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Mandibular third molar autotransplantation--literature review with clinical cases.

Autotransplantation of mandibular third molars in a precocious phase of development is indicated when a substitute for adjacent compromised or missing molars is needed, and when mesial movements of the posterior teeth, the resultant loss of space, and overeruption of opposing teeth and consequent changes in the occlusion must be avoided. Provided that the apices of the mandibular third molar are immature, the immediate replacement of a lost or compromised tooth usually ensures a good outcome. Transplantation of third molars helps to maintain alveolar bone and enables endosseous implantation without requiring bone regeneration. We present examples of transplantation of mandibular third molars and review the factors that affect the success or failure of this procedure, such as atraumatic extraction and adequate immobilization of the transplanted tooth and root development after transplantation. Sex or age seem to have no effect on the final outcome.

Adolescent↗

Long-term results of restoration of feline resorptive lesions with micro-glass-composite.

Twenty-five Class I-III resorptive lesions in 19 cats were restored with Charisma, a micro-glass-composite material. Twenty two restorations were examined 6 and 12, and 10 were examined 24 months post-treatment. Excellent results (restoration intact, no additional resorption visible) were seen in 68% of restorations at 6 months, 36% at 12 months, and 10% at 24 months.

Animals↗

The localisation of ED1 antibody in the resorbing hard tissues of the periodontium.

A dental hard tissue resorptive model was used to determine the periodontal ligament (PDL) distribution of lysosomal membrane antibody ED1 to cells of the macrophage-phagocyte lineage. Immunolabel was identified in mononuclear cells around inflammatory sites in the PDL, while multinuclear cells were labelled in resorption bays present in both bone and dentine. As repair of the tissues occurred, the label became less obvious. The presence of strong ED1 label in alveolar bone marrow provided evidence supporting the haemopoietic origin of the similarly labelled PDL cells. Also, evidence confirming the current theory that multinucleated resorptive cells differentiate along a monocyte-macrophage pathway was provided. t was concluded that ED1 is a positive PDL marker for mononuclear and multinuclear cells involved in the inflammatory and resorptive processes.

Alveolar Bone Loss↗

Patterns of periodontal destruction associated with incomplete root fractures.

OBJECTIVES: To clarify the differential radiographic diagnostics of teeth with incomplete root fracture. METHODS: Information on 88 teeth with either a vertical root fracture without displacement of the fractured fragments (n = 22), a vertical periodontal defect (n = 22), a periodontal-endodontic lesion (n = 22) or an endodontic-periapical lesion (n = 22) was collected retrospectively from the patients' records. RESULTS: Significant differences in the mean probing pocket depths were found between each of the four groups of lesions. Teeth with root fractures demonstrated smaller mean probing pocket depths than those with either periodontal or periodontal-endodontic lesions. Radiographic bone loss was significantly greater in teeth with periodontal and periodontal-endodontic lesions when compared with those with fractures. In teeth with vertical root fractures, there was no correlation between the probing depth and the radiographic bone loss (r = 0.01). The correlation coefficient between the greatest probing depth and alveolar bone loss was r = -0.16 in the fractured teeth, with higher values for the other three groups of lesions. 86.4% of the teeth with fractures had a complete root canal filling. Posts were present in 22.7% of the fractured teeth and in 13% of those with an endodontic periapical lesion. 91% of the teeth with vertical fractures were crowned or fixed-bridge abutments. Only 5% of the fractured teeth had no evidence of periapical bone changes. CONCLUSIONS: Incomplete root fractures mainly involve teeth which have undergone successful endodontic treatment. An isolated pocket on one aspect of a suspected tooth is reliably diagnostic for a root fracture.

Alveolar Bone Loss↗

[Histologic observation of upper central incisors after surgical immediate torsion].

The purpose of this study is to verify the treatment results of rotated teeth by using surgical immediate torsion method. Seven upper central incisors in four monkeys were chosen in our experiment. The surgical treatment was accomplished by rotating the teeth in about 45 degree. The animals were sacrificed at 2, 3, 4 and 12 weeks after operation. The results showed that two of seven dental pulps were necrosis, three were injured and two were normal. Absorption of dental cementum and dentine occurred at the apex and the middle third of the root. There was no evidence of ankylosis between the tooth and bone tissues. According to our experiment, we think that the surgical immediate torsion method for treating rotated teeth is not available.

Animals↗

A clinical follow-up study of 278 autotransplanted teeth.

This open study was undertaken to investigate the outcome of autotransplanted teeth over a 6-year period. The subjects were 296 patients who underwent autotransplantation in the 6-year period September 1986-August 1992 and outcome was measured by considering root formation, occlusion, endodontal and periodontal complications. 18 patients were excluded because of inadequate notes or radiographs (n = 3) or because they were lost to follow-up (n = 15). The groups were divided into open apex and closed apex, and duration of follow up was 6 months-5 years. Aplasia was the indication for operation in 158 (77 percent) of the open apex group but only 10 (14 percent) of the closed apex group, whereas caries and associated disease was the most common in the latter (n = 45, 61 percent compared with 20, 10 percent). There were 24 complete failures, 12 in each group (p <0.01). Only 7 teeth in total developed full roots, and 159 showed incomplete growth. In the open apex group 112 teeth were in occlusal contact and 4 were extracted for severe infraocclusion. In the closed apex group there were 10 cases of mild infraocclusion, none of which required treatment. There were 7 cases of pulp necrosis in the open apex group, 4 of which required extraction. Two teeth in the closed apex group were extracted for endodontic reasons. Only 1 tooth (in the closed apex group) had to be extracted for periodontal reasons. Autotransplantation is a reliable method with a good prognosis for donor teeth with both open and closed apexes. The technique is applicable whatever the aetiology of the agenesis, and is worthy of consideration should there be a suitable donor tooth.

Adolescent↗

Deciduous canine and permanent lateral incisor differential root resorption.

When a permanent maxillary canine erupts apical to the permanent lateral incisor and the deciduous canine, resorption typically takes place only on the deciduous canine root. An understanding of this differential resorption could provide insight into the reasons for excessive iatrogenic root resorption during orthodontic tooth movement. The purpose of the present study was to examine the response of roots of permanent lateral incisors and deciduous canines to simulated resorption, and to acid and enzyme attack, reflecting the physiologic environment of an erupting permanent canine. Groups of maxillary permanent lateral incisor and deciduous canine roots were exposed to 5 combinations of Ten Cate demineralizing solution, Ten Cate demineralizing solution with EDTA, and a Type I collagenase solution. Sections of the roots were examined under a polarized light microscope. Analysis of variation of the resulting root lesions demonstrated that the lesion depths for deciduous canines were greater than those for permanent lateral incisors when averaged across 4 of the conditions (F(1,24) = 7.49, P =.0115). On average, deciduous canine roots demonstrated lesions 10% deeper than did permanent lateral incisor roots. We concluded that when deciduous canine and permanent lateral incisor roots are subjected to acid and enzyme attack, reflecting the physiologic environment of an erupting permanent canine, significantly deeper demineralized lesions are seen in the deciduous roots compared with the permanent roots. This finding may partially explain the differential root resorption during permanent tooth eruption.

Acids↗

External cervical resorption associated with localized gingival overgrowth.

AIM: To describe the presentation and management of an unusual lesion of external cervical resorption. SUMMARY: The salient features of this unusual presentation of the external cervical resorption with localized gingival overgrowth, and the resorption located almost wholly on the labial aspect of a maxillary incisor crown are described. Extensive loss of enamel had occurred. The management and possible aetiology of the resorptive lesion are discussed. KEY LEARNING POINTS: Localized gingival overgrowth can be associated with external cervical resorption.The cervical resorption does not necessarily indicate pulp canal infection and the need for root-canal treatment.

Adult↗

The submucosal implantation of human allogeneic decalcified dentin.

Decalcified human dentin was implanted into the buccal oral mucosa of 10 human volunteers and was later recovered for histologic examination. Extensive resorption took place. Bone did not form. Human dentinal matrix is not a bone inducer. Differences between the two methods of decalcification were not relevant.

Adult↗

Optical and scanning electron microscopy in the single osteoclast resorption assay.

The present studies relate to the single or isolated osteoclastic resorption function assay which we introduced in 1983 to overcome objections to assays based upon measurements of calcium release from bones, in which it was never strictly controlled whether the mechanism involved the destruction of bone with the formation of classical Howship's lacunae. The method may prove to be quite popular in the near future and has already been adopted by other research groups. In previous work, we had utilised stereophotogrammetry of scanning electron micrographs to measure the depth, volume and other parameters of the individual lacunae. However, increasing experience with the method has suggested that we can await a wide range of biological variability in single cell function in any one experiment. We have therefore tested other methods from which data could be obtained more rapidly to permit a better statistical analysis, albeit with reduced accuracy, of each resorption complex. The main aim of the studies reported here was to evaluate various methods of optical and scanning electron microscopy that can be used for the visualization of osteoclasts and their associated resorption lacunae generated in vitro in slabs of dentine and bone. Optical microscopy was found to be complementary to SEM, enabling vital microscopy of unstained and stained cells. In particular, oblique illumination LM and tandem scanning reflected LM (TSRLM) proved to be of paramount value for this purpose. Fixed coated specimens could be most rapidly scanned for resorption lacunae using darkfield reflected LM or TSRLM.

Animals↗

Effect of polylactic acid on replanted teeth in dogs.

An attempt to inhibit root resorption and ankylosis of replanted roots in the mandibles of dogs was made by coating the root segments with a biodegradable compound. Resorption was not inhibited, but ankylosis response was apparently averted until the compound began to degrade.

Animals↗

Prevalence of odontoclastic resorptive lesions in a population of clinically healthy cats.

The prevalence of odontoclastic resorptive lesions (ORLs) was determined in a clinically healthy cat population (228 cats) using both clinical (oral examination) and radiographic (full-mouth series with intraorally positioned dental film) methods. The overall prevalence rate was 29 per cent (mean age of the cat population 4.9 years). The mandibular third premolars (307, 407) were the most commonly affected tooth and the pattern of ORL development was symmetrical in most cats. The risk of having ORLs was found to increase with increasing age and cats with clinically and radiographically missing teeth were more likely to have the condition. Neutering, gender, age at neutering or mean whole mouth gingivitis index did not affect the prevalence of ORLs.

Age Distribution↗

The orthodontic implications of traumatized upper incisor teeth.

With the demand for orthodontic treatment increasing, it is inevitable that the practitioner will see a significant number of patients with previously traumatized teeth who require orthodontic treatment. The possible risks and guidelines for the management of these teeth during active tooth movements are discussed. The use of orthodontic appliances in the management of incisors traumatized during active orthodontic treatment is also discussed.

Contraindications↗

Are anterior occlusal radiographs indicated to supplement panoramic radiography during an orthodontic assessment?

Five hundred pairs of dental panoramic tomographs (DPT) and maxillary anterior occlusal radiographs (AO) from patients referred to the orthodontic department of a dental teaching hospital were examined to assess the diagnostic yield from a panoramic radiograph of the premaxillary region alone and then assess the additional yield when this view was supplemented by a maxillary anterior occlusal radiograph. Of the 500 DPTs assessed, 208 (42%) lacked clarity of the premaxillary region when the labial segments were used to locate the patient in the DPT machine. An association was found between patients who had abnormal incisor relationships and poor clarity in the premaxillary region of the DPT. Overall 165 (33%) of the supplementary AO views were used to support or refute findings identified on the DPT. It was concluded that in patients referred for an orthodontic assessment, supplementary radiography of the premaxilla may be justified in the following situations: 1. unsatisfactory image quality which may frequently be the case where there are abnormal incisor relationships, 2. localisation of tooth position by vertical parallax and 3. where a reasonable expectation that pathology exists on clinical grounds.

Humans↗

Periodontal attachment responses to surgical injury in the cat. Removal of buccal bone with and without placement of foreign body at ligament periphery.

Recently, PDL progenitor cells were claimed essential for the establishment of new connective tissue attachment to root surface. To further test new periodontal attachment after surgical injury, portions of the buccal alveolar plate were removed from the canines of 4 cats. Removal of bone was carried out with or without removal of the underlying PDL, and in half of the experimental sites, dental amalgam was placed at ligament periphery. Tissue blocks were prepared for routine histologic evaluation (H & E) and specific collagen stains (Mallory Trichrome and Mallory PATH). Exfoliation of amalgam was noted in 6 experimental sites during the healing period. At all sites, plaque accumulation and marginal gingivitis were observed before sacrifice. Histologic observation demonstrated limited new connective tissue attachment to root surfaces at PDL periphery where bone, PDL and cementum had been removed. Where PDL was retained, connective tissue attachment was present which appeared to be the result of fiber interdigitation between root-inserted fiber ends and gingival wound edge fibers. "Blockage" of PDL cell migration by amalgam could not be well controlled. However, the placement of amalgam seems to have interfered with new connective tissue attachment and/or cementogenesis. In 5 specimens, root resorption had progressed into dentin. At these sites, collagen tufts appeared to arise from dentin. These tufts were in intimate contact with zones of dense inflammatory cellular infiltrate and connective tissue elements. We suggest that this observation may be a further tissue response to injury, namely: root resorption with the unmasking of dentinal collagen, which may finally lead to fiber interdigitation.

Alveolar Process↗

Tissue changes in immature dog teeth autotransplanted to surgically prepared sockets.

Tissue reactions in teeth autotransplanted to surgically prepared sockets were investigated by means of microangiographic, enzyme histochemical, and histologic methods. The experimental material consisted of 28 immature teeth in six mongrel dogs. In each tooth, approximately three fourths of the root was formed at the time of transplantation. Ten days after transplantation, a vascularized, well-stained connective tissue was observed in the apical area of the pulp. An ingrowing tissue had reached the pulp horn in all teeth 90 days after surgery. Odontoblasts were not found in any of the transplanted teeth. External root resorption was seen in all teeth but repair usually occurred approximately parallel to the ingrowth of new tissue into the pulp cavity. In a few teeth, however, advanced inflammatory root resorption was observed in cracks in the cervical area. When compared with the results of a previous study, the ingrowth of tissue occurred at a considerably slower rate than in teeth autotransplanted to natural sockets.

Animals↗

Concrescence of teeth: cemental union between the crown of an impacted tooth and the roots of an erupted tooth.

Concrescence of teeth is a condition showing a union of adjacent teeth by only cementum. In all the previously reported cases, the union has been observed between the roots of the affected teeth. Here, we describe the first case that showed a concrescence of the crown of an impacted tooth and the roots of the erupted tooth. In addition, we discuss how this condition, especially the deposition of acellular cementum on the crown, occurred.

Female↗