Endodontic emergency treatment following root amputation in periodontally involved teeth.
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Thirty-four maxillary molar teeth were evaluated from 11 to 84 months after root amputation. The most consistent finding was that although 24 were neither splinted nor supported in any way, only three developed mobility. Two of these were used as abutments for partial dentures. One other tooth was extracted due to recurrent lateral abscesses and subsequent involvement of the mesial furca.
An investigation was designed to study the clinical and histological effects of delaying endodontic therapy for a period of 2 weeks without dressing of the exposed pulp, after vital intentional root amputation had been carried out on periodontally involved teeth. From the results obtained it was possible to conclude that: 1. Endodontics, prior to surgical root amputation, remains the treatment of choice. 2. When preoperative endodontics is not possible, the approach used in this study will provide good results without severe, adverse clinical or histological effects. 3. The altered periodontal condition and tooth form do not interfere with the performance of definitive endodontics 2 weeks after surgery. 4. Definitive preparation of the cut tooth surface at the time of root amputation facilitates maintenance of oral hygiene after removal of the periodontal dressings. 5. The high percentage of involvement of the distobuccal root of the first maxillary molar in periodontal situations requiring correction by root amputation, may be due to the anatomy of this root.
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A simple inexpensive method of making a laboratory model for the teaching of root resection has been presented. The technique of fabrication of the models requires only a rubber dental model mold, extracted or dentiform teeth, laboratory wax, and laboratory stone or plaster. This is one attempt to fulfill the need for developing laboratory exercises for the teaching of the various periodontal procedures.
A study was undertaken to evaluate the long term results of root resections. Records of 100 patients who had undergone root resections 10 years prior to the study were reviewed. Although the immediate postoperative results were gratifying, they were not always lasting. Eighty-four per cent of the failures occurred after 5 years. Most failures were in the mandibular arch and derived from reasons other than inflammatory periodontal disease. Suggestions are made as to how to improve the prognosis of resected teeth.
There are only a few long-term investigations on root-resected teeth in the literature. This article is a 10-year review of 28 root-resection cases, which mainly had been used as bridge abutments. The periodontal, prosthetic, and endodontic problems were evaluated. After 10 years a total failure rate of 32% was observed. The analysis of the failure causes revealed that endodontic--not periodontal--complications were predominating. The study also includes a comparison of root-resected teeth restored with root screws and composite cores versus those which had been restored with cast gold dowels, showing that both types of reconstruction had the same durability concerning the risk of root fractures or loss of retention.
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The reestablishment and rate of osteodentin and dentin matrix formation in 27 apicoectomized replanted and 20 control incisors in cats were studied after Procion H8-BS vital staining. In control teeth the pattern of matrix formation differed in the various pulpal zones, with a higher rate of matrix formed toward apical areas, most dominantly in maxillary incisors. Osteodentin formation could be traced after a lag period of more than 10 days after replantation. Thirty and 60 days postoperatively osteodentin matrix was found in the total pulpal length in 83% and 73% of the teeth, respectively. A common finding was a tubular osteodentin matrix in the pulpal apical third in the replanted teeth. Tubular osteodentin matrix was, however, present most incisally in some teeth 60 days postoperatively. Internal resorption corresponding to outer cervical lesions dominated the pulpal reactions in the maxillary replanted teeth after 60 days. It is concluded that under the present experimental conditions the pulp tissue possesses a high healing potential and that the osteodentin formation reflects the pulpal healing pattern after replantation traumas. The results also indicate that successful pulpal healing depends on unexposed dentinal tubules.
The cellular dynamic pattern of pulpal healing 4, 10, 30, and 60 days after replantation of 47 apicoectomized cat incisors was studied after pulse labeling with 3H-thymidine and 35S-sulfate, autoradiography, and routine histology. In the control teeth the labeling index was less than 0.05%. The apical pulpal cells were capable of ground substance formation and cell proliferation already 4 days after replantation, with a labeling index of 7%, which increased up to 43% within 10 days. A gradual postoperative restitution and reorganization within the pulpal cellular compartment was seen. The maximum cell density, reached after 30 days, was reduced to on average 60% compared with the controls. The tissue reorganization was near completion within all pulpal zones after 60 days, and the labeling index was reduced to 2.5%. In some instances internal resorption in cervical pulpal areas negatively influenced the favorable healing. The present study shows that the pulpal healing in replanted teeth follows a consistent basic pattern in cellular dynamics and in histologic changes. The replanted tooth thus seems to be a suitable model for studies of healing and repair in connective tissues.
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Hydroxyapol, hapcol and colapol were used to repair the postoperative defects in the jaws in 83 patients of different sex and age. Ossification of bone cavities was more rapid and complete than in the reference group. Complications observed in 7 patients resulted from strategic or technological errors.
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There are certain complications involved in maxillary ostetomies; devitalization of teeth, loss of part or all of the osteotomized segment, and relapse are possible problems. The paramount cause of the complications in seven different cases seemed to be the interruption of the blood supply to the operative site. A seven-point guideline is formulated; it integrates preoperative planning, surgical procqedures, and postoperative care.
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