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PubMed2001

Splinting of traumatized teeth with a new device: TTS (Titanium Trauma Splint).

Displacement injuries of permanent teeth are an increasing emergency in the dental office. Children and adolescents are particularly prone to dental trauma due to participation in risky activities. Repositioning or replantation with subsequent stabilization by a dental splint is the standard of care for most displaced or avulsed permanent teeth. Non-rigid fixation allowing physiologic tooth mobility has been shown to be desirable for periodontal healing. A flexible splint of short duration appears to reduce the risk of dentoalveolar ankylosis or external replacement resorption. Different splinting techniques are currently recommended for stabilization of repositioned or replanted teeth, including a wire-composite splint, an orthodontic bracket splint or a resin splint. Each splinting option has its specific advantages and shortcomings. This paper describes a new splinting technique which offers improved comfort and handling to the patient and dentist alike.

Adult↗
PubMed1998

A review of nondestructive test methods and their application to measure the stability and osseointegration of bone anchored endosseous implants.

Threaded and cylindrical metallic endosseous implants are being used increasingly in cranio-facial, dental, and orthopedic surgery. There is a significant need for the development of quantitative noninvasive test methods to measure implant stability and success. Such success can be quantified by measurements of the stiffness and damping of an implant in the surrounding bone, and also the height of the marginal bone around an implant. In the case of a failing implant, the bone around it is replaced by fibrous tissue, and in the case of an overloaded implant the bone height around the implant falls. Nondestructive test methods have been applied to the testing of implant and tooth mobility, and commonly these have used transient or steady-state test methods. Transient methods entail tapping an implant, measuring its response and then performing a Fast Fourier Transform to resolve the fundamental frequencies. Steady-state methods measure the frequency response of a system using a swept frequency wave form. A number of dedicated electronic instruments have been designed to perform these tasks, and this article discusses their applications, accuracy, and value as clinical diagnostic instruments.

Biocompatible Materials↗
PubMed2002

Parametric finite element analysis and closed-form solutions in orthodontics.

The goal and clinical relevance of this work was the development of closed formulas that are correct and simple enough for a fast decision making by the orthodontist in the daily praxis. This paper performs a parametric three-dimensional finite element linear analysis on a maxillary central incisor with a root of paraboloidal shape, which is subjected to typical orthodontic force-systems. Parameters of most importance, such as the tooth mobility in translation and in pure moment rotation including orthodontic centers, as well as the stresses inside the periodontal ligament are calculated for a large variety of over four hundred different couples of root lengths and root diameters around a nominal value. Regression analysis is afterwards performed and establishes closed-form solutions, which are also explained in terms of analytical strain energy and hydrostatic stress considerations within the periodontal ligament characterised by a small compressibility. The obtained expressions include both the root length as well as the root diameter.

Computer Simulation↗
PubMed2001

The role of the mouthguard in the prevention of sports-related dental injuries: a review.

OBJECTIVES: This paper examines the literature dealing with oral-facial injuries received during participation in sport and the possibilities open to athletes for their prevention. In particular, the paper examines five different aspects of this topic: the risk of dental injury while playing sports, the role of the mouthguard in preventing injury, types of athletic mouthguard, implications for patients undergoing orthodontic treatment and behavioural aspects of mouthguard wear. RESULTS: It is clear from this review that participation in a number of sports does carry a considerable risk of sustaining dental injury, not only in the so-called contact sports such as rugby and hockey, but also in less obviously dangerous sports such as basketball. Although some evidence exists to the contrary, the majority of studies have found the mouthguard to be the most effective way of preventing such injuries. It is also clear that the custom-fabricated mouthguard, in particular the pressure-laminated variety, is seen to afford most protection. Athletes undergoing orthodontic treatment present a particular problem as they are potentially at greater risk of injury because of increased tooth mobility and the presence of orthodontic appliances. The fabrication of mouthguards for these patients is also problematic and the literature covering this is reviewed. As with other preventive measures, mouthguard usage is often less than the dental profession would like; the reasons for this are explored in a small number of studies. CONCLUSION: While much progress has been made in this area, the profession could do much more to promote the greater use of mouthguards.

Adolescent↗
PubMed2002

The dental health status of dialysis patients.

BACKGROUND: The number of patients with kidney failure who require dialysis is growing by 10% to 15% annually, and the likelihood that dentists will treat such patients is also increasing. The dental care of patients undergoing dialysis can be complex, given the prevalence of comorbid conditions such as diabetes, hypertension, renal osteodystrophy and immunosuppression, the presence of nondental prosthetic devices, and the use of antihypertensives and anticoagulants or antiplatelet agents. These patients appear to be predisposed to a variety of dental problems such as periodontal disease, narrowing of the pulp chamber, enamel abnormalities, premature tooth loss and xerostomia. Dental care, as well as primary preventive measures, seems to have been neglected in these patients. Therefore, a study of the dental health of dialysis patients was undertaken. METHOD: Completion of a questionnaire and a noninvasive oral examination was obtained from hemodialysis and peritoneal dialysis patients registered in the dialysis program at St. Paul's Hospital in Saskatoon, Saskatchewan, as of March 1, 1999. Information was also gathered from the medical chart. Medication history as well as history of diabetes, hypertension, and nondental prosthetic devices were also recorded. RESULTS: Of 226 dialysis patients in central and northern Saskatchewan, 147 were interviewed and examined. Of these, 94 (64%) were dentate, and the same number had been on dialysis for a mean of more than 2 years; about a third were diabetic, almost all were hypertensive and all had nondental prosthetic devices or arteriovenous fistulae, or both. Sixty (64%) of the dentate patients were candidates for kidney transplantation. Most of the dentate patients reported brushing once or more daily, but they flossed infrequently or never. Dental visits were infrequent, less than every 5 years in 59 (63%) of the dentate patients. Findings in the dentate group included increased tooth mobility, fractures, erosion, attrition, recession, gingivitis and a high plaque index. A patient's dentist was contacted if the patient had seen him or her since starting dialysis (31 of the 94 dentate patients). Most (81%) of the dentists were aware that they were treating a dialysis patient. Medication records were incomplete for 29% of the patients, and only 2 (6%) of the patients had received antibiotic prophylaxis despite the fact that all had prosthetic devices or arteriovenous fistulae. CLINICAL SIGNIFICANCE: We conclude that the dental health of dialysis patients is poor and requires greater attention.

Adolescent↗
PubMed2004

Rapid maxillary expansion with palatal anchorage of the hyrax expansion screw--pilot study with case presentation.

BACKGROUND: Rapid maxillary expansion (RME) with the appliance fixed at the crowns of the first premolars and molars leads not only to transversal expansion but also to tipping of the anchorage teeth and a risk of increased tooth mobility as well as of root and bone resorptions. These disadvantages were to be avoided by fixing the transversal screw directly to the hard palate. MATERIAL AND METHOD: Following preliminary experimental work to determine the extent to which the hard palate could be loaded with orthodontic implants, two female patients were treated for extreme transverse maxillary deficiency using a Hyrax expansion screw fixed on one side with an implant with the following dimensions: length 4.0 mm, diameter 3.5 mm, abutment diameter 5.00 mm (EO implant, Straumann, Freiburg i. Br., Germany), and on the other side with a bone screw between the roots of the second premolars and the first molars. Presurgical osteotomy according to Glassmann was followed immediately by loading, i. e. by expansion through activation of the screw several times per day. Additional anterior guidance of the right and left maxilla was provided by crossed segmented archwires and a tension coil spring for space opening in the incisor region. After adequate expansion by 8.0 mm and correction of the position of the buccal teeth, the Hyrax expansion screw and the osteosynthesis screw were removed. The implant served as orthodontic anchorage for a molar-to-molar transpalatal bar aimed at preventing relapse. RESULTS AND CONCLUSIONS: The tooth axis inclination measured on cut sections of the plaster casts made at the beginning and end of treatment was largely without transversal discrepancies. Direct fixing of the transversal screw in the palatal arch prevents buccal tipping of the posterior teeth, especially in patients with a small apical base. Compared with other direct procedures involving osteosynthesis plates, this technique offers adequate guiding stability and is minimally invasive.

Adult↗
PubMed2000

Periodontal healing after intentional auto-alloplastic reimplantation of injured immature upper front teeth.

BACKGROUND/AIMS: Conventional endodontic treatment results in high complication quota when performed in immature teeth. Intentional reimplantation with extraoral insertion of an endodontic implant (auto-alloplastic reimplantation) is an alternative. METHOD: In a retrospective study, the healing of 40 teeth reimplanted intentionally according to this method in patients aged 7 to 15 years was evaluated. Clinical tests (palpation, percussion sound, periotest values) and radiographical examinations were used to determine the type of periodontal healing (inflammatory resorption/periodontitis apicalis; replacement resorption/ankylosis; normal healing). RESULTS: Mean lifetime of the replanted teeth was 59.2+/-42.5 months, estimated survival time on the basis of the Kaplan-Meier analysis was 99.5 months. 17 teeth (42.5%) were classified as failures, mostly due to inflammatory resorption or periodontitis apicalis. Further investigations demonstrated that success rate and retention period of intentionally replanted teeth depend on the preoperative condition of the pulp. Teeth with preoperative infection suffered frequently from inflammatory resorption or periodontitis apicalis after being replanted (14 of 28 teeth). Estimated survival time according to Kaplan-Meier was 75.5 months. In contrast, inflammations or progressive resorptions were not observed in teeth without preoperative infection of the pulp. All these 12 teeth showed normal periodontal healing and regular tooth mobility. In the absence of any pathology in clinical or radiological findings after an average functional period of 72.3 months, the prognosis can be presumed excellent. Estimated survival time of 148.3 months according to Kaplan-Meier differs significantly from survival time of teeth infected preoperatively. CONCLUSIONS: From the results of this investigation, it may be concluded that an infection of the pulp - due to delay of treatment or attempts at endodontic therapy - should be avoided before intentional replantation of immature front teeth with pulp necrosis. Periodontal healing of the autologous root is not impaired by the insertion of posts made of Al2O3-ceramics or titanium. The inserted posts do not ankylose. Orthodontic movement of auto-alloplastically replanted teeth is possible.

Adolescent↗
PubMed1988

Gingivitis in the human deciduous dentition. A correlative clinical and block surface light microscopic (BSLM) study.

This study examined the relationship between clinical and histomorphometric parameters in the human deciduous dentition. Clinical parameters including plaque index, gingival swelling, gingival color, tooth mobility and degree of root resorption were determined prior to the extraction of teeth. The teeth were extracted with their surrounding gingiva in order to preserve the in situ relationship between the hard and soft tissues. Histomorphometric analysis was carried out on 55 sites, using block surface light microscopy (BSLM). Apical migration of the junctional epithelium was found at 53% (29) of the sites. The gingival sulcus was shallow (0.3 +/- 0.19 mm) and coronal to the cemento-enamel junction at 84% (46) of the sites. Junctional epithelium with retepegs was present at 89% (49) of the sites, whilst an inflammatory cell infiltrate (ICI) was present at all sites examined. The ICI was located opposite to the junctional epithelium and cementum at 80% (44) of the sites. The extent of ICI correlated positively with the patients' age and was significantly increased when clinical evidence of gingival swelling or redness was present.

Adolescent↗
PubMed1987

The community periodontal index of treatment needs (CPITN) procedure for population groups and individuals.

The FDI-WHO Joint Working Group 1 on periodontal diseases supports the use of the CPITN as an epidemiological screening procedure for periodontal treatment needs in populations and also, in a modified form for screening and monitoring of individuals by dental practitioners. The advantages of the CPITN procedure have become more evident following 7 years of development and field experience. This report reviews the CPITN procedure and describes in detail the use of the method for both purposes. Methods, clinical criteria and evaluation of the CPITN data are discussed. The CPITN is primarily a screening procedure which requires clinical assessment for the presence or absence of periodontal pockets, calculus and gingival bleeding. Use of a special CPITN periodontal probe (or its equivalent) is recommended. For epidemiological purposes in adult populations, 10 specified index teeth are examined; for persons under 20 years of age only six index teeth are specified. In dental practice all teeth are examined and the highest score for each sextant noted. Only 6 scores are recorded. Measures of gingival recession, tooth mobility, intensity of inflammation, precise identification of pocket depths or differentiation between supra- and subgingival calculus are not included in the CPITN. Individuals are assigned to one of four treatment need categories determined from their CPITN scores. Detailed explanations are given for the evaluation of epidemiological data. Four tabulations provide an insight into the overall pattern of prevalence, severity and categories of treatment need. For health services planning, the data provide a basis for estimating overall population needs in terms of treatment categories and the clinical personnel required for periodontal care. In the clinical care situation the procedure offers a simple screening method for determining the level of intervention required and also a tool for the longitudinal monitoring of disease changes. Used with commonsense and an understanding of periodontal disease, the CPITN procedure provides the epidemiologist and the practitioner with a practical means of assessing periodontal treatment needs.

Adolescent↗
PubMed1992

Considerations for physicians caring for older adults with periodontal disease.

Periodontal disease is a generic term encompassing a variety of inflammatory conditions affecting the supporting tissues of the teeth. Periodontitis is inflammation associated with net resorption of supporting alveolar bone and periodontal ligament. Gingivitis is inflammation limited to the covering gingival tissues and does not directly lead to tooth mobility or loss. Periodontal diseases are very prevalent. Because the bone and ligament resorption are essentially irreversible, accumulated tissue damage of periodontitis is reflected in a prevalence and severity that increase with age. Periodontitis is not caused by aging per se but by a complex host-parasite relationship in which specific pathogens among the subgingival microbiota not only injure tissues directly but stimulate a cascade of inflammatory mediators to damage host tissues. Analytic epidemiology has identified several risk indicators for advanced periodontitis in older adults. These are microbiologic (prevalence of certain anaerobes in the microbiota), behavioral (tobacco smoking and infrequent professional dental care), medical (older age, preexisting and generalized periodontitis, gingival bleeding), and social (financial worries). Periodontitis in older adults is treated by reducing the impact of these risk indicators. The infections are controlled by combinations of debridement, antimicrobial agents, and surgical procedures as indicated. Medically well older adults can be treated similarly to younger adults. Management of periodontal conditions can be complicated for patients who are medically compromised. Communication between physicians and dental personnel is often required to ascertain the medical history and list of medications taken by older patients. Many of the medications prescribed for medical problems associated with aging impact on treatment choices for managing periodontitis. Moreover, periodontists frequently prescribe analgesics, antibiotics, and anti-inflammatory agents that might interact with others among the numerous drugs taken by older patients. Older adults with cognitive or physical disabilities have special needs for individualized hygiene instruction and implements. Periodontal health promotion and improving access to periodontal care for the elderly are challenges, because dental services are most often in the private sector and dental insurance does not often apply after retirement. Because they grew up in an era in which tooth loss due to "gum" diseases was considered inevitable, their current motivation toward regular preventive care must be improved by removing barriers and impediments to care. In addition to life-threatening medical conditions, frail individuals institutionalized in collective living centers face compounded problems concerning the provision of adequate, not even optimal, dental care. Their periodontal health often deteriorates rapidly after institutionalization, and in some instances it can possibly predispose to aspiration pneumonia or other disseminated infections.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1985

Oral features of Wegener's granulomatosis.

A review of the dental literature yielded ten cases of Wegener's granulomatosis manifesting in the oral cavity, but only one was found in the medical literature. The most common oral lesion is hyperplastic gingiva, which is red to purple, with many petechiae. Tooth mobility, loss of teeth, and failure of wounds to heal are also common manifestations. The disease may remain localized in the oral cavity for unusually long periods of time before multiorgan involvement occurs. Histologically, oral biopsy tissue does not exhibit the characteristic features of vasculitis and granulomas. There are, however, diagnostic histologic features that are consistently present, including pseudoepitheliomatous hyperplasia, epithelioid histiocytes, giant cells, and eosinophils. Failure to recognize these diagnostic clinical and histologic features resulted in a 24-month delay in the diagnosis and treatment of our patient.

Child↗
PubMedDate not supplied

Gorham's disease affecting the maxillofacial skeleton.

Twenty-one cases of Gorham's disease in the maxillofacial region are described in the literature. This case is an additional one. The disease has a slight male predominance. All cases involved either the mandible alone or in association with the maxilla or other bones of the head and neck. The most common symptoms were pain, tooth mobility, mandibular pathological fractures, and facial deformity. The mean duration of symptoms prior to diagnosis was 6.4 years. Treatment included surgery, radiotherapy, and various medications, alone or combined. Four patients died of their disease. The diagnosis of the initial biopsy was incorrect in 45% of these cases. The current case appears to be the only one successfully treated by excision and autogenous bone graft reconstruction. In order to make an accurate diagnosis, the histologic features should be correlated with the clinical features.

Adolescent↗
PubMed1999

Simulation of orthodontic tooth movements. A comparison of numerical models.

Orthodontic tooth movements are based on the ability of bone to react to mechanical stresses with the apposition and resorption of alveolar bone. Currently, the underlying biophysical, biochemical, and cellular processes are the subject of numerous studies. At present, however, an analytical description of orthodontic tooth movements including all components of the processes involved seems to be impossible. It was the aim of the present study to develop a mechanics-based phenomenological model capable of describing the alveolar bone remodeling. Thus, 2 different models were developed. The first is based on the assumption that deformations of the periodontal ligament (PDL) are the key stimulus to starting orthodontic tooth movement. The second supposes that deformations of the alveolar bone are the basis of orthodontic bone remodeling. Both models were integrated into a finite element package calculating stresses, strains and deformations of tooth and tooth supporting structures and from this simulating the movement of the tooth and its alveolus through the bone. Clinically induced canine retractions in 5 patients as well as force systems were exactly measured and the tooth movements were simulated using both models. The results show that the first model allows reliable simulation of orthodontic tooth movements, whereas the second is to be rejected.

Alveolar Process↗
PubMed1998

In vitro evaluation of a measurement method to analyze the interdental, mesially directed force.

In order to evaluate interdental forces as a benchmark for mesial drift, a measurement technique was tested and evaluated on a human specimen. The measurement technique is based on the principle that a mesially directed horizontal force (FH) within a complete dental arch has an effect on interdental friction at the points of contact. The dynamic force (FZ), needed to pull out a defined metal strip from the interdental space is equal to the interdental frictional force (FR). Assuming unmodified approximal surfaces and unchanged tooth mobility in a complete dental arch, relative modifications of the interdental frictional force level provide a way of measuring horizontal force fluctuations. The validity of this measurement technique was measured by applying mesially directed forces of 1 to 5 N to the distal surface of the 2nd molar in a human specimen. The frictional forces measured increased in proportion to the distally applied force. The mesially directed force on the 2nd molar was transmitted in the dental arch anteriorly up to the incisor region and resulted in an increase of frictional forces. The reproducibility of this measurement technique was tested by quantitative analysis of potential measurement errors in the human specimen. The effect on interdental force measurement of the speed at which the metal strip is pulled was evaluated in a range of 50 to 500 mm/min. At the maximum pulling speed of 500 mm/min, a maximum scatter of 8% was recorded. Dependency of the dynamic force on direction of pull was measurable only when the metal strip was angled at more than 15 degrees. Experimental tests on the human specimen confirmed that the measurement technique presented here is sufficiently valid and reproducible for clinical long-term studies of interdental forces.

Bite Force↗
PubMed2005

[HIV-associated lymphoma -- an unusual cause of pathological mandibular fracture].

Despite the introduction of highly active antiretroviral therapy (HAART), diffuse large B-cell lymphoma (DLBCL) remains a common malignancy in human immunodeficiency virus (HIV)-infected patients, especially the plasmablastic variant. About 50% of lymphomas in HIV patients are extranodal and half of them occur in the head and neck area. The main oral symptoms are pain, swelling, numbness and tooth mobility. We report the case of a 52-year-old patient with a known HIV infection and fracture of the angular region of the mandible. The fracture did not unite following open reduction and osteosynthesis. A biopsy performed at the time of revision revealed the diagnosis of a primary lymphoma in the mandible. After chemotherapy had induced complete remission of the lymphoma and autogenous iliac crest bone grafting had been performed the fracture united. Primary lymphoma in the mandible is a disease that presents with a nonspecific radiological appearance which may mimic osteomyelitis or periodontal pathology. A rapid and accurate diagnosis is critical for the appropriate treatment. In our experience HIV-positive patients with mandibular fracture should be treated according to the guidelines established for HIV-negative patients. However, risky compromises such as intraoral approach or hazardous fracture fixation should be avoided.

Biomarkers, Tumor↗
PubMed2002

Microcirculation of the healthy human gingiva.

The purpose of this study was to evaluate the microcirculation in healthy human gingiva. Forty-two adult volunteers with clinically healthy gingiva participated. The ages of this research sample ranged from 20 to 30 years. Periodontal conditions were evaluated and assessed by using the qualitative plaque index, gingival index, gingival bleeding index, tooth mobility, and laser Doppler flow-metry (LDF) on 12 maxillary and mandibular anterior teeth. The LDF data were recorded on the facial aspect of the free gingiva, interdental gingiva, attached gingiva, and alveolar mucosa of 12 maxillary and mandibular anterior teeth, utilizing an acrylic stent to stabilize the probe. This technique was then modified to circumvent contamination by saliva and gingival exudate. Blood flow in the maxillary anterior gingiva differed significantly from that in the mandibular anterior gingiva in interdental gingiva, attached gingiva, and alveolar mucosa, at P< 0.01. The maxillary anterior gingiva, at each point on the stent, showed significant differences in the mean LDF, at P< 0.01. For the mandibular anterior gingiva, the difference was significant only in the alveolar mucosa region.

Journal Article↗
PubMed2002

Blood flow and human periodontal status.

The purpose of this study was to evaluate the microcirculation in subjects with moderate gingivitis, periodontitis, and healthy gingiva. Sixty adult volunteers with clinically healthy gingiva, moderate gingivitis, and periodontitis (20 subjects each) participated in this study. The ages of the research samples ranged from 20 to 35 years. Gingival health was evaluated by using the qualitative plaque index, gingival index, gingival bleeding index, tooth mobility, probing pocket depth, clinical attachment level, and laser Doppler flowmetry (LDF) on six maxillary anterior teeth. LDF data were recorded at the facial aspect of free gingivae, interdental gingivae, attached gingivae, and alveolar mucosae on six maxillary anterior teeth, utilizing an acrylic stent to stabilize the probe. This technique was then modified to circumvent contamination by saliva and gingival exudate. When results were compared at similar sites in each patient within a trial group, there were significant differences in blood flow measurements at all the sites examined between moderate gingivitis and periodontitis when compared with measurements in healthy human gingiva. However, blood flow measurements within the same group showed significant differences at every site, at P< 0.01.

Journal Article↗