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PubMed2004

Clinical significance of the structural integrity of the superior aspect of the mandibular canal.

BACKGROUND: Sparse data can be found regarding the structural integrity of the superior aspect of the mandibular canal. In many cases, the mandibular canal must be carefully evaluated prior to defining patient treatment. METHODS: In this case report, a 54-year-old patient presented with a periapical infection involving the mesial root of the mandibular right second molar (#31). Radiographic evaluation revealed that the periapical lesion extended from the apex of the tooth to the superior aspect of the mandibular canal. Upon surgical removal of the tooth, an apical communication between the extraction socket and mandibular nerve was located. A guided bone regeneration procedure was performed to protect the nerve from subsequent damage and to prepare the site for future implant placement. Implants were placed in the area approximately 5 months following the regenerative procedure. RESULTS: After implant placement, the patient experienced normal function and no mandibular symptomatology. Implants have been in function for the past 4 years. CONCLUSIONS: Many factors, both pathologic and developmental, can lead to a discontinuity of the superior aspect of the mandibular canal. Normally, a thin cortical plate of bone protects the nerve. When a lack of structural integrity of the canal roof is discovered, enucleation of a periapical infection or subsequent implant placement can lead to potential disruption of the nerve. Limited information is available regarding the integrity of this protective cover. This case report underscores the importance of proper clinical diagnosis before implant placement in the posterior mandible.

Bone Regeneration↗
PubMed1999

Autotransplantation as a treatment option after loss of a maxillary permanent incisor tooth. A case report.

A case is described of the management of a maxillary left permanent incisor, damaged by several traumatic injuries, in a 13-year-old girl. The traumatized incisor tooth required extraction and as part of an orthodontic treatment plan, a mandibular left second premolar was surgically transplanted to the prepared extraction socket at the maxillary anterior alveolus. After splinting, the transplanted tooth underwent endodontic treatment, because of pulpal necrosis. Orthodontic treatment commenced 3 months post-transplantation. Permanent root obturation was provided after orthodontic treatment and a porcelain veneer was placed to restore aesthetic appearance. The case emphasizes the importance of correct case selection, a multidisciplinary approach to treatment planning, and regular follow-up for transplanted teeth.

Adolescent↗
PubMed2003

The use of bovine porous bone mineral in combination with collagen membrane or autologous fibrinogen/fibronectin system for ridge preservation following tooth extraction.

Preservation of the alveolar ridge following tooth extraction is desirable since it facilitates placement of endosseous implants and may improve the adverse esthetics often associated with fixed partial dentures. The purpose of this study was to compare the clinical effectiveness of bovine porous bone mineral (BPBM) used as a graft material combined with either guided tissue regeneration (GTR) or with the autologous fibrinogen/fibronectin system (AFFS) in preserving alveolar ridges following tooth extraction. Twenty-six patients who required extraction of two or more anterior or bicuspid teeth participated in a split-mouth design study. Following tooth extraction and elevation of a buccal full thickness flap, sockets were filled with bovine porous bone mineral which was then covered with either a collagen membrane or mixed and covered with an AFFS system. An acrylic stent served as a reference point for measurements. Primary flap closure was achieved in all surgical sites, and reentry surgery was performed at 6 months. Reentry surgery showed that BPBM/GTR sites presented with [1] significantly more internal socket bone fill (6.04 +/- 0.21 mm vs. 4.98 +/- 0.26 mm), [2] less, although not statistically significant, resorption of alveolar bone height (0.23 +/- 0.28 mm vs. 0.3 +/- 0.21 mm), and [3] significantly less horizontal resorption of the alveolar bony ridge as compared to BPBM/AFFS (1.06 +/- 0.28 mm vs. 2.60 +/- 0.25 mm). This study suggests that treatment of extraction sockets with a combination of bovine porous bone mineral and guided tissue regeneration is of slightly more benefit in preserving alveolar ridge dimensions following tooth extraction than treatment with a combination of bovine porous bone mineral and the autologous fibrinogen/fibronectin system.

Adult↗
PubMed2004

An oral choristoma in a foal resembling hairy polyp in humans.

A neonatal foal was presented with a 6.5-cm pedunculated mass arising from the upper deciduous incisors. The distal end was soft and covered by haired skin, whereas the proximal end was firm, covered with mucosal epithelium, and at the point of transection contained a fully developed tooth. Microscopically, the mass was covered by epidermis and mucosal epithelium and the remaining portion of the mass consisted of mature collagen, nonneoplastic fat and smooth muscle, and a single tooth within a bony socket. The mass is consistent with an oral choristoma and has features similar to those described for hairy polyp in humans.

Animals↗
PubMed1991

Six-year histology of an avulsed molar reimplanted in a hydroxyapatite augmented socket: a case report.

This case report deals with the histologic examination of an avulsed tooth that was reimplanted in a socket where a distal root defect was augmented with hydroxyapatite. The 6-year results showed a "repair" type of connective tissue attachment. There were areas of ankylosis present on the distal root above an area of prior cystic debridement. The hydroxyapatite particles present demonstrated biocompatibility and encapsulation by new bone growth. There was a longer junctional epithelium present on the distal root than on its mesial counterpart. Histology of the distal root demonstrated fibrous repair, ankylosis, and osseous formation around the hydroxyapatite particles. This type of result was not apparent on the mesial root, devoid of hydroxyapatite, where a "splicing" type of healing occurred in the periodontal ligament.

Adult↗
PubMed2000

Influence of bioactive glass on changes in alveolar process dimensions after exodontia.

BACKGROUND: Preservation of the alveolar process after tooth extraction is desirable because it facilitates placement of endosseous implants and minimizes adverse esthetic results associated with fixed partial dentures. The purpose of this study was to evaluate the clinical effectiveness of bioactive glass used as a graft material combined with calcium sulfate used in the form of a mechanical barrier in preserving alveolar ridges after tooth extraction. METHODS: Sixteen patients who required extraction of 2 anterior teeth or bicuspids participated in the study (split mouth design). After tooth extraction and elevation of a buccal full-thickness flap, experimental sockets were filled with bioactive glass, which in turn was covered with a layer of calcium sulfate. Control sites did not receive any graft or calcium sulfate. Titanium pins served as fixed reference points for measurements. No attempt was made to advance the flap to cover the socket areas on control or experimental sites (open socket approach). Reentry surgeries were performed at 6 months. RESULTS: Reentry surgeries showed that experimental sites presented with (1) significantly more internal socket bone fill (6.43 +/- 2.78 mm vs 4.00 +/- 2.33 mm on control sites), (2) less (although not statistically significantly less) resorption of alveolar bone height (0.38 +/- 3.18 mm vs 1.00 +/- 2. 25 mm on control sites), and (3) similar degree of horizontal resorption of the alveolar bony ridge as compared with controls (3. 48 +/- 2.68 mm vs 3.06 +/- 2.41 mm on control sites). CONCLUSIONS: This study suggests that treatment of extraction sockets with a combination of bioactive glass and calcium sulfate is of some benefit in preserving alveolar ridge dimensions after tooth extraction.

Adult↗
PubMed1986

Splinting and replantation after traumatic avulsion.

A rational approach can be taken in the dental office to avulsion and replantation. Consideration must be given to: Extraoral time. During this critical time, the prognosis for successful replantation noticeably decreases as the out-of-mouth time increases. Transport. Preferably the tooth will be transported in the socket, but milk or water may be used to keep the tooth moist. The buccal vestibule may be recommended for adults and teenagers but not for young children. Root surface. The root surface must not be handled, scraped, brushed, or have any part removed; it can be rinsed with sterile water, saline, or tap water but not with caustic solutions, disinfectants, or medicaments to clean the surface. Endodontic treatment. A tooth with an open apex should be evaluated bimonthly for revitalization. A tooth with a fully formed apex should have the pulp removed in 7 to 14 days after avulsion. Status of the alveolar process. Alveolar fractures may require a modified splint design to provide additional strength for a longer splinting duration. Obturation materials. Calcium hydroxide paste is used for a minimum of 6 to 24 months before filling permanently with gutta-percha. Selection of a splint. Each case is different and should be treated as such. Special consideration must be given to splint design, which will directly influence the desired result. Although any number of splints may be effective, inherent advantages and disadvantages of each should be understood fully by the clinician. This is where the art, the clinical experience, and the common sense of endodontic therapy dictate the proper splint and appropriate duration of splinting for the patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

A fused central incisor. Periodontal considerations in comprehensive treatment.

This report details the treatment of a permanent central incisor fused to a supernumerary tooth. The level of fusion was first determined by radiographs, but surgical visibility indicated a more extensive fusion. The two roots were separated, and the supernumerary tooth was removed. At 10 weeks postoperatively, orthodontic treatment was instituted, bringing the retained tooth through the healing socket left by the supernumerary, and into contact with the interdental septum. After endodontic treatment and splinting, a periodontal re-entry procedure was necessitated by the persistence of inflammation caused by incomplete removal of the furcation-like area between the fused teeth. The improved periodontal prognosis of this case at 1-year follow-up can be attributed to careful postsurgical evaluation and subsequent removal of this plaque-retentive area.

Child↗
PubMed1992

Abnormal incisor teeth and body weight in the obese mouse (genotype ob/ob).

Inherently obese mice (genotype ob/ob) developed abnormal incisor teeth at 26 weeks of age. Up to that age, their teeth were indistinguishable by visual criteria, from those of lean (wild-type) litter-mate mice. Radiography and preliminary histology suggested impaction of the tooth in its alveolus (socket) due to the disorganized production of enamel and dentine. Incidence was high (92 per cent) in obese and zero in lean mice. Upper incisor teeth were more severely affected than lower. The severity of teeth lesions could not be correlated with age or body weight. Both sexes were equally affected. The onset of teeth lesions marked the end to the rapid rise in body weight characteristic of the obese mouse. An irregular fall in body weight ensued which could be alleviated by powdering the pelleted food. This indicated the fall to be a consequence of impaired function of the incisor teeth. Abnormality of the teeth was entirely prevented by feeding obese mice from weaning, a similar amount of food to that eaten by lean mice. The high circulating levels of adrenocorticosteroids in the obese mouse are suggested as a cause of the incisor tooth abnormality.

Age Factors↗
PubMed1986

Effect of lyophilized autologous plasma on periodontal healing of replanted teeth.

The purpose of this histologic and autoradiographic study of replanted teeth was to evaluate the beneficial effect, if any, of lyophilized autologous plasma (LAP) application on periodontal healing and to re-examine rates of repair in different areas of the associated periodontium following replantation. Maxillary and mandibular incisors and premolars of three rhesus monkeys were used. Teeth were extracted with forceps and placed in sterile physiologic saline. After 5 minutes each tooth was returned to its socket and immobilized by interproximal acid-etch splints. Splints were removed after 1 week. Of the 48 replants performed, 24 (controls) were replanted as described. Of the 24 experimental teeth, during the 5 minute interval between tooth extraction and replantation, the root surface and the inner socket walls were bathed with 1 ml of the reconstituted LAP-saline solution (800 mg/ml). Replants and animal sacrifice were scheduled to provide observations at 1, 3, 7, 14, 28 and 45 days following replantation. One hour prior to sacrifice, each monkey received an intravenous injection of tritiated thymidine, 1 microCi/gm body weight. Tissue specimens were processed for evaluation following standard procedures. Eight replanted teeth were available for evaluation for each of the six time-points. Four teeth were treated with LAP and four without it. Histologically, tissue sections were examined for epithelial proliferation and attachment, periodontal fibers organization and maturation, inflammatory cell types, presence or absence of cementum resorption and dentoalveolar ankylosis and degree of vascularity of the tissues. For autoradiographic evaluation, the periodontium associated with the replanted tooth was divided into nine spatial cell compartments. In each compartment, labeled tissue cells, epithelial or connective, were counted and recorded. Differences between the control (untreated) replanted teeth and the LAP-treated teeth, at each time-point and within each compartment, were analyzed for significance using the paired t-test. The findings of this study indicate that LAP use enhanced healing by early replacement of the fibrin clot, increased connective tissue cell proliferation, reduction of the inflammatory response and inhibition of root cementum resorption. Periodontal healing and repair occurred more rapidly in the supracrestal or transseptal connective tissue region than within the periodontal membrane space.

Alveolar Process↗
PubMed1987

Effect of fibronectin on healing of replanted teeth in monkeys: a histologic and autoradiographic study.

The purpose of this study was to evaluate the effect of fibronectin application on healing of replanted teeth. Three rhesus monkeys were used. Maxillary and mandibular incisors and premolars were extracted and replanted. Teeth were extracted with forceps and placed in saline solution. After 5 minutes, each tooth was returned to its socket and immobilized by interproximal acid-etch splints, which were removed after 1 week. Of the forty-eight teeth replanted, twenty-four control teeth were replanted as described. On each of the remaining teeth, the root surface and the inner walls of the socket were bathed with 1 ml of fibronectin in saline solution (400 micrograms/ml) during the 5-minute interval between tooth extraction and its replantation. Replanted teeth and animal killings were scheduled to provide observations 1, 3, 7, 14, 28, and 45 days after replantation. Each monkey received an intravenous injection of tritiated thymidine, 1 microCi/g body weight, 1 hour before it was killed. Tissue specimens were processed for histologic and autoradiographic evaluation following standard procedures. For each of the six points of time, four pairs of contralateral teeth were available for evaluation; four teeth were treated with fibronectin and four without it. The findings of this study indicate that fibronectin use resulted in enhanced healing by early replacement of the fibrin clot, increased connective tissue cell proliferation, reduction of the inflammatory response, and inhibition of both cementum resorption and dentoalveolar ankylosis.

Animals↗
PubMed1997

Large arteriovenous high-flow mandibular, malformation with exsanguinating dental socket haemorrhage: a case report.

Arteriovenous malformations (AVMs) of the jaws are extremely rare lesions, which are probably hamartomas of developmental malformations. In this article we present an extremely high-flow AVM of the lower jaw with exsanguinating bleeding from the socket of the exfoliated tooth. Repeated episodic bleedings were controlled with local pressure and packing. Digital subtraction angiography revealed a high-flow, high-shunt AVM. Preoperative embolization and external carotid artery ligation, dental extraction, curettage and packing with Gelfoam were done. Postoperative bleeding stopped, bruit ceased, and it had disappeared completely after 6 months follow-up. On the second follow-up visit, 3 months later, the patient was found to have no problems.

Alveolar Process↗
PubMed1985

Alveolar wound healing alteration under uranyl nitrate intoxication.

The deposit of uranium compounds in calcifying zones has been demonstrated in bone. Nevertheless, no studies on the effect of uranium on osteogenesis have been performed. A histologic and histometric study of the effect of a single intraperitoneal injection of 2 mg/kg of body weight of uranyl nitrate on bone formation is presented. It was performed on rats' healing sockets, 14 days after tooth extraction. The alveolar bone volume (15 X 10(5) micron vs. 34 X 10(5) micron2), total bone formation areas (4.85% vs. 19.55%), and volume density of bone in the alveolar apical third (0.26 vs. 0.40) were significantly lower in intoxicated animals than in the controls. These results indicate the inhibitory effect of uranyl nitrate on bone formation.

Alveolar Process↗
PubMed2000

Epithelial rests of Malassez express immunoreactivity of TrkA and its distribution is regulated by sensory nerve innervation.

The periodontal ligament is the connective tissue that fills the space between the tooth and its bony socket. It is abundantly innervated by the sensory and sympathetic nerves. We first investigated the immunoreactivity of TrkA, which is a high-affinity receptor of nerve growth factor (NGF), in the periodontal ligament of rats. Immunoreactivity was observed at the epithelial cells in the cervical and furcation regions of the molars. These epithelial cells, which gather together to form clusters or networks, are known as the epithelial rests of Malassez. Immunoreactivity was not observed in other non-neuronal cells, such as osteoblasts, fibroblasts, odontoblasts, cementoblasts, endothelial cells, and/or osteoclasts. On the basis of these findings, we investigated the possible involvement of sensory nerve innervation in the immunoreactivity of the epithelial cells. Denervation of the inferior alveolar nerve resulted in a marked decrease in the distribution area and size of the clusters of immunoreactive cells compared with those of sham-operated rats. These findings suggest that sensory nerve innervation may have a regulatory role in maintenance of the epithelial rests of Malassez expressing TrkA in the periodontal ligament.

Animals↗
PubMed2003

[Replacement of a missing tooth with transplantation. Case report].

The replantation and transplantation are wide-spread therapies applied in case of tooth avulsion. It is also possible for such a tooth not to get back into the original socket, and it would be replaced to another tooth alveoli. In this presented case we transplanted a wisdom tooth to the place of the first lower molar immediately after extraction. The same time, by this case we discussed the therapeutical principles and possible prognosis too.

Adult↗