and 8.2 mm for the canine model. Thus, the centre of resistance of a human canine seems to be located around two-fifths of the root length from the alveolar margin. Using these results, uncontrolled tipping (1 N of mesializing force and 5 Nmm of derotating momentum), as well as pure translation (additionally about 10 Nmm of uprighting momentum) were calculated. Comparing the idealized and the realistic models, the uncontrolled tipping was described by the parabolic-shaped model within an accuracy limit of 10 per cent as compared with the canine model, whereas the results for bodily movement differed significantly showing that it is very difficult to achieve a pure translation with the realistic canine model.
Computer Simulation↗
High-speed filming of the Periotest measurement.
Periodontal disease may be diagnosed with the Periotest technique, which involves electronically controlled and reproducible percussion of tooth. The movement on percussion was investigated with high-speed film and then compared with the return of teeth after static deflection for several seconds as has been reported previously by Lukas and Scholz. The elastic and viscous properties of the periodontium and the surrounding bony tooth socket are to a large extent non-linear. The 10-20 microns deflection of the healthy tooth represents only a fraction of static tooth mobility published by Parfitt or Schulte et al. The visco-elastic properties of a healthy tooth enabling the percussion of the Periotest tapping head to be decelerated in less than 1 ms are largely lost in periodontitis. It is this essential difference which the Periotest method utilizes.
Alveolar Bone Loss↗
[Analysis of the denture dynamics in R.P.D.'s. 2. Influence of retainers on the dynamics of free-end-saddle].
The ordinary denture movement during function is defined as the "Denture dynamics" in R.P.D.'s. by K. H. Körber (1975). The Author has already reported the evaluating method of the denture dynamics objectively by two ways: The displacement sensors of magnetoresistors detected the vertical and horizontal movements of denture saddle in free end situation. Tiny accerelometer also detected the accerelation during the movements. In this present study, the correlations among the retainers used, the extent of the denture dynamics in displacement and accerelation, the occluding force and the abutment tooth mobility induced by the denture support were correlatively evaluated in two patients with class I free end R.P.D.'s. with interchangeable retainers by above methods. All the data were collected simultaneously by the electronic measuring and recording apparatus. Following results were obtained: 1. The denture dynamics depended on the selection of retainers examined. The extent of the dynamics reduced from the denture with the wrought wire clasps, the denture with the cast clasps, then to the denture with cone crown telescopes in sequence. 2. The occluding force increased just as the changes in sequence of the denture dynamics. 3. The abutment tooth moved to the distal in each case. The highest value of the mobility was found in the denture with the cast clasps, then in the denture with the wrought wire clasps. The least value of the tooth mobility was found in the denture with the cone crown telescopes. These results will strongly support the concept of the free end saddle R.P.D.'s anchored and supported rigidly by the abutments and the residual ridges in clinics.
Dental Abutments↗
A split-mouth study on periodontal and microbial parameters in children with complete unilateral cleft lip and palate.
BACKGROUND: Complete unilateral cleft lip and palate (UCLP) is a hereditary or multifactorial malformation that can be corrected successfully with a combined orthodontic, surgical and restorative treatment. Such multidisciplinary treatment takes many years and demands a lot of attention to both patients' teeth and periodontium. OBJECTIVES: This split-mouth study aimed to compare the periodontal health as well as the microbial parameters between cleft and non-cleft region. MATERIAL AND METHODS: 75 patients (52 males, 23 females) between 8 and 20 years with a complete unilateral cleft lip and palate (before (n = 30), during (n = 34) and after (n = 11) the active orthodontic treatment) volunteered for this study. Four regions were defined for the split-mouth comparison: teeth neighbouring cleft (site 1), tooth in cleft (site 2), and the corresponding contra-lateral teeth, respectively, in the unaffected quadrants (sites 3 and 4). At all sites the following periodontal parameters were recorded: plaque and gingivitis indices, pocket depth, attachment loss, bleeding on probing, tooth mobility (visual and Periotest), radiographic bone loss and gingival width. In addition, three pooled subgingival plaque samples were taken (around tooth in cleft, teeth facing the cleft, and contra-lateral teeth of the latter). RESULTS: The differences between the teeth neighbouring the cleft and the corresponding contra-lateral opponents were of borderline significance (P <or= 0.05) for the plaque index, the approximal probing depths and the attachment loss (teeth facing the cleft always had slightly higher parameters). When the tooth in the cleft was compared to the contra-lateral tooth, differences were only found for both the approximal probing depths, attachment loss and bone loss, which were significantly higher for the tooth in the cleft. The microbial analysis did not reveal differences between the different sites, neither in the proportion of aerobic and anaerobic bacteria (differences < 0.5 log), nor in the detection frequency of periopathogens. CONCLUSIONS: These data indicate that the periodontium in UCLP patients can cope well with a long-term orthodontic treatment, even in unfavourable conditions (like absence of attached gingiva and poor oral hygiene).
Adolescent↗
[Mechanical studies on the dental bridges by the finite element method. (1)--An abutment tooth model-- (author's transl)].
Biomechanical considerations are very important to design a prosthetic appliance; however, there have been no satisfactory quantitative studies of such problems, mainly because theoretical and experimental models are unable to represent exactly the natural conditions in the mouth. The finite element method has been successfully applied in each field of applied mechanics and found to be effective for the structural analysis of the biological systems, for it has the advantage of greater versatility for modelling. Accordingly, this analytical, computer-aided method was applied to the dental bridges to evaluate the loads transmitted to the abutment tooth and the stress distributions in the supporting tissues. As the preliminary study a two-dimensional model was constructed to simulate the tooth subject to a vertical and a horizontal load and a moment at the coronal portion. The stress distributions in the tooth and the periodontal membrane and the force distributions on the socket wall were calculated for three load conditions. The tooth mobility and the center-of-rotation position were compared with actual data available in some literatures and the characteristics of tooth support were discussed in terms of three spring constants.
Dental Abutments↗
Factors related to decisions to extract or retain at-risk teeth.
OBJECTIVES: Decisions to extract a tooth may be among the most critical in dentistry. The aim of this study was to prospectively investigate both clinical and nonclinical factors related to decisions to extract or retain teeth in private general dental practice. METHODS: A convenience sample of 196 Iowa dentists in private general dental practice reported on 549 cases where decisions were made to extract or retain teeth as they occurred in their practices during a one-month period in May 1997. Bivariate and multivariate analyses were used to identify factors that differentiated between cases where a tooth (or teeth) was extracted and cases where an at-risk tooth was retained. RESULTS: Of the 549 cases, 67 percent involved extraction, while the remainder involved alternatives to extraction. In comparing extraction cases to alternative treatment cases, we excluded 150 extraction cases because dentists reported that no alternative to extraction was available. Using Generalized Estimating Equations (GEE), we identified cost of treatment, presence of tooth mobility, poor prognosis of alternative treatment, and presence of gross caries as significant factors associated with extraction, while previous treatment of the tooth and concerns with patients' health were significantly associated with alternatives to extraction. CONCLUSIONS: For teeth at risk for extraction, cost, substantial periodontal disease, and several clinical factors were predictive of extraction.
Analysis of Variance↗
The mobility of the lathyritic rabbit mandibular incisor in response to axially-directed extrusive loads.
Axially-directed extrusive loads of 0.01-0.1 N were applied to the lathyritic mandibular incisors of 12 rabbits. Tooth position was monitored continuously with a variable capacitance displacement transducer. Compared with pair-fed controls, lathyritic teeth showed markedly reduced resistance to extrusive loading, indicating that the periodontal collagen has a role in supporting the tooth. The pattern of tooth mobility, however, was little affected. The results may have implications for the eruptive mechanism. That eruption rates can appear unchanged by lathyrogens might not preclude an effect of the drug upon the eruptive force, assuming that there is a concomitant decrease in the resistance of the periodontal tissues to eruption. The teeth of rabbits in the pair-fed control group showed increased resistance to extrusive loading compared with animals fed ad libitum, indicating that changes in food and water intake may also influence the mechanical properties of the periodontium.
Aminoacetonitrile↗
A novel multidisciplinary approach for the treatment of an intruded immature permanent incisor.
The optimal treatment for intruded permanent teeth has not yet been determined. The ideal treatment option is the one with the lowest probability of developing complications such as external root resorption and marginal bone loss. Each case should be considered individually, bearing in mind the severity of the intrusion, the stage of root development, and tooth mobility. Management of an intruded permanent tooth may consist of: (1) observation for spontaneous eruption; (2) surgical crown uncovering; (3) orthodontic extrusion (with or without prior luxation of the intruded tooth); (4) and partial surgical extrusion, immediately followed by orthodontic extrusion and surgical repositioning. The purpose of this article was to review the treatment options for intruded immature permanent incisors, and to present a new modality of an elective internal strengthening of the immature root weakened by external root resorption. A case of an intrusive luxation injury in a 7 1/2-year-old child and the resulting complications utilizing this technique is described. This is the first known report in the pediatric dentistry literature of performing an elective (preventive) internal strengthening of an immature root weakened by severe external inflammatory resorption. The child was followed for 5 years with an excellent clinical outcome. This technique should be considered for treatment of immature permanent teeth with thin cervical root dentin and external or internal root resorption due to trauma or caries.
Child↗
A clinical study of the periodontal status of abutment teeth supporting swinglock removable partial dentures--a pilot study.
Eleven patients wearing mandibular swinglock bilateral distal extension removable partial dentures opposing maxillary complete dentures were studied for a period up to 2 years. They had moderate to advanced periodontal disease with retrograde mobility patterns. Periodontal therapy, as well as treatment of dental carious lesions, was completed before fabrication of the prosthesis. Recordings of the gingival status, pocket depth, plaque score, tooth mobility, and dental caries were made at the time of the placement of the prosthesis and thereafter at 6-month intervals. Final results were obtained at the end of 2 years in six patients (group A) and at 1 1/2 years in five patients (group B). Our findings show that both groups had a statistically significant increase in gingival inflammation. However, no differences in degree of inflammation were observed between the two groups with regard to the status of gingival tissues that were covered and uncovered by the components of the swinglock removable partial denture. Also, no statistically significant differences in pocket depths and plaque scores were found between the time of placement of the swinglock removable partial denture and the final recall visit. Of the 61 abutment teeth, 85.2% had no significant change in mobility, 11.5% showed a substantial decrease in mobility, and 3.3% showed a considerable increase in mobility. The patients were able to successfully wear the swinglock removable partial denture without clinically significant changes in the supporting structures of the abutment teeth. This report is part of an ongoing study to determine the efficacy of swinglock removable partial dentures.
Adult↗
Periodontal reasons for tooth loss in an Asian population.
This study analysed data on periodontal reasons for tooth extractions, obtained from 52 dentists practising general dentistry in Singapore. The results revealed that, out of 2172 teeth extracted from 1276 patients, 35.8% were lost due to periodontal disease and 35.4% due to caries. Extraction due to periodontal problems increased with age, were more conspicuous in the Indian ethnic group and were frequently associated with pocketing and tooth mobility.
Adolescent↗
[Evaluation of relation between signs of trauma from occlusion and severity of periodontitis].
The aim of the present study was to evaluate the various occlusal interferences, signs of trauma from occlusion and their relations to severity of periodontitis. 32 cases of moderate to advanced adult periodontitis patients participated in the study with a mean age of 37.6 years. All subjects received a complete periodontal examination and occlusal analysis. The results indicated that teeth with various occlusal interferences did not exhibit any greater severity of periodontitis than those without interferences. However, widened periodontal ligament space (PDLS) was frequently seen in teeth with occlusal interference. Two combined criteria were initially suggested to identify the occlusal trauma in clinic. The first criterion included presence of functional tooth mobility plus radiographically widened PDLS. The second, presence of significant tooth wear plus radiographically thickened lamina dura. The results showed that teeth with the first criteria had deeper probing depth, more clinical attachment loss and less alveolar bone support than teeth without these findings. However, teeth with the second criteria had less attachment loss and more bone support than teeth from control group. It was suggested that both of the combined criteria provide better reliability in determination of established occlusal trauma as well as evaluation of adaptive capacity of periodontal structure to increased biting force. The regression analysis demonstrated that given equal clinical attachment levels and similar inflammation, teeth with evidences of functional mobility and widened PDLS had less osseous support than teeth without these findings (P < 0.01). The difference became greater in line with the more loss of clinical attachment.
Adult↗