Intraosseous sarcoidosis of the maxilla: case report.
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This report describes the transplantation of a primary canine after traumatic loss of a central incisor in an 8-year-old boy. The 7-month follow-up revealed normal periodontal healing with absence of infection, ankylosis or progressive resorption. The patient was then lost for control. After 16 months another trauma in the same patient resulted in an avulsion of the transplant. However, the alveolar bone was maintained in vertical and sagittal dimensions. Another primary canine was transplanted and followed for further 11 months. Again normal periodontal healing could be observed. The transplantation of a primary canine is seen as a promising method to replace a lost permanent tooth and maintain the surrounding tissues in very young patients.
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Avulsion, following traumatic injuries, is relatively infrequent. The treatment of avulsed teeth is by replantation of the avulsed tooth into its own socket. However, sometimes the avulsed tooth cannot be found at the accident site. We report a case in which the avulsed maxillary central incisor is replaced by an embedded lower premolar. A 2-year follow-up shows complete periodontal healing and a very satisfactory clinical result.
Replacement resorption (ankylosis) may be a significant complication after replantation of avulsed permanent incisor teeth. This report explains the aetiology, diagnosis, management and current treatment options in ankylosis and then describes an alternative surgical technique, intentional luxation and repositioning. This technique, in the presence of an acceptable root length, may be a realistic treatment option in adolescence until osseointegrated implants can be considered at the age of 18-20 years.
The aim of this study was to evaluate, through histologic examination, the effect of surgical repositioning of intruded dog teeth upon the pulpal and surrounding tissues. Thirty teeth in 10 adult dogs, aged 2-3 years, were used. Fifteen teeth were intruded, surgically repositioned and fixed using orthodontics wire, composite resin, and enamel acid conditioning. All these teeth served as the experimental group. The remaining intruded teeth were not treated (control group). The animals were sacrificed to allow observations at 7, 15, and 30 post-operative days. The maxillary and mandibular arches were removed and processed for histologic exam. Based on the methodology and observed results, we concluded that: pulpal necrosis, external root resorption and ankylosis were common sequelae to severe traumatic intrusion; a careful immediate surgical repositioning of severed intruded permanent tooth with complete root formation has many advantages with few disadvantages.
The reliability of laser Doppler flowmetry in a two-probe assessment of pulpal blood flow is well known. The purpose of this case report was to determine its use as an exclusive and reliable tool for tooth vitality diagnosis in a long-term follow-up. As a result of a traumatic injury to a 24-year-old Caucasian female, tooth pulp vitality was studied in six maxillary front teeth over 30 weeks using two-probe laser Doppler flowmetry and current sensitivity tests. A similar assessment was repeated after 228 weeks. Confronted with an alveolar bone fracture with a tooth in the fracture line, one intrusion and several luxated teeth, current sensitivity tests are found not to be as reliable indicators of revascularisation, as significant results are obtained later (7 weeks) than using laser Doppler flowmetry tests (1 week). A pathway with ischaemia (3 weeks), hyperaemia (7 weeks) and restored blood supply in the pulp measured by laser Doppler flowmetry tests was found and avoided endodontic treatment. Teeth vascularisation evolved normally (228 weeks). Despite a strong indication in all sensitivity tests for endodontic treatment, the use of laser Doppler flowmetry tests was clear, more reliable than sensitivity tests and exclusive, as denervation was postponed and pulp vascularisation evident.
- The aim of this retrospective study was to determine the type of healing which occurred in root-fractured permanent incisor teeth in children. The objectives were to determine whether gender, age, stage of root development or location of the fracture affected the healing type. The method involved careful scrutiny of clinical records and radiographs of children who attended a unit of paediatric dentistry in a dental hospital. Relevant information was entered onto a data collection sheet. The results were tabulated and analysed by the chi2-tests using the SPSS statistical package. The results are based on 34 root-fractured teeth in 33 children aged 8-15 years. Root development was incomplete in 27 of the root-fractured teeth and complete in seven teeth. A good healing outcome was seen in 27 (79.4%) of the teeth and poor healing in 7 (20.6%). The only factor which was found to be statistically significantly related to healing was the stage of root development. It can be concluded that root-fractured teeth with immature roots have a better chance of showing good healing than teeth with mature roots.
A longitudinal outcome study was designed to identify variables that influenced tooth survival as well as pulpal and periodontal outcomes of laterally luxated permanent maxillary incisors of children and adolescents. All cases were treated between June 1988 and June 1998 in a teaching hospital clinic. Clinical and radiographic data were collected for 42 patients (26 males, 16 females) that represented 58 permanent maxillary incisors. Mean age at the time of injury was 11.4 years (range: 6.3-17.8 years). Mean follow-up time was 1460 days (range: 183-3905 days). In the entire sample (n = 58), no incisors required extraction. Survival analysis and logistic regression were used to identify variables significantly related to the survival and healing outcomes of these incisors. Pulp necrosis (PN) (40%) and pulp canal obliteration (PCO) (40%) were common healing complications. Proportional hazards (Cox) regression showed that PN develops within the first year. Logistic regression demonstrated that root development (P = 0.3, PN; P = 0.8, PCO) and extent of lateral luxation (P = 0.5, PN; P = 0.9, PCO) were not significantly related to PN and PCO. This study provides the first report of incisor survival in children and adolescents following lateral luxation injuries.
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AIM: To present two clinical cases and demonstrate that occlusal trauma may affect healing of periapical pathoses. SUMMARY: Two teeth with periradicular disease did not respond successfully to conventional root canal treatment or endodontic surgery. Occlusal adjustment was finally performed on both cases. After occlusal adjustment, uncomplicated healing and periapical repair occurred in both cases. The findings in these two cases suggest that occlusal trauma may play a role in the healing of periapical pathoses. KEY LEARNING POINTS: Occlusal trauma is positively correlated with changes in periodontal tissues. Although experiments in animals have shown that application of forces to teeth will not induce further periodontal destruction, we believe that some failures of root canal treatment may be due to the presence of occlusal trauma modulating the responses of inflamed periapical tissues or apical pathoses with persistent infection.
The aim of this review article is to supplement the recently published International Association of Dental Traumatology (IADT) guidelines on treatment of the avulsed tooth. A thorough discussion on the reasoning behind each guideline is presented. In addition, the author's views on alternate treatment strategies and future directions, along with recent research on the subject of the avulsed tooth, are also presented.
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42 very deeply fractured or otherwise damaged single roots which could not be saved by intra-alveolar transplantation only were replanted to a supragingival level after extraoral transapical elongation by either an ordinary titanium root screw (method 1) or a specially designed titanium post (TransApex, Dentatus) (method 2). After observation periods of x = 73 months (method 1) and x = 34 months (method 2), 61% and 85% of the cases-respectively, were considered successful, fulfilling all 5 predefined success criteria. No other resorptions than slight surface resorptions were seen and all teeth showed very shallow pocket depths and physiological mobility, indicating that the long extraoral treatment had not caused lasting traumatic injury to the PDL cells. The most frequent complication in method 1 was periapical osteitis, indicating that the elongation system had become insufficient. On the other hand, the method showed the capacity to heal many of the pre-existing osteitis cases. Both root elongation techniques described in this report are comparatively inexpensive and safe, since the apical elongation is never extended beyond the lamina dura structure of the alveolus. Method 2 is to be preferred, however, as the specially designed through-and-through post-system which simultaneously provides apical closure, transapical elongation and coronal retention, allows treatment of even very short roots and seems to give better results.
To date, there has been no reliable method for treating bucco-palatal fractured maxillary molar teeth. We have developed a simple repositioning method to fix teeth fractured in this way using wire. The effectiveness of this new approach was evaluated in both in vitro experimental research and clinical studies.
The present case report describes the reimplantation of avulsed teeth with the treatment of Emdogain. Case was avulsed right maxillary permanent central and lateral incisor in a 9-year-old girl suffering from a traumatic injury. After pretreatment of avulsed teeth, Emdogain was applied to the root surface and into the extraction socket with subsequent replantation of the tooth. Evaluation parameters included horizontal and vertical percussion sound and periapical radiographs. At 1-2-6-12-month follow-up period, the clinical and radiographic appearance of the teeth showed resolution of mobility and no signs of replacement resorbption.