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Hyper-IgE syndrome with recurrent infections--an autosomal dominant multisystem disorder.

BACKGROUND: The hyper-IgE syndrome with recurrent infections is a rare immunodeficiency characterized by recurrent skin and pulmonary abscesses and extremely elevated levels of IgE in serum. Associated facial and skeletal features have been recognized, but their frequency is unknown, and the genetic basis of the hyper-IgE syndrome is poorly understood. METHODS: We studied 30 patients with the hyper-IgE syndrome and 70 of their relatives. We took histories, reviewed records, performed physical and dental examinations, took anthropometric measurements, and conducted laboratory studies. RESULTS: Nonimmunologic features of the hyper-IgE syndrome were present in all patients older than eight years. Seventy-two percent had the previously unrecognized feature of failure or delay of shedding of the primary teeth owing to lack of root resorption. Common findings among patients were recurrent fractures (in 57 percent of patients), hyperextensible joints (in 68 percent), and scoliosis (in 76 percent of patients 16 years of age or older). The classic triad of abscesses, pneumonia, and an elevated IgE level was identified in 77 percent of all patients and in 85 percent of those older than eight. In 6 of 23 adults (26 percent), IgE levels declined over time and came closer to or fell within the normal range. Autosomal dominant transmission of the hyper-IgE syndrome was found, but with variable expressivity. Of the 27 relatives at risk for inheriting the hyper-IgE syndrome, 10 were fully affected, 11 were unaffected, and 6 had combinations of mild immunologic, dental, and skeletal features of the hyper-IgE syndrome. CONCLUSIONS: The hyper-IgE syndrome is a multisystem disorder that affects the dentition, the skeleton, connective tissue, and the immune system. It is inherited as a single-locus autosomal dominant trait with variable expressivity.

Abscess↗

Effect of tetracycline on gingival inflammation and alveolar bone resorption in beagles: an individual tooth by tooth analysis.

The effect of systemic tetracycline on gingival inflammation and alveolar bone resorption was studied in beagle dogs. Seventeen dogs were divided into three groups receiving either no treatment, 250 mg tetracycline HCl, or 500 mg tetracycline HCl daily. The severity of gingival inflammation and activity of alveolar bone resorption during a 6-month pretreatment period was compared to a 24-month treatment period for each individual tooth studied. In the first 12 months of treatment there was a significant decrease in the severity of gingival inflammation and the activity of alveolar bone loss in the tetracycline treated dogs. By 24 months of treatment increased gingival inflammation and rate of bone loss was evident in the treated dogs. In the untreated control dogs there was a statistically significant association between the severity of gingival inflammation and activity of alveolar bone resorption about the teeth studied. In the tetracycline treated dogs, no such association existed.

Alveolar Process↗

The effect of physiological root resorption on repair potential of primary tooth pulp.

The aim of this study was to determine, the effects of root resorption on repair potential of healthy deciduous tooth pulps. Fourteen canine teeth which needed to be extracted for orthodontic purposes and in which resorption had just begun (1st group, resorption did not exceed 1/3 of root length) or was in advanced resorption stage (2nd group, resorption was between 1/3 and 2/3 of root length) were used for this study. Direct pulp capping treatment was implemented in vivo, to 7 teeth in each group. Reparative dentin formation was determined three months later following extraction. The teeth were examined histopathologically under light microscope. As a result, in the teeth with different resorption levels, dentin bridge formation in the capping area was observed. Although maturation of the thin dentin bridges was completed in all teeth, maturation of the thick dentin bridges was still continuing at the 90th day.

Adolescent↗

Loss of root length and crestal bone height before and during treatment in adolescent and adult orthodontic patients.

It is broadly documented that orthodontic tooth movement enhances the risk of apical root resorption and loss of alveolar crestal bone height, but virtually all studies have focused on the conventional adolescent patient. In this study, samples from adolescent and adult patients were matched for sex, malocclusion, and treatment regimen. In-treatment changes in root length were the same for both groups, whereas loss of crestal bone height was somewhat greater in adults. Major differences, however, were found at the start of treatment: Adults (mean = 28 years) had significantly shorter roots and greater alveolar recession than the young teenagers (mean = 12 years). Consequently, treatment per se does not place adults at greater risk; it is the involvement extant at the start of mechanotherapy that merits careful evaluation.

Adolescent↗

The role of endodontics in the treatment of luxated permanent teeth.

Pulp necrosis is a common complication following traumatic dental injuries and is related to the type and severity of the injury, as well as to the stage of development of the injured tooth. Endodontic intervention is required when there are clinical and radiographic signs of pulpal infection and its sequelae. Arrested tooth development with periradicular pathosis, external inflammatory root resorption, sinus tract formation and pain on percussion are indicative of root-canal infection in the post-traumatized teeth, and require immediate endodontic treatment. The use of calcium hydroxide in the treatment of teeth with post-traumatic pulp necrosis and its sequelae has been shown to be extremely beneficial for the long-term retention of the injured teeth. Calcium hydroxide has been shown to arrest and repair external inflammatory root resorptive defects, eliminate the endodontopathic microorganisms from the root canal system and induce hard-tissue barrier formation at the apex of non-vital immature teeth. This paper reviews the endodontic treatment required by post-traumatic non-vital permanent teeth.

Calcium Hydroxide↗

The fate of developing teeth in facial trauma: tooth buds in the line of mandibular fractures in children.

Mandibular fractures in children present the surgeon with a unique set of considerations. Tooth buds within the body and ramus of the mandible restrict the type of surgical intervention that may be used. In addition, the fate of nonerupted dentition in the direct line of the fracture remains unclear. Between July 1985 and June 1990, 30 patients in deciduous or mixed dentition presented with a total of 45 mandibular fractures. Of these 45 fractures, 33% (n = 15) involved 16 nonerupted teeth. Age at the time of fracture was 6.0 +/- 2.3 years (mean +/- SD). Thirty-three percent of patients were treated with open reduction and internal fixation of fractures; 67% of patients were treated with closed reduction and either intermaxillary fixation or a lingual splint. Normal eruption was exhibited by 82% (n = 9) of the tooth buds in the line of mandibular fracture. The results of this study indicate the following: (1) Mandibular fractures in children involve unerupted teeth directly in one-third of cases. (2) The majority of tooth buds (82%) in the line of mandibular fractures eventually erupt normally. And (3) a significant percentage of dentition (18%) may exhibit either delayed eruption or noneruption with resorption of the tooth bud if directly involved in the line of fracture.

Child↗

Sinus floor augmentation through a rotated palatal flap at the time of tooth extraction.

Rapid crestal bone resorption following maxillary tooth loss is further accentuated in the posterior regions because of pneumatization and enlargement of the maxillary sinuses. A treatment rationale that allows preservation and/or augmentation of vertical available bone at the time of posterior maxillary tooth extraction may offer numerous therapeutic benefits. The present study comprised 14 patients in whom 18 posterior maxillary teeth with no evident bone between the tooth apex and sinus floor, as estimated through preoperative radiographic analysis, were carefully extracted using a palatal approach. The empty alveolus was thoroughly debrided and incrementally filled with tricalcium phosphate. The graft material was gently pushed beyond the empty alveolus to elevate the sinus membrane using an osteotome. Primary soft tissue closure over the grafted sites was achieved by a rotated palatal flap. The distance between bone crest and sinus floor was radiographically estimated 6 to 7 months after the first procedure. Another procedure was then carried out to place the 10- to 14-mm implants, together with a bone-added osteotome sinus floor elevation. At uncovering, all implants were clinically stable, with no signs of infection. The presented surgical procedure performed at the time of extraction of posterior maxillary teeth in close proximity to the sinus floor allowed placement of implants of proper length and width, together with a bone-added osteotome sinus floor elevation during a second procedure.

Adult↗