Coronectomy: a questionable procedure.
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Humans↗
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Antibiotic usage for coronectomy: is it necessary?
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Antibiotic Prophylaxis↗
Fracture resistance of endodontically treated maxillary premolars restored with CAD/CAM ceramic inlays.
STATEMENT OF PROBLEM: Endodontically treated posterior teeth are more likely to fracture compared to posterior teeth with vital pulps. Reinforcement with an extracoronal restoration that covers the cusps is the most commonly recommended method for reducing the risk of fracture. It is not known whether bonded intracoronal restorations without cuspal coverage will reduce the risk of fracture. PURPOSE: The aim of this in vitro study was to investigate whether reinforcement of endodontically treated premolars with MOD preparations could be achieved by insertion of bonded CAD/CAM ceramic inlays. MATERIAL AND METHODS: Forty-five extracted maxillary premolars were equally distributed among 3 groups (END, CER, CTR). In group END (n=15), root canals were enlarged with a rotary NiTi system and obturated with heat-softened gutta-percha around a plastic carrier (Thermafil). After filling of the endodontic access cavities with autopolymerizing composite resin (Luxacore), standardized MOD cavity preparations were made and CAD/CAM ceramic inlays (CEREC) were fabricated and then bonded to the teeth with composite resin (Tetric) and an adhesive system (Syntac Classic). In group CER (n=15), teeth without endodontic treatment were restored with bonded inlays (CEREC). Sound premolars served as controls (group CTR, n=15). Teeth were then thermal cycled (1445 cycles, dwell time: 30 seconds, 5 degrees /55 degrees C). An eccentric load was applied on the buccal incline of the palatal cusp in a universal testing machine until cusp fracture (N). Fracture load was evaluated with the Mann-Whitney test, and type of fracture, with a chi-square analysis (alpha=.05). The type of fracture was determined by visual inspection: type I - supragingival fracture within the palatal cusp; type II - fracture below cemento-enamel junction of palatal cusp; and type III - fracture of palatal cusp and central portion of the tooth exposing the root canal cavity. RESULTS: No significant difference was found among the 3 groups with respect to load required for fracture. Mean fracture load +/- SD was recorded as follows: 291.6 +/- 113.7 N for group END, 363.2 +/- 140.3 N for group CER, and 296.5 +/- 170.5 N for group CTR. Regarding fracture modes, significantly more teeth from group END exhibited fractures of type III and II compared with control specimens. CONCLUSION: Teeth restored with bonded CAD/CAM ceramic inlays (CEREC) fractured with a significantly higher number of severe fractures compared to the control group.
Bicuspid↗
Enamel defects and Lyonization in focal dermal hypoplasia.
We report a pattern of enamel hypoplasia in focal dermal hypoplasia similar to that found in females with X-linked amelogenesis imperfecta. Three cases of focal dermal hypoplasia are described, with specific focus on the oral and dental features. In these cases the teeth all had vertical grooving with notching of the incisal or cuspal tips. Also recorded were blunt roots of taurodont form with open apices and missing teeth in 1 case. Oral papillomas were present in 2 cases. The pattern of enamel defects is attributed to Lyonization, which is consistent with the pattern of skin and bone lesions typically seen in focal dermal hypoplasia. This supports the proposal that focal dermal hypoplasia is X-linked. The authors conclude that the pattern of dental defects in focal dermal hypoplasia is consistent with Lyonization.
Anodontia↗
Enamel dysplasia with odontogenic fibroma-like hamartomas: review of the literature and report of a case.
This article reports on a case presenting with a rare syndrome characterized by enamel dysplasia and multiple unerupted teeth with large solid fibrous pericoronal lesions manifesting with odontogenic fibroma-like features. Our case shows in addition to these findings an anterior open bite malocclusion and gingival overgrowths. These overgrowths exhibit the microscopic features of the multiple pericoronal odontogenic fibroma-like lesions that appear to be the hallmark of this syndrome. This unusual case brings the total number documented in the literature to 5, all of which were reported from South Africa.
Black People↗
A comparative profilometric in vitro study of the susceptibility of polished and natural human enamel and dentine surfaces to erosive demineralization.
This study sought to compare the depths of erosive lesions in samples from different tooth sides as well as from enamel, dentine and root surfaces, and to examine the effect of preparation and polishing of specimens on erosive demineralization. From 30 impacted human third molars, two enamel samples from the mesial, distal, buccal and oral aspects, and similar samples from the radicular dentine, were prepared. One of each pair of samples was polished whereas the other was left untreated. Four samples were also prepared from the coronal dentine. For erosive demineralization, all samples were immersed in 0.05 M citric acid for 3 h and the erosion depth was calculated profilometrically. In general, natural surfaces showed significantly smaller erosion depths than polished surfaces (p< or =0.001) and enamel samples showed greater depths than coronal dentine (not significant) and root dentine (p< or =0.001). The erosion depths of the four tooth sides correlated significantly for polished enamel and coronal dentine samples but not for natural enamel specimens. There was no correlation between erosion depths for enamel and coronal dentine, and only a weak correlation between enamel and root dentine.
Citric Acid↗
Intercusp differences in enamel prism patterns in early and late stages of human tooth development.
Enamel prism-packing patterns reflect the past history of ameloblasts, providing information about growth patterns in tooth development. Here, the area and density of enamel prisms on the cuspal surface of molar teeth were measured to examine if the onset and rate of enamel apposition differ according to stage of development and/or cusp type. Scanning electron-microscopic images were taken from the mesiobuccal and distal cusp tips of 30 mandibular first permanent molars at different stages of development recovered from archaeological sites in Israel dating to the past 10000 years. Selected enamel microstructural characters were measured for each cusp. The mean area of prisms on the mesiobuccal (MB) cusp was significantly larger than that of the distal (D) cusp at all stages of development and the differences in prism area between cusps were significant for each stage of development. Prism density was significantly smaller on the MB cusp than the D cusp at all stages of development but no significant differences were found between early and later stages in each cusp. This was interpreted as indicating that enamel formation in the MB cusp was almost complete, even in the earliest tooth germs studied, whereas in the D cusp it was less advanced. The differences between MB and D cusps are proposed to result from asynchrony of enamel formation between the different cusps of molar teeth in recent populations. The method provides a non-destructive approach to the study of growth patterns in teeth and provides baseline data for comparison with fossil teeth.
Ameloblasts↗
Deformation/recovery cycle of the periodontal ligament in human teeth with single or dual contact points.
The recovery of the human periodontal ligament after transitory tooth deflection is largely obscured. The objective here was to determine the periodontal deformation/recovery cycle of a tooth with a single or dual contact point. 'Single contact point', refers to a tooth with a contact point on one side but not on the other; 'dual contact point' refers to a tooth with two contact points. The hypothesis that a single contact point will recover more slowly due to periodontal changes, as reported in hypofunctional conditions, was tested. The tightness of the contact point between contiguous mandibular premolars (P(1)-P(2)) during a deformation/recovery cycle was measured in three groups: group 1, single contact point of P(2) (14 individuals with a missing mandibular first molar); group 2, dual contact point of the contralateral P(2) (same 14 individuals with no missing mandibular first molar); group 3, dual contact point of both P(2) (32 individuals with no missing mandibular first molars). The deformation/recovery cycle was initiated by placing a spacer for 1 min between P(1) and P(2). The recovery of the contact point P(1)-P(2) to the initial tightness was recorded in five consecutive measurements: four of these were taken at 1-min intervals and an additional measurement was made 30 min later. The contact-point tightnesses of group 1 were significantly (P<0.001) lower ( approximately 50%) than those of the control groups (groups 2 and 3). All groups showed a similar viscoelastic recovery pattern consisting of a short-term elastic response (after 1 min, 82% of the pre-deformation level was regained) and a long-term viscous response (after 30 min, an additional 6% was regained). Thus, contact-point tightness adjacent to an extraction site is strongly affected by the absence of the tooth and presumably due to reorganisation of the transseptal fibres, but this has no effect on the periodontal ligament deformation/recovery cycle, which showed a uniform viscoelastic response independent of contact-point tightness (rejecting the null hypothesis).
Adult↗
Differential repair responses in the coronal and radicular areas of the exposed rat molar pulp induced by recombinant human bone morphogenetic protein 7 (osteogenic protein 1).
Bone morphogenetic protein 7 (BMP 7), also termed osteogenic protein 1, a member of the transforming growth-factor superfamily, was examined for its efficacy in inducing reparative dentinogenesis in the exposed pulps of rat molars. To determine if the reaction was dose-dependent, collagen pellets containing 1, 3 or 10 microgram of recombinant BMP 7 were inserted in intentionally perforated pulps (10-12 pulps per group) in the deepest part of half-moon class V-like cavities cut in the mesial aspect of upper first molars. As controls, the collagen carrier (CC group) alone and calcium hydroxide (Ca group) were used as capping agents. All cavities were then restored with a glass-ionomer cement. Half of the animals were killed after 8 days and the other half after 28 days, by intracardiac perfusion of fixative. The molars were processed for histological evaluation by light microscopy. No difference in effect could be detected between the three concentrations of BMP 7 groups at either time interval. After 8 days, all groups showed varying inflammation, from mild of severe, and the Ca group demonstrated early formation of a reparative dentine bridge. At 28 days the CC group displayed irregular osteodentine formation, leaving some unmineralized areas at the exposure site and interglobular unmineralized areas containing pulp remnants. In the Ca-treated pulps, the initial formation of thick reparative osteodentine bridges that sealed more or less completely the pulp perforation was followed, in the deeper part, by irregular tubular dentine. In most BMP 7-treated specimens, the initial inflammation has resolved at 8 days and at 28 days heterogeneous mineralization or osteodentine filled the mesial coronal pulp. They also had complete filling of the radicular pulp by homogenous mineralization in the mesial root; this reaction was found in 11 teeth in the BMP 7 group, one tooth in the CC group an none of the Ca group. These results emphasize the biological differences the coronal and radicular parts of the pulp, and the potential of bioactive molecules such as BMP 7 to provide an a alternative conventional endodontic treatments.
Animals↗
Calbindin D28K-like immunoreactive nerve fibres in the predentine of rat molar teeth.
Immunoelectron-microscopy was applied to reveal the existence of nerve fibres and terminals showing calbindin D28k (CB)-like immunoreactivity (IR) in the rat molar tooth pulp. In the root pulp, thick, smooth-surfaced CB-IR nerve fibres were in bundles accompanying the blood vessels. In the coronal pulp, the fibres arborized repeatedly and extensively. CB-IR nerve fibres had a predominantly thick, smooth-surfaced appearance, though parts appeared thin and beaded. Occasionally some thin, varicose CB-IR nerve fibres ran along the odontoblasts, penetrating into the predentine alongside the dentinal tubules. They could be traced for approx. 10-20 microns into the predentine from the pulp-predentine border. Immunoelectron-microscopy revealed that only some of the nerve terminals in the predentine showed CB-IR, and that predentinal CB-IR nerve terminals were located close to the odontoblast processes. No synaptic structures were observed between them. The presence of CB-IR nerve terminals in the predentine suggests that many, if not all, CB-IR nerve fibres could be nociceptors. The CB could be involved in Ca2+ homeostasis during the activation of nociceptors.
Animals↗
A scanning electron-microscopic study of developing human deciduous enamel on the dependence of the outline of surface pits on the angle of observation.
On the developing enamel surfaces of fetal human deciduous teeth, many of the surface pits were arcade-shaped with the arcade preferentially pointing in a cervical direction. The configuration of the interprism ridges between the pits contributed to this appearance. Surface cracks allowed verification of an incisal inclination of the subsurface prisms. This apparent paradox was solved when the specimens were tilted so that the pits were viewed in the directions of the prisms, giving the pits a compressed arcade-shape with the arcades pointing incisally. It is recommended that care should be exercised and due attention paid to the angle of observation when determining the orientation of pit arcades. Pit entry direction seems to be a more reliable feature for inferring the direction of tangential ameloblast movement.
Ameloblasts↗
The craniofacial complex in 45,X/46,XX females.
Fourteen Finnish 45,X/46,XX females were compared with population female and male controls, and in addition, nine of them were compared with their first-degree female relatives. Linear and angular measurements were made from standardized lateral cephalograms of patients and normal population controls from the "Kvantti" study series. In both comparisons the results indicated that craniofacial dimensions in 45,X/46,XX females were smaller than those in population female and male controls. The general metric pattern was similar to that observed in relation to the tooth crowns of 45,X/46,XX females. Several of their craniofacial proportions and plane angles differed from those of normal women: shorter anterior and posterior cranial bases and a flatter cranial-base angle, a sagittally shorter maxilla and a sagittally shorter mandible with an enlarged ramus:corpus length ratio, posterior rotation of the mandible and a tendency to bimaxillary retrusion. It is suggested that the reduction of X-chromosomal genetic material in 45,X/46,XX females results in smaller craniofacial dimensions than in normal females, with substantial effects on dimensional ratios and especially plane angles of the cranial base.
Adolescent↗
A histological study of the effect of growth hormone on odontogenesis in the Lewis dwarf rat.
The effect of growth hormone (GH) on the dentition has been described in children with pituitary dwarfism where teeth fail to form; those that do form tend to be reduced in size and the eruption potential is diminished. The aim here was to examine the effect of GH on odontogenesis via molar development in Lewis (control), dwarf (Dw) and Dw GH-treated (Dw+GH) rats aged 3, 6, 9, 12 and 15 days. Dw+GH animals received a twice-daily dose (65 microg/kg) of GH which commenced at 2 days of age. Animals were killed, mandibles removed, processed to embedding in paraffin, sectioned and stained for histological examination of molar morphology during development. Variations in enamel mineralization and root development were observed. In 6-day-old animals, enamel mineralization was delayed in Dw and Dw+GH animals. Root initiation was evident at 6 days of age in controls but was not observed until 9 days of age in Dw and Dw+GH animals. At 12 days of age, maturation of enamel in Dw and Dw+GH animals remained delayed. By 15 days of age no variation in tooth development was evident. These data indicate that enamel mineralization is affected by the level of circulating GH in the rat. A specific deficiency of GH did not appear to delay bone resorption prior to tooth emergence.
Animals↗
Geographic distribution of porcelain veneer preparation depth with various clinical techniques.
STATEMENT OF PROBLEM: Various clinical techniques have been advocated for uniform reduction of the tooth surface before a porcelain veneer restoration. Often these techniques do not produce a consistently uniform labial reduction. PURPOSE: The purpose of this study was to identify the degree of inconsistency on a geographic scale in the depth of labial reduction for porcelain veneers, resulting from the use of 3 clinical techniques. The technique of co-ordinate metrology was used to map the variations in the depth of the preparation. MATERIAL AND METHODS: A single operator using 3 techniques (dimples as depth guides, freehand, or depth grooves as depth guides) prepared 90 noncarious, unrestored extracted teeth to receive porcelain veneers (n=30). Impressions of the prepared and unprepared teeth were scanned with a co-ordinate measuring machine. In-house software was used to color-code the plotted images on the basis of the depth of preparation. Profile measurements were also made along the mid-labial sagital plane at the mid-labial, incisal, and cervical regions, as well as along the mesial proximal and distal proximal areas along the mid-labial horizontal plane. The ideal depth range for the labial reduction was chosen to be 0.4 to 0.6 mm. One-way analysis of variance and the Bonferroni test were performed to determine the significance (P<.05) in the difference between the means of reductions achieved with the 3 techniques. RESULTS: There was no statistically significant difference in the mean percentage area prepared to the ideal depth range (0.4 mm-0.6 mm), between dimple (44.59%), freehand (36.35%), and depth groove (38.43%) techniques. The difference in the mean percentage area of reduction greater than 0.6 mm between dimple (12.98%), freehand (29.66%), and dimple and depth groove (37.32%) techniques were statistically significant (P=.0000), but not between freehand and depth groove techniques. With the profile measurements it was seen that there were statistically significant differences in the mean depth between dimple (0.45 mm) and depth groove (0.63 mm), and freehand (0.51 mm) and depth groove in the mid-buccal (P<.0004) and cervical (dimple = 0.48 mm, freehand = 0.52 mm, depth groove = 0.63 mm) (P<.0005) regions. There was statistically significant difference (P<.0000) in the mean depth between the dimple (0.39 mm) and freehand (0.30 mm), dimple and depth groove (0.50 mm), and freehand and depth groove techniques in the incisal area. In the mesial proximal region statistically significant difference (P<.0034) in the mean depth was found between the dimple (0.52 mm) and freehand (0.68 mm), and dimple and depth groove (0.64 mm) techniques only. In the distal proximal region, there was no statistically significant difference in the mean depth between dimple (0.55 mm), freehand (0.66 mm), and depth groove (0.64 mm) techniques. CONCLUSION: The use of dimple technique showed a trend to greater consistency and fidelity in labial reduction to a depth of 0.4 to 0.6 mm. The 3 techniques for veneer preparations studied were associated with varying degrees of inconsistency in the distribution of depth of preparation within a tooth and between teeth in the same technique group.
Analysis of Variance↗
A simple method for the restoration of fractured anterior teeth.
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Cementation↗
Prosthetic restoration after coronoradicular resection: mechanical behavior of the distal root remaining and surrounding bone.
PURPOSE: This 3-dimensional finite element analysis evaluated: (1) the mechanical behavior of the distal root remaining after resection of the mesial root in a mandibular molar; (2) the consequences of the remaining distal root displacements on the bone; and (3) the role of the radicular post in the transmission of stress to the remaining root. METHODS: Three-dimensional finite element analysis was performed. RESULTS: The most reliable solution for the remaining root and surrounding bone consisted of fitting a conventional fixed partial denture with abutments on either side of the amputated root. The solution provided a single cantilever supported only by the residual root. CONCLUSIONS: This analysis makes it possible to quantify, in the model situation, the risks taken for each prosthetic option.
Alveolar Process↗
Qualitative and quantitative determination of dental amalgam restoration volume.
STATEMENT OF PROBLEM: Volume of tooth structure replaced by an existing restoration, as assessed by visual and radiographic examination, is one diagnostic measure used by dental practitioners and dental insurance agencies to determine the relative need to restore a tooth with a full-coverage cast restoration. However, use of these methods has not been validated. PURPOSE: This study compared the volume of a range of dental amalgam restorations placed in typodont teeth, as estimated by dentists, dental students and laypersons, with the actual volume of each restoration. METHODS AND MATERIAL: Sixty subjects (20 dental school faculty, 20 dental students, and 20 clerical staff [laypersons]) participated. After reviewing photographic images of typodont teeth with mesial-occlusal-distal dental amalgam restorations, subjects estimated the volume of each restoration using various restorations on different teeth as a percentage of its tooth's coronal volume. The actual volume of each dental amalgam restoration and that of the coronal portion of the prepared teeth was calculated with a volumetric displacement technique. The single sample 2-sided t test with a.05 level of significance was used to evaluate the null hypothesis (H0 ): The survey participant's estimates of each restoration's percentage volume are the same as the measured volume values versus the alternative hypothesis (H1 ): estimates differed from the measured volume values. One-way analysis of variance was used to determine the significance of any difference between the estimates of the 3 survey test groups. RESULTS: Average volumes reported by all 3 groups were significantly different than the measured volume values (P <.05). Experience and dental training did not significantly affect a participant's ability to evaluate restoration volumes with greater accuracy. Results reported by dentists, dental students, and laypersons were not significantly different (P >.05). CONCLUSIONS: The volume of a restoration is inaccurately assessed by visual and radiographic examination.
Analysis of Variance↗
Preeruptive idiopathic coronal resorption: a case report.
A bitewing radiograph obtained from a general dentist revealed an intracoronal radiolucency within an unerupted immature permanent second molar. This rare entity was successfully treated by surgical exposure and vital pulp therapy. Apexogenesis was confirmed radiographically and a permanent restoration placed at the time of eruption. Possible etiologies for this condition are discussed and recommendations for treatment are proposed.
Child↗