[Postextraction alveolitis. A 10-year case study of clinical activity in tooth extraction].
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Dry Socket↗
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Randomized study evaluating recombinant human bone morphogenetic protein-2 for extraction socket augmentation.
BACKGROUND: Conventional dentoalveolar osseous reconstruction often involves the use of grafting materials with or without barrier membranes. The purpose of this study was to evaluate the efficacy of bone induction for the placement of dental implants by two concentrations of recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered on a bioabsorbable collagen sponge (ACS) compared to placebo (ACS alone) and no treatment in a human buccal wall defect model following tooth extraction. METHODS: Eighty patients requiring local alveolar ridge augmentation for buccal wall defects (> or =50% buccal bone loss of the extraction socket) of the maxillary teeth (bicuspids forward) immediately following tooth extraction were enrolled. Two sequential cohorts of 40 patients each were randomized in a double-masked manner to receive 0.75 mg/ml or 1.50 mg/ml rhBMP-2/ACS, placebo (ACS alone), or no treatment in a 2:1:1 ratio. Efficacy was assessed by evaluating the amount of bone induction, the adequacy of the alveolar bone volume to support an endosseous dental implant, and the need for a secondary augmentation. RESULTS: Assessment of the alveolar bone indicated that patients treated with 1.50 mg/ml rhBMP-2/ACS had significantly greater bone augmentation compared to controls (P < or =0.05). The adequacy of bone for the placement of a dental implant was approximately twice as great in the rhBMP-2/ACS groups compared to no treatment or placebo. In addition, bone density and histology revealed no differences between newly induced and native bone. CONCLUSION: The data from this randomized, masked, placebo-controlled multicenter clinical study demonstrated that the novel combination of rhBMP-2 and a commonly utilized collagen sponge had a striking effect on de novo osseous formation for the placement of dental implants.
Absorbable Implants↗
Caiman periodontium as an intermediate between basal vertebrate ankylosis-type attachment and mammalian "true" periodontium.
The teeth of many fish, amphibia, and reptiles are attached to the alveolar bone via ankylosis. In contrast, mammalian periodontia are characterized by a gomphosis, an attachment of the tooth root in the alveolar bone socket via periodontal ligament fibers. Among the reptiles, the crocodilians are the only group featuring a gomphosis-type connection between tooth root and alveolar bone, while in other reptiles tooth-root and jawbone are connected via ankylosis. The purpose of the present study was to compare several key features of the crocodilian periodontium with those of the mammalian and noncrocodilian reptile periodontium. As experimental models for our study we chose the periodontium of newborn geckos (Hemidacylus turcicus), juvenile caimans (Caiman crocodilus crocodilus), and 10-day-postnatal Swiss-Webster mice (Mus musculus) as representative models for noncrocodilian reptiles, crocodilian reptiles, and mammals. The caiman periodontium emerged as an intermediary between the mineral-free mouse ligament and the mineralized gecko ankylosis-type attachment. Caiman ligament fibers were less organized than mouse ligament fibers but featured distinct fasciae surrounding ligament fiber bundles. Caiman Hertwig's epithelial root sheath (HERS) was similarly perforated as mouse HERS and distinctly different from the continuous gecko HERS. Both caiman and mouse HERS covered the entire tooth root length, while in the gecko HERS was limited to the coronal portion of the root, allowing for cementoid-mediated ankylosis at the apical tip of the root. We interpret our data to indicate distinct differences in mineral distribution, periodontal ligament fiber organization, and HERS distribution between noncrocodilian reptiles, crocodilian reptiles, and mammals. Mineral deposits in the caiman ligament may reflect an evolutionary position of the caiman periodontium between ankylosis and gomphosis.
Alligators and Crocodiles↗
Pre-replantation storage of avulsed teeth: fact and fiction.
Recent laboratory and clinical studies have proven that there is a rapid decrease in the regenerative potential of normal periodontal ligament the longer an avulsed tooth is out of the socket. These findings make some guidelines for the management of avulsed teeth inaccurate. This paper will review the effects of pre-replantation storage on periodontal ligament healing. In addition, current management recommendations are reviewed and suggestions for change presented.
Animals↗
Alveolar bone response to submerged bisphosphonate-complexed hydroxyapatite implants.
BACKGROUND: In most studies using submerged hydroxyapatite implants, maintenance of alveolar bone after tooth extraction was attempted with plain hydroxyapatite materials. However, clinical results have shown that hydroxyapatite may require biological modification with a bone resorption-inhibiting agent which may be beneficial for maintenance of alveolar bone. We conducted experimental and clinical studies to evaluate the effect of highly bisphosphonate-complexed hydroxyapatite implants on osteoconduction and repair in alveolar bone. METHODS: Porous hydroxyapatite implants were pre-incubated in 10(-2)M bisphosphonate solutions at pH 3.49. The implants had a diameter of 2.1 mm and a height of 2 mm and adsorbed 115 microg bisphosphonate. Five goats were implanted with 4 plain hydroxyapatite implants on each side of the mandible in root extraction sockets for the precision analysis of dual x-ray absorptiometry (DEXA) measurements. Ten goats were implanted with 4 bisphosphonate/hydroxyapatite implants on one side of the mandible and 4 plain hydroxyapatite implants on the opposite mandible. In a clinical study, 23 bisphosphonate/hydroxyapatite implants were placed in periodontally destroyed tooth root sockets and followed up during one year. RESULTS: The range for the bone mineral density (BMD) measurement errors for goat histologic sections was 0.48% to 1.03%. There were large differences in peri-implant BMDs in the left and right mandible of the same goat, irrespective as to whether hydroxyapatite or bisphosphonate/hydroxyapatite implants were present. This was due to local anatomical differences typical of alveolar bone. These differences were not significant. Histologically, all bisphosphonate/hydroxyapatite as well as hydroxyapatite controls appeared to be fully integrated and effective as bone replacement material in goat alveolar bone. They exhibited vascularization and osteoconduction of alveolar bone growth along and inside their porous structure. In patients peri-implant healing was clinically and radiographically comparable to plain hydroxyapatite implants. All implants were retained and no dehiscences developed. Radiographically, peri-implant radiolucencies disappeared and alveolar bone was deposited in close proximity to the implants. CONCLUSIONS: This study contributes to the understanding of the biological properties of hydroxyapatite implants as carriers for the bone-modulating agent bisphosphonate. Our study suggests that normal osteoconduction and repair occurred in alveolar bone around the highly bisphosphonate-complexed hydroxyapatite implants.
Absorptiometry, Photon↗
Preventing the negative sequelae of tooth extraction.
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Dry Socket↗
Tooth survival and periodontal tissues healing of allogenic-transplanted teeth in the mice.
OBJECTIVE: For the successful organ transplantation, immune rejection has to be considered. Autogenic transplantation of human teeth is generally carried out free of clinical difficulty because of the lack of immune reaction, whereas allogenic tooth transplantations easily induce host immune rejection to donor tissues. The aim of the present study was to evaluate the replacement of donor tissue by host cells after allogenic tooth transplantation. MATERIALS AND METHODS: First molars extracted from lacZ transgenic ROSA26 mice were transplanted into the alveolar socket and the tongue of host wildtype mice, where the first molar had existed. RESULTS: Donor cells from lacZ transgenic mice were not detected in the periodontal ligament space, but rather in the pulp chamber of the donor tooth. Furthermore, if the pulp chamber was widely open to an affluent blood supply, odontoblasts and fibroblasts in the donor tissue survived in the dental pulp. CONCLUSIONS: Our experimental models using lacZ transgenic ROSA26 mice clearly demonstrate that donor periodontal tissue cells are replaced by host cells and that periodontal tissue can regenerate after allogenic tooth transplantation. Furthermore, our models suggest that donor pulpal cells can survive if the vascular supply into the pulp chamber is sufficient.
Animals↗
Factors influencing periodontal repair and regeneration.
The purpose of the present study was to evaluate independently the regeneration capacity of a reduced periodontium, and the potential for new connective tissue attachment to a periodontally exposed root surface. A reduced periodontium was produced around a maxillary central incisor in two Rhesus monkeys using orthodontic elastics. The regeneration capacity of this reduced peridontium was investigated by extracting the periodontally involved tooth and transplanting into the socket the contralateral incisor which had a normal periodontium. The potential for new connective tissue attachment to a periodontally exposed root surface was evaluated by transplanting an exposed root into a normal periodontium. These exposed roots were the incisors extracted from the reduced peridontium. Control specimens were obtained by extracting and reimplanting or transplanting the remaining maxillary and mandibular incisors. Forty days after the experimental procedures, block sections were removed and prepared for histologic analysis. The exposed root surface that had been put into the normal periodontium was lined with epithelium interposed between root surface and alveolar bone. The normal root surface that had been put into the reduced periodontium had connective tissue reattachment in the periodontal ligament and supracrestal regions. Areas of ankylosis and root resorption were present in all specimens, as was new cementum in the periodontal ligament region. The results indicated that root surface alterations, rather than presence of a reduced periodontium, inhibited new connective tissue attachment.
Animals↗
Intentional replantation - a 'last resort' treatment or a conventional treatment procedure? nine case reports.
Intentional replantation is an accepted endodontic treatment procedure in which a tooth is extracted and treated outside the oral cavity and then inserted into its socket to correct an obvious radiographic or clinical endodontic failure. This article reviews nine cases of intentional replantation (IR) that show the feasibility of the procedure in a variety of indications. Only one case of replantation showed evidence of pathosis that reflected root resorption or ankylosis. This report suggests that IR is a reliable and predictable procedure and should be more often considered as a treatment modality in our efforts to maintain the natural dentition.
Adult↗
Rotated palatal flap in immediate implant procedures. Clinical evaluation of 26 consecutive cases.
Immediate implant placement after tooth extraction is a successful treatment modality. Primary flap closure is important for satisfactory final results in these procedures. The purpose of this article was to evaluate a surgical approach that would enable predictable primary soft tissue closure over implants placed into fresh extraction sockets. In 24 patients, 26 consecutive implants were placed immediately following extraction of one anterior or premolar maxillary tooth. Primary closure was achieved by a surgical technique based on a rotated palatal flap (RPF), covering the implant. Deproteinized bovine bone was used as grafting material. The apicocoronal distance between the buccal alveolar crestal bone and the coronal aspect of the implant body was measured at time of implant placement (mean 2.6 mm, SD 1.72) and at second stage surgery (mean 0.6 mm, SD 0.70). The difference between both records was calculated. The mean gain in crestal bone was 2.0 mm (SD 1.69, P < 0.001). In 1 patient, where the implant cover screw became exposed early, crestal bone loss was noted. This technique offers a predictable valuable treatment approach to achieve and maintain primary soft tissue coverage and crestal bone regeneration over implants immediately placed within a bony envelope, after extracting maxillary teeth, without the use of barrier membranes.
Adult↗
[Histological studies on the controlled eruption to the rabbit lower incisor].
In order to investigate the mechanism of eruption, the rabbit lower incisors under the influence of controlled eruption were examined. The first experiment was carried out by repeated resection of the incisal edges of both upper and lower incisors so that the rate of eruption was accelerated. The second experiment was to crown the incisors for the purpose of inhibiting the eruption. In the control group, the periodontal ligament was made up of three layers. Fibers of the inner layer were continuous to the Sharpey's fibers of the cementum, and those of the outer layer were to the alveolar bone. Fibers of the middle layer ran parallel to the tooth axis. In the repeated resection group, the distance between the root end and the bottom of socket was increased, indicating the extrusion of the tooth took place. The odontogenic tissue showed increased frequency of mitosis, and the formative end of the enamel as well as the cementum shifted cervically. The eruption rate measured by the movement of metal bead embedded in the dentin, demonstrated that the rate was increased about 2 times in the repeated resection group, while the rate of growth measured by the Tetracycline method remained 1.6 times of the control group. This discrepancy was supposed to be due to the extrusion of the tooth. In case of the crowing group, the opposite was observed; the rate of eruption was reduced to about a third. Whereas the rate of growth to about a half, probably due to the intrusion of the tooth. In the crowing group, the distance between the root end and the bottom of socket was reduced, resulting the resorption of the bone tissue, and the root became sinuous, particularly at the labial side. In the lingual side, mitotic figures of the odontogenic tissue were rarely observed. The middle layer of the periodontal ligament increased in breadth in the repeated resection group, while it reduced in breadth in the crowing group. Indicating the middle layer plays an important part to the mechanism of eruption.
Animals↗
Management of tooth extractions in hemophiliacs by the combined use of hypnotic suggestion, protective splints and packing of sockets.
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Hemophilia A↗
[Mechanical studies on the dental bridges by the finite element method. (1)--An abutment tooth model-- (author's transl)].
Biomechanical considerations are very important to design a prosthetic appliance; however, there have been no satisfactory quantitative studies of such problems, mainly because theoretical and experimental models are unable to represent exactly the natural conditions in the mouth. The finite element method has been successfully applied in each field of applied mechanics and found to be effective for the structural analysis of the biological systems, for it has the advantage of greater versatility for modelling. Accordingly, this analytical, computer-aided method was applied to the dental bridges to evaluate the loads transmitted to the abutment tooth and the stress distributions in the supporting tissues. As the preliminary study a two-dimensional model was constructed to simulate the tooth subject to a vertical and a horizontal load and a moment at the coronal portion. The stress distributions in the tooth and the periodontal membrane and the force distributions on the socket wall were calculated for three load conditions. The tooth mobility and the center-of-rotation position were compared with actual data available in some literatures and the characteristics of tooth support were discussed in terms of three spring constants.
Dental Abutments↗
Healing of marginal defects at implants placed in fresh extraction sockets or after 4-6 weeks of healing. A comparative study.
The purpose of this study was to evaluate the clinical healing of buccal marginal defects around implants placed in fresh extraction sockets or after several weeks together with barrier membranes and bone graft. Two implant placement protocols were compared: delayed-immediate sites primarily closed by a rotated (full thickness) palatal flap (RPF) at the time of tooth extraction and implantation after 4-6 weeks (Group 1, 24 patients, n = 31 implants) and immediate procedures (into fresh extraction sockets) primarily closed by a rotated split palatal flap (RSPF) (Group 2, 19 patients, n = 23 implants). One or two proximal maxillary implants were simultaneously placed. Height and width of the marginal defect were measured at the time of implant placement and after 6-8 months, at second stage surgery. For Groups 1 and 2, the mean percentage of the reduced defect height was 91.2% (+/- 9.12) and 77.4% (+/- 16.92), respectively, and the mean percentage area of the reduced defect was 97.2% (+/- 3.85) and 90.2% (+/- 9.15), respectively. Differences between groups were statistically significant. Groups were subdivided according to number of implants placed (one or two). Spontaneous implant cover screw exposure was seen only in Group 2. There was an association between the number of implants simultaneously placed and the occurrence of spontaneous exposure. The mean percentage reduction of the defect height and area was significantly smaller where there was spontaneous exposure. Significant differences were found for mean percentage reduction of the defect height and area only between the two implant subgroups within each group.
Alveolar Ridge Augmentation↗
Improving prosthetic results through periodontal procedures.
The purpose of this article is to discuss how the periodontist can aid the restorative dentist in achieving the best prosthetic result. The procedures discussed include: surgical crown lengthening to provide access to subgingival preparation margins, esthetic gingival contouring to blend gingival architecture with tooth shape, esthetic root coverage by gingival grafts, grafting to prevent loss of alveolar plates in extraction sockets and preservation or correction of the alveolar ridge.
Alveolar Bone Loss↗
In vitro formation of mineralized nodules by periodontal ligament cells from the rat.
The purposes of this study were to determine whether periodontal ligament (PDL) cells are capable of producing mineralized nodules in vitro and to analyze ultrastructural features of the nodules. Rat PDL cells were obtained from coagulum in the socket at 2 days after tooth extraction and cultured at confluence in standard medium containing Dulbecco's Modified Eagle's Medium supplemented with 10% FBS and antibiotics. To test mineralized nodule formation, cells were further cultured for an additional 3 weeks in the standard medium containing (1) ascorbic acid (50 micrograms/ml) and sodium beta-glycerophosphate (10 mM), (2) ascorbic acid, sodium beta-glycerophosphate, and dexamethasone (5 microM), or (3) ascorbic acid alone. Cells were then fixed in 2.5% glutaraldehyde, postfixed in 1% OsO4, and prepared for light and electron microscopy. Three-dimensional nodules containing mineralized matrices were formed only when the cells were cultured in the presence of ascorbic acid and dexamethasone. They were composed of multilayered fibroblasts (up to 13 layers), and highly organized collagen fibrils with 64 nm cross-banding patterns between the cell layers. The fibroblasts in the nodules exhibited an elongated shape with a high degree of cytoplasmic polarity throughout the nodule, and have the morphological features of PDL fibroblasts as seen in vivo. Mineral deposition with needle-like crystals was initiated on collagen fibrils located in intercellular spaces of the upper cell layers and became increasingly heavier towards the bottom half of the nodules. X-ray microanalysis and electron diffraction analysis confirmed that mineral deposition contained calcium and phosphate in the form of immature hydroxyapatite.(ABSTRACT TRUNCATED AT 250 WORDS)
Alkaline Phosphatase↗
Synthesis of noncollagenous extracellular matrix proteins during development of mineralized nodules by rat periodontal ligament cells in vitro.
To characterize the mineralized nodules produced by rat periodontal ligament (PDL) cells in vitro, we have studied the synthesis and distribution of mineralized tissue proteins at various stages of nodule formation. PDL cells were obtained from coagulum in the socket at 2 days after tooth extraction and cultured in Dulbecco's Modified Eagles Medium (DMEM) containing 10% fetal bovine serum and antibiotics. Confluent cells were grown in the presence of ascorbic acid (50 micrograms/ml), dexamethasone (5 microM), and beta-glycerophosphate (10 mM) for 3 weeks. Four stages showing distinct morphological characteristics during development of mineralized nodules were identified. Protein synthesis and deposition of proteins into the matrix were studied during these stages by metabolic labeling with [35S]methionine for 24 hours. Large quantities of SPARC (secreted protein, acidic and rich in cysteine) were synthesized by confluent cells but decreased during the progress of mineralized nodule formation. Two forms of osteopontin (OPN) (67 kDa and 61 kDa) were synthesized in comparable quantities by confluent cells; OPN and bone sialoprotein (BSP) were induced by dexamethasone and represented the major proteins in the mineralized matrix. The 67 kDa form of OPN was the predominant species in the mineralized matrix. Both OPN and BSP were localized by immunogold electron microscopy on globular as well as fused electron-dense structures at sites of tissue mineralization.
Animals↗
[Dental implantations of ceramics-coated metals].
Recent studies and personal experience of the Authors in the field of dental implants have encountered the same fundamental problem which arises with orthopedic prosthesis procedures. The basic problem is that of adhesion between the bone tissue and the metal implant. Chrome-cobalt alloy, Tantalum and Titanium are the metals of most recent use. The Authors therefore proceeded to investigate the behaviour of alveolar bone tissue in the proximity of artificial teeth made of alloy (platinum-gold) covered with ceramic, as used in prosthetic dentistry. The experiment was carried out in a dog and a man. In the dog, two of its mandibular teeth were substituted with the same ceramic-gold implants: the first, a replica of natural tooth, was placed in the socket and held in place by metal splint and mandibular circumferential wirings. The other implant, without a replicated crown, was left free, within the alveolus, without contacting the near or opposing teeth. A solid smooth surfaced alumina device, shaped like a small cylinder, was implanted in the upper femoral epiphysis of the same animal.
Alveolar Process↗