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PubMed1986

An ultrastructural study of tooth resorption in the kitten.

Eleven kittens of various ages were used to obtain teeth in situ at differing stages of exfoliation. The teeth were processed by routine techniques for examination by light and transmission electron microscopy. The dental hard tissues were eroded by odontoclasts supported by numerous blood vessels, fibroblasts, and macrophages. No evidence of intracellular collagen was found within any of these cells, indicating that helper cells are not required to remove the collagenous component of dentin and cementum. The loss of periodontal ligament during shedding involved the removal of cells and extracellular material. Two forms of fibroblastic cell death were identified: One, apoptotic cell death, involved condensation, and its occurrence suggests that exfoliation of deciduous teeth is a programmed physiological event; the other occurred in cells containing many profiles of collagen and involved the selective disruption of the mitochondria and eventual dissolution of cytosol. This form of cell death has not been previously described and is significantly different from necrotic cell death, which was not observed during exfoliation. Some fibroblasts maintained a normal morphology. These various cellular responses suggest that phenotypically different populations of fibroblasts may exist in the periodontal ligament. Collagen removal was an extracellular occurrence which did not seem to involve increased phagocytotic activity by fibroblasts.

Animals↗
PubMed1993

A histological study of the exfoliation of human deciduous teeth.

For clarification of the histological details of the shedding of human deciduous teeth, exfoliated and extracted deciduous teeth were examined by light and electron microscopy. After the roots were completely resorbed, the dentogingival junction migrated along the inner resorbing surface and finally reached the pulpal surface of the crown. At the same time, the gingival epithelium also proliferated and migrated under the crown of the deciduous tooth in such a way that part of it lined the residue of the pulp and another part lined the surface overlying the erupting successional tooth. This phenomenon took place from various sides of the tooth surface. Therefore, just before exfoliation, the migrated gingival epithelium formed narrow necks of tissue, and the crown was only superficially attached to the gingiva by them. The final shedding of the tooth appeared to occur by a tearing of these narrow tissue regions. The results of the present study suggest that the dento-gingival junction as well as gingival epithelium play important roles in the process of exfoliation of human deciduous teeth.

Cell Division↗
PubMedDate not supplied

Coffin-Lowry syndrome and premature tooth loss: a case report.

Coffin-Lowry syndrome was first described by Coffin in 1966 and later by Lowry in 1971. Several oral manifestations have been described previously. We report a case with additional information on the histology of prematurely exfoliated teeth.

Child, Preschool↗
PubMedDate not supplied

Predicting pulpectomy success and its relationship to exfoliation and succedaneous dentition.

This study evaluated factors that affected pulpectomy (PE) success and its effect on the succedaneous tooth's eruption and enamel formation. Sixty-five of 250 patients with PEs met the selection criteria and yielded 81 zinc oxide-eugenol PEs (30 incisors, 51 molars) followed a mean time of 90.8 months. Overall PE success was 77.7% with no difference between molars and incisors (P = 0.53). Enamel defects were observed in 18.7% of succedaneous teeth and were related (P = 0.005) to the pre-existing infection causing excess root resorption (>1 mm preoperative root resorption = 44.4% defects) but were not related to overretention of ZOE filler (P = 1) or length of fill (P = 0.36). The PE procedure was not related to causing succedaneous tooth defects since teeth replacing PEs showed no significant increase in the incidence of defects compared with untreated contralateral controls (P = 0.99). There was a 20% incidence of succedaneous tooth anterior cross-bite or palatal eruption following incisor PEs and 21.6% ectopic eruption of premolars following primary molar PEs. Most PEs (95.9%) were lost at their normal exfoliation time or earlier, but 35.8% needed extraction due to overretention by soft tissue at the time of shedding. Pulpectomy success rates showed that the most important preoperative predictor was the amount of primary tooth root resorption. Greater than 1 mm of root resorption resulted in only a 23.1% success rate, which was significant (P = 0.001). Pulpectomies filled short or to the apex had a significantly greater success (P = 0.011) than long fills. Pulpectomies correctly done do not appear to contribute to adverse effects on succedaneous tooth formation but have a 20% chance of altering the path of permanent tooth eruption.

Amelogenesis↗
PubMed1998

Factors affecting the lifespan of the human dentition in Britain prior to the seventeenth century.

OBJECTIVE: To confirm that compensatory eruption (supereruption) of teeth past a stable periodontium occurs in response to severe occlusal attrition. DESIGN: Regression analysis study from radiographs and direct measurements. SETTING: Archaeological material at the University of Aberdeen. SUBJECTS: 47 individuals > 21 years old and dating from Late Mediaeval times (1300-1600 AD). MAIN OUTCOME MEASURES: Occlusal attrition was recorded on the first permanent mandibular molars. Measurements on radiographs of the teeth from the fixed point of the inferior dental canal were taken to the occlusal surface, the alveolar crest and the tooth apex. Regression analysis was undertaken between these variables and related to attrition (age). RESULTS: Continuous eruption of the permanent human dentition past a stable periodontium does occur in response to tooth height lost by wear, despite the fact that supereruption may lead to the eventual self destruction of the dentition. This mechanism was primarily responsible for the early loss (at 40-45 years of age) of dentitions in Mediaeval times. CONCLUSIONS: Stability of occlusal height appears to be an important function of the dentition and if triggered by severe wear will lead to increasing root exposure and eventual exfoliation of the teeth. It is important not to confuse bone loss due to periodontitis with root exposure due to supereruption of the teeth.

Adult↗
PubMed2002

The fate of the carious primary teeth of children who regularly attend the general dental service.

OBJECTIVE: To describe the care and resultant outcomes of the carious primary teeth of children who regularly attend the General Dental Service (GDS). SETTING: Four districts in the North West of England SUBJECTS AND MATERIALS: A retrospective study of the case notes of 677 children who received their dental care from 50 general dental practitioners (GDPs). Each dentist must have had a minimum of 10 patients and a maximum of 20 patients whose care had been provided by the same dentist from or before the age of five to the age of 14. All of the children included in the study had a history of approximal caries. The outcomes of interest were extraction due to pain or sepsis, or exfoliation and whether or not a tooth had given rise to the prescription of a course of antibiotics. Teeth that did not have a history of extraction were assumed to have exfoliated naturally. Logistic regression models, taking into account the clustering of the teeth within patients, were fitted to compare the outcomes for restored and unrestored teeth according to size of lesion (one or two surface), age caries was first recorded and by tooth type. RESULTS: A total of 4,056 teeth had been either recorded as carious or had received an intervention of some kind. Some 44.1% (N=1,789) of these teeth were extracted, however only 475 (11.7%) were extracted due to pain or sepsis. Of the teeth with a documented history of caries or restoration and for which an outcome was recorded (N=3,145), most first (81.1%) and second (84.3%) carious primary molars were filled during their lifetime, but only 40.5% of primary carious anterior teeth were filled. The majority of carious primary teeth exfoliated naturally. There was no difference in the proportions of teeth extracted due to pain or sepsis whether a carious tooth was restored or left unrestored, either by cavity type or by tooth type, after controlling for age when caries was first recorded. There was also no difference in the number of filled or unfilled carious teeth that caused a course of antibiotics to be prescribed. CONCLUSIONS: Treatment by extraction was common, but GDPs restored the majority of carious primary molar teeth of their regularly attending child patients. The bulk of carious teeth exfoliated naturally irrespective of whether they were filled or not. The reasons for these findings require further investigation.

Adolescent↗
PubMedDate not supplied

Radiographic success of ferric sulfate and formocresol pulpotomies in relation to early exfoliation.

PURPOSE: The purpose of this retrospective study was to evaluate the radiographic findings with formocresol and ferric sulfate pulpotomies in relation to early tooth loss. METHODS: Vital pulpotomies with either ferric sulfate or formocresol, performed by faculty members between 1992 and 2002 at The University of Iowa, were evaluated retrospectively. Radiographic criteria were established to assess success or failure of the treated tooth. This was then correlated with time of tooth loss and space management. RESULTS: Eighty-five molars, followed between 6 to 61 months, met the inclusion criteria. Of these, 15 (43%) teeth treated with ferric sulfate, 23 (56%) treated with formocresol, and 5 (55%) treated with a combination of ferric sulfate and formocresol remained free of any radiographic pathology. Overall, 13% of the pulpotomized teeth were prematurely lost due to abscess formation and in need of space management. Regardless of the treatment type, internal root resorption was the most common cause of premature exfoliation. CONCLUSIONS: Both ferric sulfate and formocresol pulpotomies can lead to premature exfoliation of primary teeth, with the subsequent need for orthodontic space maintenance. Therefore, radiographic criteria should be taken into consideration when evaluating pulpotomized teeth at recall visits.

Alveolar Bone Loss↗
PubMed2003

Premature exfoliation of primary molars related to the use of formocresol in a multivisit pulpotomy technique: a case report.

Since its introduction in 1904, formocresol has become one of the most widely studied dental medicaments. In the United Kingdom, it is the preferred primary tooth pulpotomy medicament of the majority of Specialists in Paediatric Dentistry. Reports of adverse effects resulting from its clinical use are rare. This paper presents a case of premature exfoliation of primary molars that may be related to the use of formocresol in a multivisit pulpotomy technique.

Child↗
PubMedDate not supplied

Enamel pearls in the primary dentition: report of two cases.

Two cases of enamel pearls present in the furcation area of primary mandibular second molars are reported. Clinical and histologic examination revealed that the pearls were composite enamel pearls. Complications arising from this uncommon entity may include delayed exfoliation of the primary tooth and/or deviation of the succedaneous tooth. Radiographic interpretation and detection of the enamel pearl may be complicated by the superimposition of the developing permanent tooth, and their incidence may be higher than reported.

Adolescent↗
PubMed1985

A children's oral health status index based on dentists' judgment.

The children's oral health status index was developed as an integrated measure for the direct appraisal of pediatric patient populations in private practices, dental clinics, or school programs. The index is derived from a paired preference experiment with five pedodontists and five general dentists acting as judges of oral health in 200 case comparisons. Four easily measured variables are united numerically by the index: decayed teeth, occlusion, tooth position, and missing teeth (which have not been exfoliated). Clinical applications of the index in three geographic areas have all had good results.

Adolescent↗
PubMed2000

A histological study of root-resected and root-transected rat incisors when eruption ceases, shortly before they are exfoliated from the socket.

Resection of the odontogenic region or root transection of normal (impeded) rat lower incisors showed that eruption ceased from 1 to 13 weeks when the base of the resected teeth (87.5%) or of the distal segment of the transected ones (86%) reached the alveolar-crest region. When the operated teeth reached the crestal region, the enamel-related periodontal tissues were absent and the periodontal ligament (PDL) was the only periodontal tissue that remained. The PDL of the crestal region may be considered as mature PDL, showing a length of approx. 5-6 6 mm at the mesial face of the tooth, 4-5 mm at lingual face and 1 mm at distal face; from these limits towards the apical end of the socket the PDL becomes gradually immature. The mature PDL seems not to have a role in the process of tooth eruption. Several factors can be suggested to explain the more frequent retention, at the crestal region of the socket, of impeded rather than unimpeded incisors submitted to the same procedures. The connective tissue that develops between the base of the tooth and the bone that fills the alveolus may have more time to organize itself in impeded than in unimpeded teeth, which erupt at a faster rate; this tissue could support and retain the impeded operated teeth longer than the unimpeded ones. The decrease in the mechanical properties of the PDL in the unimpeded condition may ease the traumatic effects and lead to exfoliation. Eruption might be stopped by the increase in occlusal forces, per unit area of root surface, as the root becomes shorter; this effect is likely to be greater in impeded than unimpeded teeth.

Alveolar Process↗
PubMed1990

[A study of trace elements in deciduous teeth. The differences of Cd, Zn, Pb, and levels in prenatally and postnatally formed deciduous teeth].

It has been reported by some investigators that deciduous teeth could be useful materials for the analysis of the trace elements available to the human body burden. In this study, an attempt was made to define that uptake of trace elements (Cd, Zn, Pb and Cu) take place during formation of the deciduous tooth. Samples were prepared from exfoliated human upper deciduous central incisors divided into two or three sections at incremental lines includes neonatal line. Samples were dissolved with nitric acid and dried at 80 degrees C. Each element was separated chromatographically using acetone-HCl gradient solution with a cation exchange resin and then analyzed by flameless atomic absorption spectrophotometry. The results were as follows: 1. Ca, P, Ca/P ratio levels showed no significant differences between prenatally and postnatally formed teeth. 2. In the enamel, (1) Cd level showed a tendency to be higher in the postnatally formed enamel, but not significant. (2) Zn and Pb levels were found to be significantly higher in the postnatally formed than in the prenatally formed enamel. (3) Cu level was reversed significantly. 3. In the dentin, (1) Cd and Cu levels in the postnatally formed dentin I were significantly less than prenatally formed denin, and these were almost equal to the postnatally formed dentin II. (2) Zn level in the postnatally formed dentin I was almost equal to the prenatally formed dentin, but that was significantly less than the postnatally formed dentin II. (3) Pb level in the postnatally formed dentin I was significantly less than the prenatally formed dentin and the postnatally formed dentin II. Therefore, the results suggest that the accumulation of Cd and Cu to the deciduous tooth mainly occur in the prenatal and the accumulation of Zn and Pb to the deciduous tooth occur not only in the prenatal but also continuously in the postnatal, and the deciduous tooth can be a useful materials for environmental contamination recorder.

Cadmium↗
PubMed1999

Immediate placement of implants in extraction sites of maxillary impacted canines.

BACKGROUND: Treatment of asymptomatic impacted maxillary canines in adults is inevitable when primary canine becomes lost through extraction or exfoliation or when the impacted tooth becomes symptomatic. Treatment alternatives include an orthodontic procedure to bring the unerupted tooth to the dental arch or prosthetic replacement of the missing tooth. The authors describe an alternative treatment that involves immediate placement of implants into extraction sockets of the teeth. CASE DESCRIPTION: A patient with bilateral palatally impacted upper canines chose to have the unerupted teeth removed and replaced with implants and crowns. Two hydroxyapatite cylindrical implants were inserted through the alveolar ridge into the extraction sites. The unfilled areas in the extraction sites, around the dental implants, were packed and covered with demineralized freeze-dried bone allograft in conjunction with a collagen membrane barrier. Six months after implantation, computed tomography revealed complete osseous fill of the extraction defects and no bone loss around the implants. The implants were uncovered, and porcelain-fused-to-metal restorations were fabricated and placed. CLINICAL IMPLICATIONS: This treatment modality avoids the need for conventional preparation of teeth as part of prosthetic reconstruction or prolonged orthodontic treatment aimed at bringing the impacted canine to the dental arch. Combining the implantation with bone augmentation preserved the alveolar bone and shortened the treatment period.

Bone Transplantation↗
PubMed2006

Development of a nonrigid, durable calcium phosphate cement for use in periodontal bone repair.

BACKGROUND: Calcium phosphate cement (CPC) hardens in situ to form hydroxyapatite and has been used in dental and craniofacial restorative applications. However, when CPC was used in periodontal osseous repair, tooth mobility resulted in the fracture and exfoliation of the brittle CPC implant. The objective of the authors' study was to develop a strong and nonrigid CPC to provide compliance for tooth mobility without fracturing the implant. METHODS: The authors used tetracalcium phosphate, dicalcium phosphate anhydrous and biopolymer chitosan to develop a strong and nonrigid CPC. They used a powder:liquid ratio of 2:1, compared with the 1:1 ratio of a previously developed nonrigid CPC control. Specimens were characterized using a flexural test, scanning electron microscopy and powder X-ray diffraction. RESULTS: After 28 days of immersion, the new cement had a flexural strength (mean +/- standard deviation; n = 6) of 5.2 +/- 1.0 megapascals, higher than 1.8 +/- 1.5 MPa for the control (P < .05) and overlapping the reported strengths of sintered hydroxyapatite implants and cancellous bone. This cement showed a high ductility with a strain at peak load of 6.5 +/- 1.3 percent, compared with 4.4 +/- 1.9 percent for the control; both were 20-fold higher than the 0.2 percent of the conventional CPC. Nanosized hydroxyapatite crystals, similar to those in teeth and bones, were formed in the cements. CONCLUSIONS: The new nonrigid cement, containing nanohydroxyapatite crystals, possessed a high ductility and superior fracture resistance. This strong, tough and nonrigid CPC may be useful in periodontal repair to provide compliance for tooth mobility without fracture. CLINICAL IMPLICATIONS: The results of this study may yield the first self-hardening and nonrigid hydroxyapatite composite with high strength and durability and large deformation capability to be useful in the regeneration of periodontal osseous defects.

Alveolar Bone Loss↗
PubMed2005

Current concepts in vital pulpotomies in primary teeth.

Vital pulpotomies in primary teeth are performed to maintain the vitality of the pulp and to hold the tooth until it can be normally exfoliated. There exists much controversy surrounding the issue of pulpotomy agents, and the ideal pulp dressing material has not yet been identified. Therefore, it seems that formocresol will still be the first choice for pulpotomies in primary teeth until such agent is identified.

Aluminum Compounds↗
PubMed2004

Argon laser irradiation and fluoride treatment effects on caries-like enamel lesion formation in primary teeth: an in vitro study.

PURPOSE: To evaluate topical acidulated phosphate fluoride (APF) and low fluence argon laser (Ar) treatment effects on in vitro caries formation in primary tooth enamel. METHODS: 20 extracted or exfoliated primary teeth with sound buccal and lingual surfaces underwent soft tissue debridement and a fluoride-free prophylaxis. Treatment groups were: (1) Control [n=5]; (2) Ar [231mW, 10 seconds, 11.5J/cm2; n=5], (3) 1.23% APF for 4 minutes before Ar [n=5]; (4) Ar before APF [n=5]. Buccal and lingual enamel surfaces were treated, and then rinsed in deionized,distilled water (24 hours). An acid-resistant coating was applied leaving buccal and lingual sound enamel windows exposed. In vitro enamel caries was created (2.2 mM calcium, 2.2 mM phosphate, 5.0 mM fluoride, pH 3.90, 10 days). Following longitudinal sectioning, two lesions per primary tooth (10 lesions total) with each group were evaluated for lesion depth (polarized light, water imbibition) and compared (ANOVA, Duncan's Multiple Range). RESULTS: Argon laser irradiation alone provided a 41% reduction in lesion depth (176 +/- 21 microm, P< 0.05) when compared with that for the no treatment controls (297 +/- 31 microm). The combination of argon laser irradiation with APF treatment resulted in lesion depth decreases of slightly over 50% (140 +/- 23 microm for APF before ArTx; 124 +/- 17 microm for ArTx before APF, P< 0.05) compared with control lesion depths, and 20 to 30% over that for argon laser treatment alone (P< 0.05). There was no statistical difference in lesion depth regardless of whether fluoride treatment occurred before or after laser irradiation (P> 0.05).

Acidulated Phosphate Fluoride↗
PubMed2006

Comparison of methods for measurement of hypoplastic lesions.

Enamel hypoplasia is a quantitative defect of enamel thickness. Methods previously used for its measurement have limitations in clinical studies. The aim of this study was to investigate new methods of measurement using image analysis. Lesions on 8 teeth affected by enamel hypoplasia were quantified from study models and impression surfaces using an image-analysis system. The measurements made included lesion area and tooth surface area; from these the proportion of tooth surface area affected was calculated. For comparison, manual measurement was performed on impression surfaces and study models, using digital callipers. Images were also acquired of lesions on 12 exfoliated teeth, and the lesion area and total tooth area were calculated. For assessment of intra-operator reliability, the +/-repeatability coefficient was calculated. Measurement of the surface of lesions direct from the exfoliated teeth gave the best results overall, followed by direct image analysis of the silicone impression.

Dental Enamel↗
PubMed2002

Additional human remains from Blombos Cave, South Africa: (1999-2000 excavations).

The uppermost Middle Stone Age (MSA) layers at Blombos Cave contain high densities of Still Bay bifacial points. Information from other regional sites places the Still Bay prior to the Howiesons Poort industry, which has been dated at 65-70 ka. The Blombos Cave MSA strata have yielded nine human teeth or dental fragments. Four that were recovered during the 1997-1998 excavations have been published elsewhere. The remaining five were discovered during the 1999-2000 field seasons; these are described here. Three of the new specimens are deciduous teeth, and two are permanent premolar and molar crown fragments. The entire dental sample probably represents at least five and as many as seven individuals. The deciduous teeth from the upper MSA levels are likely to have been exfoliated in the cave. One deciduous tooth and the permanent tooth fragments from the lower MSA levels probably represent three individuals who died in or near the cave. The Blombos Cave premolars preserve horizontal circum-cervical striae suggestive of palliative tooth pick use. Approximately half of the permanent and deciduous crown diameters exceed those of recent Africans; for the remainder, the fossil values fall among modern African sample means. The Blombos Cave tooth crowns tend to be smaller than the majority of penecontemporaneous Neandertal teeth. The morphology of the Blombos Cave di is comparable to MSA homologues from the nearby, and presumably somewhat younger site of Die Kelders Cave 1.

Adult↗