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The relationship between restoration and furcation involvement on molar teeth.

The purpose of this cross-sectional study was to examine the correlation between the presence of a crown (CR) or a proximal restoration (RE) and furcation involvement (FI) on molar teeth. Data were collected from 134 periodontal maintenance patients who had restored and non-restored molars present both with and without FI. A majority of the restorations that were present in these patients had been in place for at least 5 years prior to the study. First and second molars were examined clinically using the following criteria: CR, RE, FI, mobility (MO), and probing periodontal attachment level (AL). Data were analyzed with a statistical program utilizing Pearson chi-square and the pair-difference t test. The results indicated that molars with CR or RE had a significantly (P < 0.01) higher percentage of FI but no greater mobility when compared to molars without restorations. Mean probing periodontal attachment loss was greater for restored than non-restored molars but only with marginal significance (P = 0.051). There was a greater difference in mean AL between restored versus non-restored maxillary molars than for mandibular molars. This cross-sectional study provides evidence that molars with crowns or restorations involving the proximal tooth surfaces had a higher prevalence of FI and greater AL than molars without restorations.

Chi-Square Distribution↗

Crown-to-root ratio: its significance in restorative dentistry.

The definition of the crown-to-root ratio, its manifestation as a clinical problem, and associated problems were reviewed. Treatment possibilities were discussed in terms of plaque control, periodontal surgery, occlusal adjustment by selective grinding, splinting, restorative considerations, and extraction. The original guidelines for crown-to-root ratio in the selection of abutments were found to be exceptionally conservative and treatment limiting. New treatment modalities were considered in light of increased understanding of periodontal inflammation and its control. With inflammation controlled and with a carefully designed occlusion, some degree of mobility may be tolerated, thereby permitting the retention of teeth with minimal alveolar support.

Alveolar Process↗

Orthodontic, genetic, and periodontal considerations in the treatment of impacted maxillary central incisors: A study of twins.

Treatment of twins each with one impacted maxillary central incisor and a mesiodens is described. Treatment included rapid expansion, extraction of the mesiodens, surgical exposure of the impacted central incisor, and its forced eruption. The impacted incisor was brought into functional position in one patient but was lost in the other because of insufficient root length and high mobility. Orthodontic, genetic, and periodontal considerations of these 2 cases are evaluated.

Adolescent↗

Accidental orthodontic elastic band-induced periodontitis: orthodontic and laser treatment.

The periodontal effects of elastic bands in the subgingiva have been reported since 1870. Case reports illustrate the treatment of elasticband-induced periodontitis in two children with a combination of laser treatment, antibiotics, splinting and orthodontics. Follow-up evaluations show reattachment, maturation of the apical portion of the roots, improved radiographic bone levels and minimal sulcus depth, mobility and recession. Continued orthodontic and periodontic care is planned.

Accidents↗

Facial approach to stabilization of mobile maxillary anterior teeth with steep vertical overlap and occlusal trauma.

The necessity for splinting and the advantages of some types of permanent, semipermanent, and temporary splinting are given. Specific step-by-step instructions are given for a special purpose splint that can be used for stabilizing mobile maxillary teeth when the patient has thin teeth faciolingually and a steep vertical overlap. This can be the treatment of choice for such patients.

Acid Etching, Dental↗

The prosthodontic concept of crown-to-root ratio: a review of the literature.

Crown-to-root ratio is intended to serve as an aid in predicting the prognosis of teeth. However, controversy persists as to its impact on diagnosis and treatment planning. This article critically reviews the available literature on the crown-to-root ratio assessment and criteria for evaluation of abutment use of periodontally compromised teeth. A Medline search was completed for the time period from 1966 to 2003, along with a manual search, to locate relevant peer-reviewed articles and textbooks published in English. Key words used were "crown-to-root ratio," "periodontal compromised dentition," "mobility," and "biomechanics." There was a dearth of evidence-based research on the topic. Although the use of the crown-to-root ratio in addition to other clinical indices may offer the best clinical predictors, no definitive recommendations could be ascertained.

Alveolar Bone Loss↗

Measuring mobility of 2 dental implant fixtures of different configurations: an in vitro study.

OBJECTIVES: To our knowledge, it has not as yet been determined if mini-dental implants can be used as a long-term treatment method compared to endosseous standard root-form dental implant fixtures. This in vitro study investigates the stability of 2 different implants, 1 mini-dental implant and 1 endosseous standard root form dental implant, under lateral forces. METHODS: There were 2 different screw-type dental implants with the O-ring/ball attachment prosthetic heads used. A mini-dental implant (Sendax MDI MAX; IMTEC, Corp., Ardmore, OK) 13 mm in length and 2.2 mm in diameter, and root form implant (Brånemark; Nobel Biocare AB, Goteborg, Sweden) 13 mm in length and 4 mm in diameter. These implants were then embedded into a matrix mixture of pumice, two-fifths BaSO4 powder and one-fifth plaster. Parallel periapical radiographs were taken pretest and after lateral forces were applied. The implants were vibrated using electric toothbrushes. They were attached to O-rings on the implants. Periapical radiographs were secured periodically every 5 minutes. The first discrepancy was observed at the 35th minute. Mobility and discrepancy values were recorded at the instances of 35th, 60th, 90th, and 120th minutes. Stability was measured and recorded using a manual stress and tension gauge. Radiographic discrepancy values were measured using a stereomicroscope. RESULTS: The Brånemark implant showed less mobility and discrepancy values than the mini-dental implant. The discrepancies were observed mostly at the cervical region of the 2 implants. CONCLUSIONS: According to the experimental results of this study, the Brånemark implant was more stable than the mini-dental implant at the end of 2 minutes.

Dental Implants↗

The uses of endodontic implant stabilizers in posttraumatic and periodontal disease.

Use of the endodontic implant stabilizer presents a sound physiologic procedure for stabilizing mobile teeth. It can increase root length, alter rootcrown ratios, immobilize fractured roots and periodontally compromised teeth, or supply combinations of these benefits. Case selection, operative technique, and case reports with follow-up are presented in order to demonstrate uses and versatility.

Cellulitis↗

Oral functional limitation among dentate adults.

OBJECTIVES: The purpose of this study was to measure the prevalence of oral functional limitation in adults and to identify clinical and sociodemographic factors associated with that limitation. METHODS: The Florida Dental Care Study is a longitudinal study of risk factors for changes in oral health. Subjects (n = 873) with at least one tooth who were 45 years old or older participated in a baseline in-person interview and dental examination. Subjects were queried about oral functional limitations. RESULTS: Twenty-three percent of subjects reported difficulty chewing one or more foods using a five-item chewing index, and 10 percent reported difficulty speaking or pronouncing words because of problems with the mouth. The covariates in a multiple logistic regression identified as being significantly associated with chewing difficulty were fewer pairs of occluding anterior teeth, fewer pairs of occluding posterior teeth, more posterior teeth that are root tips, more anterior teeth that are mobile, reporting tooth pain, reporting bad breath, having but not wearing prosthetic appliances, reporting dry mouth, and being female. Having fewer anterior teeth, reporting a sore and/or broken denture, reporting unattractive teeth, and being black were significantly associated with speaking difficulty/difficulty pronouncing words because of problems with the teeth, mouth, or dentures. CONCLUSIONS: The findings in this study suggest a significant prevalence of oral functional limitation in dentate adults. Certain clinical and sociodemographic factors were strongly and independently associated with its presence.

Aged↗

Effect of different splinting methods and fixation periods on root development of autotransplanted immature third molars.

PURPOSE: The aim of the present study was to assess the influence of suture splinting for 1 week or rigid fixation for 4 weeks on final root length, root length increment, and mobility of autotransplanted immature third molars. PATIENTS AND METHODS: The sample consisted of 63 patients with a total of 65 transplanted immature third molars. All transplants had reached one-half (n = 29) to three-fourths (n = 36) of their expected root length. In 24 of the transplants, postoperative fixation was carried out with a rigid acid-etch composite and wire splint for 4 weeks (rigid group), and in 41 transplants, with a suture splint for 1 week (suture group). The fixation method depended on the initial stability of the transplants. All transplants were followed up clinically and radiologically for a mean period of 3.9 years. RESULTS: Transplants in the rigid group revealed a significantly lower final root length ( P = .002) and root length increment ( P = .001) than those in the suture group. The differences were found to be more pronounced in transplants at earlier developmental stages. No differences were found in transplant mobility. CONCLUSIONS: The results of the present study indicate that prolonged rigid fixation of autotransplanted immature third molars has a significantly negative influence on final root length and root length increment, especially in transplants at earlier developmental stages.

Adolescent↗

Federal University of Santa Catarina follow-up management routine for traumatized primary teeth -- part 1.

The objective of this study was to verify if the follow-up management routine of traumatized primary teeth set up by Federal University of Santa Catarina, which performs clinical and radiographic assessments (15 and 45 days; 4, 8 and 12 months) after the oral trauma, enabled an early diagnosis of sequelae which would indicate the need for endodontic intervention, as well as the influence a type of trauma and the child's age could have in the severity of the sequelae. In this study 52 sets of records were used of patients being seen in the last 6 months, with a total of 70 teeth that were receiving follow-up treatment. Patients returned for regular visits set up by the management routine, where clinical and radiographic examinations were performed to check for sequelae, which justified endodontic intervention. Mobility (51.2%) and crown discoloration (25.6%) were the most common sequelae found in the patient's first appointment. In the follow-up visits, replacement root resorption (22.5%) was the second most common sequela found, suggesting endodontic intervention. No significant association was found between severe sequelae, types of trauma and a child's age (chi(2) = 0.3, P = 0.8613). During the intervals of the follow-up visits, it was noticed that between 46 days and 8 months a higher number of sequelae were diagnosed (P < 0.05). The diagnosis of sequelae such inflammatory and replacement root resorption, which can lead to an early loss of a primary tooth, are frequent and that the interval between the follow-up visits has to be changed, suggesting the setting up of management routine 2. The study also concluded that the type of trauma and the child's age are not fundamental factors in the diagnosis of severe sequelae.

Child, Preschool↗

Long-term prognosis of 66 permanent anterior teeth with root fracture.

A longitudinal clinical and radiographic follow-up study was made of all permanent teeth with root fractures referred to the Oslo University Department of Pedodontics between 1953 and 1972 (n = 66). The material included 51 patients aged 6-21 years. The mean observation period was 5.2 years, ranging from 1 to 19 years. The present report documents background data and the long-term results. Two teeth with exarticulation of the coronal fragments (3%) were immediately extracted. Repair of the fracture area occurred in 51 teeth (77%). Pulp necrosis was found in 13 teeth (20%), nine of which were successfully treated endodontically; only four teeth had to be extracted. Several factors were found to influence the prognosis, most notably the degree of dislocation of the coronal fragment. The localization of the fracture influenced repair only slightly. Despite somewhat increased mobility in some cases, the longevity of teeth with fractures even in the coronal third of the root was not significantly shortened. It is concluded that when optimally treated by repositioning, fixation and relief of occlusion, anterior teeth with root fracture have a favorable prognosis. Even when pulp necrosis occurs, the long-term prognosis is good.

Adolescent↗

Posttreatment assessment of surgically exposed and orthodontically aligned impacted maxillary canines.

The records of 96 consecutively treated patients, with a total of 110 exposed maxillary canines, were reviewed after orthodontic alignment of the exposed teeth. In view of the high degree of clinical and patient satisfaction with the results, a random sample of 25 patients, with a total of 30 exposed canines, were critically assessed. The assessment involved scoring for clinical impression, mobility, gingival condition and pocketing, oral hygiene, vitality, and radiographic appearances. The results indicate that the technique of surgical exposure and orthodontic alignment of ectopic maxillary canines provides a satisfactory method of treatment.

Adolescent↗

Bruxism and its effect on the natural teeth.

Bruxism is one of the most prevalent, complex, and destructive dental functional disorders. It is difficult to identify, especially in its early stages, because most patients are unaware of the habit. Although many factors contribute to the etiology of the disorder, there is little valid and reliable clinical research to assure a correct diagnosis. The effects of bruxism are multiple and diverse and include temporomandibular joint pain and dysfunction, head and neck pain, tooth wear, mobility, erosion, abrasion, loss of and damage to supporting structures, muscle pain and spasm, disturbance of esthetics, and interference and oral comfort. Treatment may be simple or complex, depending on the nature of the disorder. More severe disorders are difficult to treat, and the prognosis may be questionable. Because the diagnosis and treatment of bruxism is inadequately defined and poorly understood, carefully designed clinical research projects are encouraged.

Bruxism↗

An endodontic-orthodontic technique for esthetic stabilization of externally resorbed teeth.

Previous studies reveal that external root resorption is often coincident with orthodontic therapy. Some investigators have reported that root resorption ceases when orthodontic therapy is terminated. However, this is not always the case. The purpose of this article is to present an 11-year history of an unusual case in which root-resorptive processes continued for 3 years after orthodontic treatment had been discontinued. The article also describes and discusses a combined endodontic-orthodontic approach to halt external root resorption and stabilize mobile maxillary anterior teeth. Calcium hydroxide therapy was instituted to inhibit inflammatory apical root resorption. A rectangular orthodontic wire was adapted and inserted intracoronally to splint the teeth esthetically. The advantages and disadvantages of this intracoronal splinting technique are compared with other extracoronal splinting methods. Examination of one-year recall radiographs suggested inhibition of the root resorption. Masticatory function was restored for the patient. Considerations for monitoring patients with this problem are discussed.

Adult↗

Subluxation injuries of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth.

This study investigated the epidemiology, sequelae, and prognosis of subluxation injuries to the maxillary primary anterior dentition. Data were collected from dental records at the Montreal Children's Hospital, Montreal, Canada, of patients sustaining trauma between 1982 and 1993. The study group consisted of 207 teeth in 134 patients, 81 males and 53 females. The age of the patients ranged from 0.8 years to 7.5 years, with a mean of 3.5 years. The highest incidence of trauma was in males between the ages of 3 and 4 years, and in females between 1 and 3 years. The highest incidence of trauma (66.2%) involved the primary central incisors. The most common cause of trauma (52%) was simple falls indoors. Occlusal or periapical radiographs were the radiographic view of choice unless an anterior nasal spine fracture was suspected, in which case a lateral projection was exposed. Approximately 64% of the study teeth had a mobility ranging from 0.6 to 1.5 mm. Treatment varied from no treatment (80% of teeth) to extraction. Post-traumatic evaluations were distributed into six common time intervals used by dentists for follow up. The results indicated that patient discomfort and occlusal interference were not common. Discoloration and pulpal calcification increased with time. Mobility decreased with time, with the majority of teeth returning to a normal physiologic range. External resorption may have been present, but was rare. Treatment or antibiotics were rarely needed at follow-up visits. Overall, these teeth responded positively, and there was a low morbidity associated with subluxation injuries.

Accidental Falls↗