[Classification and treatment of a tooth root entering the maxillary sinus during tooth extraction].
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Foreign Bodies↗
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The not-so-harmless maxillary primary first molar extraction.
BACKGROUND: Premature loss of primary molars has been associated with space loss and eruptive difficulties, especially when the loss occurs to the primary second molars and when it occurs early. This has not been thought to be the case for primary first molars. METHODS: The author revisited 13 cases from an earlier study on the effects of premature loss of maxillary primary molars. These longitudinal cases were scrutinized, using serial panoramic radiographs, to explain the irregular response in terms of dental migration. The author presents two case reports. RESULTS: In the earlier study, the author used digitized study casts and the concept of D + E space--the space occupied by the primary first and second molars--to describe the dental migration that occurred after premature tooth loss. Using analysis of variance on data generated using an instrument capable of measuring in tenths of millimeters, the author produced findings regarding the amount of space loss, rate of space loss, effect of age at loss, amount of space regained at the time of replacement by the permanent tooth and effect on Angle's classification. Finally, the author created a simulation describing directional change; this revealed that the maxillary primary first molar loss resulted in a mesial displacement of the permanent canine during eruption. CONCLUSIONS: When the maxillary primary first molar is lost prematurely, the first premolar erupts in a more mesial direction than normal, as a result of the mesial incline of the primary second molar, and consumes the space of the permanent canine, which becomes blocked out. CLINICAL IMPLICATIONS: Rather than use a space maintainer after the premature loss of the maxillary primary first molar, the author suggests, clinicians can choose from a number of other options for preventing the first premolar from erupting too far in a mesial direction.
Adolescent↗
Periodontal manifestations of the heritable Mac-1, LFA-1, deficiency syndrome. Clinical, histopathologic and molecular characteristics.
The clinical, histopathologic and functional consequences of the genetic deficiency of leukocyte Mac-1, LFA-1 and p150,95 were assessed among three affected patients, heterozygotes and unaffected individuals among two generations of a single kindred. Longitudinal assessments of this family afforded the unique opportunity to characterize the natural history of severe periodontal manifestations associated with this disorder. Features uniformly observed among each patient included recurrent, necrotic soft tissue infections, impaired pus formation, delayed wound healing, constant granulocytosis, severe abnormalities of adhesion-dependent granulocyte functions and a profound deficiency (3%-6% of normal) of Mac-1 glycoproteins on granulocyte surfaces. Characteristic features of generalized prepubertal periodontitis including rapidly progressive alveolar bone loss affecting the primary and permanent dentitions (leading to premature tooth loss), recession, clefting and migration in association with intense gingival inflammation were uniformly observed. Biopsies of inflamed periodontal tissues in these individuals demonstrated dense infiltrates of mononuclear leukocytes but a striking absence of extravascular neutrophil granulocytes. Heterozygous family members demonstrated approximately half normal Mac-1 protein expression but no susceptibility to systemic infections and normal, adhesion-dependent leukocyte functions. Prepubescent heterozygotes demonstrated no periodontal manifestations but a 31-year-old heterozygous female exhibited clinical and radiographic features typical of postjuvenile periodontitis. The profound periodontal manifestations recognized in this clinical-pathologic model emphasize the physiologic importance of leukocyte adhesion reactions in defense of the periodontium and further suggest a possible pathologic role for Mac-1 proteins in other forms of early-onset periodontitis.
Adult↗
Mineral-related proteins of sea urchin teeth: Lytechinus variegatus.
Sea urchins have a set of five continuously growing teeth, each of which has a very complex structure. The mineral phase is calcite of varying Mg content, depending on the location within a tooth. The calcium carbonate is present in amorphous, plate-like and rod-like forms. It has been hypothesized that the mineral deposition is a matrix-mediated process, similar to that in vertebrate bone and tooth, wherein certain macromolecules within the organic matrix of the mineralized tissue play an important role in nucleating and controlling the growth habit of the mineral crystals. It has also been hypothesized that the mineral-related macromolecules involved in urchin teeth might bear a direct evolutionary relationship to those of the vertebrate tooth. These hypotheses are explored here by examining the pattern and nature of the mineral distribution, using microCT of intact teeth, and the nature of the mineral-related matrix proteins. The mineral-related proteins were extracted and fractionated by anion exchange chromatography. The relationship of certain fractions to vertebrate matrix proteins was established by immunoblots using antibodies to vertebrate tooth proteins. The antibodies were then used to localize the proteins within the teeth, by immunocytochemistry and histology with specific staining. The microCT data on mineral density has been correlated with the patterns of cellular migration and mineral deposition within the tooth as it grows. It appears that the mineralization within the different tooth compartments might take place under the influence of different matrix proteins. Further studies are in progress to more completely describe the vertebrate-invertebrate immunologically cross-reactive proteins of the urchin teeth.
Animals↗
[Role of tooth extractions in orthodontics].
Extraction therapy can be applied only under strict observation of indications. It requires thorough knowledge of the laws governing the migration of teeth after extraction, the normal development of the orofacial system and normal eruption of teeth. Careless extractions performed without thorough prior analysis cause irreparable harm instead of improving the situation. In the majority of cases extraction must be followed by appliance therapy to achieve controlled closure of the spaces, align the teeth in the dental arch and restore proper occlusion. The mode and extent of this treatment must be planned at the outset.
Humans↗
Three-dimensional presentation of cell migration in the periodontal ligament of the rat incisor.
The progenitor compartments and cell migration were examined in the tooth-related periodontal ligament (t-PDL) of rat incisors. A pulse injection of 3H-Tdr was administered to 15 rats (200 gm each) and the animals were killed in groups of five, at 1 hr and at 1 and 2 weeks after injection. Three-dimensional analysis of cell counts and labeling index demonstrated the existence of two progenitor compartments (PC). The apical PC (responsible for 70% of synthesizing cells) was concentrated in the apical 5 mm of the t-PDL. The paracemental PC (30% of synthesizing cells) was located along and around the cementum, occupying 24 micron of the t-PDL. The cells from the apical PC migrated incisally at a rate of 6 mm/week, which is a rate similar to that of tooth eruption. The cells from the paracemental PC moved in a transverse direction toward either bone or cementum at the much slower rate of 16 micron/week.
Animals↗
Gingival reactions after experimentally induced extrusion of the upper incisors in monkeys.
To evaluate the gingival movement with orthodontic tooth extrusion, the four upper incisors of monkeys were vertically extruded. The teeth were extruded (maximum 10.9 mm, minimum 2.6 mm) in five experimental subjects with three controls. The following parameters were measured before and after the experiments: (1) the movement of the free gingiva; (2) the movement of the mucogingival junction; (3) the clinical sulcus depth; and (4) the clinical crown height. The reaction of the gingival tissues attached to the extruded teeth was also examined histologically. The results were as follows: (1) The gingiva moved in the same direction in which the teeth were extruded. The free gingiva moved about 90% and the attached gingiva moved about 80% as far as the teeth were extruded. (2) The width of the attached gingiva on the labial surface increased as the teeth were extruded. (3) The sulcus depth decreased about 20% of the distance that the teeth were extruded; the clinical crown height was increased about 20%. (4) The mucogingival junction before the experiment was positioned the same after the experiment. (5) The epithelial attachment originated at the cementoenamel junction of the experimental teeth after the tooth extrusion. There was no gingival migration, gingival pocket formation, or inflammation on the labial surface. No clinical nor histologic problems were encountered in the gingival tissues if the teeth were extruded properly.
Animals↗
Occult tooth fragments spontaneously extruded after six months.
Fracture of one or more teeth is a frequent complication of trauma to the oral cavity. Broken teeth that are not accounted for are often presumed to be swallowed or lost. We report a case of fracture of incisors that were not located on physical examination following the trauma but were discovered six months later as hard, perforating papulonodules on the lower lip.
Adult↗
Identification of inner and outer cell proliferation centers during fetal tooth morphogenesis.
Patterns of cell division have been examined in the proliferative cervical loop tissues of fetal rabbit incisor tooth organs. Evaluation of the distribution patterns of silver grains, resulting from the incorporation of [3H]-thymidine into newly synthesized DNA within tooth organs in vitro, resulted in identification of two proliferation centers: (1) an inner center consisting of inner enamel epithelial cells (i.e., preameloblasts) and predontoblasts ; and (2) an outer center consisting of outer enamel epithelium and adjacent mesenchyme. In contrast to the classically held description of epithelial cell differentiation during tooth morphogenesis, our data suggest that outer enamel epithelial cells do not migrate around the cervical loop and do not provide progenitor cells for subsequent ameloblast cytodifferentiation. During tooth development, epithelial and mesenchymal cells, which arise from either an inner or outer proliferative center, migrate in distal directions relative to the proliferative sites. Therefore, the progenitor cells for ameloblasts and odontoblasts were found to be localized in the inner proliferation zone. The implications of these findings regarding the development of continuously erupting rabbit and rodent incisor tooth organs are discussed in the context of a model.
Animals↗
Ultrastructural localization of laminin-5 (gamma2 chain) in the rat peri-implant oral mucosa around a titanium-dental implant by immuno-electron microscopy.
Laminin-5 (Ln-5) is an important molecule associated with epithelial cell adhesion and migration. In the gingiva around the tooth, Ln-5 localizes within basement membranes between the junctional epithelium (JE) and the tooth or connective tissue. Recently, we reported that in the oral mucosa around a dental implant, Ln-5 is expressed within the basement membranes at the implant-peri-implant epithelium (PIE) interface, and at the PIE-connective tissue interface. However, the ultrastructural localization of Ln-5 within or along the PIE has not yet been reported. Therefore, peri-implant oral mucosa was treated with anti-Ln-5 (gamma2 chain) antibody and examined using immuno-electron microscopy. Ln-5 was localized in the cells of the innermost-third layer and basal layer of the PIE. A 100-nm-wide Ln-5-positive internal basal lamina (basement membrane) and hemidesmosomes as adhesion structures were formed at the apical portion of the implant-PIE interface. However, at the upper-middle portion of the interface, these adhesion structures were not observed. Furthermore, at the PIE-connective tissue interface, the Ln-5-positive external basal lamina (basement membrane) and hemidesmosomes were partially deficient. Judging from these findings, we concluded that Ln-5 contributes to the attachment of the PIE to the titanium surface, and that PIE attached to titanium at the apical portion of the dental implant-PIE interface.
Animals↗
[An unusual case: the "traveling root"].
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Adult↗
Dentofacial growth and development in Homo sapiens: evidence from perinatal individuals from Punic Carthage.
Study of perinatal individuals from 7-4th c. B.C. Punic Carthage and specimens from more recent sources elucidates: 1. variability in the formation of the infraorbital foramen; 2. the nature of, and variability in, the expression of the incisive suture. With regard to the latter, and in conjunction with data on the embryological formation of the upper jaw and dentition, the following generalization appears warranted in Homo sapiens. The incisors and canine may come to erupt in the alveolar bone associated with the premaxillary region. Combination of these data with those on the timing of tooth germ development and their forward migration yields an explanation of the dental anomalies associated with anterior facial cleft and a prediction of when this disorder occurs.
Adult↗
"9-year-molars" aberrantly developing and erupting: report of cases.
This paper describes delayed development and eruption of the first permanent molars, in most cases only in the upper jaw. The development and eruption of the teeth are chronologically between that of the first and second molars. The anatomy of the aberrant teeth is closest to that of the second molars. The aberrant teeth are often laying at a distance during development from the second primary molars. The clinical implications of the aberrancy are few, because the teeth will normally migrate into close contact with the tooth mesial to them, however, often into a crossbite. Most often the teeth are mistaken to be a first molar with some eruption disturbance and therefore referred for surgical or orthodontic treatment. However, such interception should be avoided because at least in the present cases all teeth are observed to erupt by themselves.
Anodontia↗
Expression of MT1-MMP during deciduous tooth resorption in odontoclasts.
Membrane type 1-matrix metalloproteinase (MT1-MMP) is a membrane-bound matrix metalloproteinase capable of mediating pericellular proteolysis of extracellular matrix components. In osteoclasts, the localization of MT1-MMP has been reported at the tips of specialized membrane protrusions (podosomes and lamellipodia) so that osteoclasts might use MT1-MMP to perform focal proteolysis and move through the extracellular matrix to the bone surface. The objectives of this study were to investigate an association of MT1-MMP in physiological root resorption of the deciduous tooth by reverse transcriptase-polymerase chain reaction (RT-PCR) and Northern blot analysis, and to identify MT1-MMP-producing cell during deciduous tooth resorption by in situ hybridization and immunohistochemistry. RT-PCR and Northern blot analysis revealed the exclusively high expression of MT1-MMP mRNA in bovine root-resorbing tissue, which lies between the root of the deciduous tooth and its permanent successor. Expression of MT1-MMP mRNA was seen in odontoclasts aligning in the surface layer of the root-resorbing tissue at sites of root resorption. Furthermore, immmunohistochemistry also confirmed the localization of MT1-MMP protein to the odontoclasts. The present identification of MT1-MMP in odontoclasts during deciduous tooth resorption might be relevant to the migration activity that these cells have to gain access to the root surface.
Animals↗
Tooth germ transposition: report of cases.
Six patients with transposed tooth germ before root formation are reported in cases with cleft lip or palate. A boy with complete bilateral cleft lip and palate had a maxillary permanent canine displaced posteriorly in the vomer. A girl with cleft palate had an upwards and distally transmigrated maxillary canine. Two girls with cleft palate had a transposed maxillary canine with the first premolar. One patient had a maxillary second premolar migrated between the first and second permanent molar, and another had the germ of a supernumerary maxillary premolar between the first and second permanent molars. The follow-up findings concerning the development of the teeth and treatment are described; they are also discussed in the light of present theories on the etiology of tooth transposition.
Adolescent↗
Migration of a dental implant into the maxillary sinus. A case report.
This article reports a rare case of a displaced dental implant that migrated into the maxillary sinus.
Dental Implantation, Endosseous↗
Connective tissue growth factor expressed in rat alveolar bone regeneration sites after tooth extraction.
OBJECTIVE: To understand bone regeneration process after tooth extraction could be a clue to develop a new strategy for alveolar bone reconstruction. Recently, accumulated evidences support that connective tissue growth factor (CTGF) is implicated in tissue repair of many tissues. In this study, we investigated the spatial and temporal expression of CTGF in the rat tooth extraction sockets. DESIGN: Five weeks old wild type male rats (weighing 120 g) were used for this experiment. Expression of CTGF was determined by immunohistochemistry and in situ hybridization in the rat upper molar tooth extraction sockets at 2, 4, 7, 10 and 14 days after tooth extraction. RESULTS: CTGF was expressed strongly in the endothelial cells migrating into the granulation tissue at the bottom of the sockets during 4 days after tooth extraction. During the reparative process, no apparent chondrocyte-like cell appeared in the sockets, while osteoblast-like cells proliferated in the sockets with low CTGF expression at 7, 10, 14 days after extraction. As expected, no staining was observed with the preimmune rabbit IgG and CTGF sense probe. CTGF may play an important role in angiogenesis and granulation tissue formation specifically at early healing stage after tooth extraction to initiate alveolar bone repair. CONCLUSION: CTGF was expressed at early healing stage of the rat tooth extraction wound.
Animals↗
Oral disease, impairment, and illness: congruence between clinical and questionnaire findings.
In 1992 a questionnaire was sent to 50-year-olds in two Swedish counties. These self-report data were compared with clinical observations with regard to number of teeth, removable dentures, caries, and periodontitis. Complete information from both data sources was obtained for 1041 persons. The relevant questionnaire item explained 71% of the missing tooth variance. An agreement of 0.91 (Cohen's kappa) was obtained for removable dentures. A question about problems in opening the mouth differentiated clearly with regard to measured mouth opening ability. Toothache and tooth sensitivity were reported with 95% probability when having 22 decayed teeth and with 46% when there were no decayed teeth (58% correctly predicted). Two teeth with pockets > or = 6 mm gave 5% probability and 22 such teeth gave 39% probability of reporting migration of front teeth. The main conclusion from this study is that there is good correspondence between subjective self-reports and clinical findings, especially for those conditions that are relatively easy for the patient to observe, such as the number of teeth and the presence of dentures. Thus questionnaire data can be used for information and screening about some well-defined oral conditions.
Dental Caries↗