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A five-year-old spayed/female Border Collie was presented with a crown-root fracture of the maxillary left fourth premolar. Surgical endodontic, and restorative techniques were performed to maintain the tooth. Re-examination 18-months following therapy indicated a successful outcome with no radiographic signs of periapical pathology.
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Many factors influence whether teeth planned for crowns or fixed prosthesis abutments need to be built up. Teeth may now be treated more conservatively with minimal fillers because of the greater strength of current cements, including hybrid ionomers and resins. Teeth planned as fixed prosthesis abutments require more remaining tooth structure and greater buildup strength than those designed for single full crowns. It appears that crown buildup is still necessary, but this procedure is needed less frequently than it was in previous years. Fillers can be used to fill holes left when previous restorations were removed, and are more commonly placed than build-ups.
Various epidemiological investigations have shown the high prevalence and incidence of caries in geriatric populations. The aim of the present study was to evaluate the dental status and some salivary parameters of elderly French subjects institutionalised in a geriatric hospital. The study population included 117 subjects (31 males and 86 females) who were neither demented nor edentulous, with a mean age of 83.0 years (SD = 7.8). Crown and root caries were recorded according to a modified caries activity index on 17,442 surfaces (9 surfaces per tooth: 5 crown surfaces and 4 root surfaces). The 17,442 surfaces examined corresponded to 1,938 teeth. The mean number of teeth per subject was 16.6 (SD = 7.6), more teeth remaining in the mandible than in the maxilla. The 2,985 unsound root surfaces showed a high percentage of active lesions (31.2 per cent) and a low percentage of filled root surfaces (4.5 per cent). Crowns and roots also presented a high percentage of destroyed surfaces: 1,446 destroyed surfaces, 8.3 per cent of the examined surfaces. Salivary parameters (flow rate and buffer capacity) were also recorded. Stimulated salivary flow rate had a relationship with crown caries (linear regression and analysis of covariance), and buffer capacity with root caries (analysis of variance and covariance). The data illustrate critical treatment needs in French geriatric institutions. This situation, which appears to differ from previous reports in European and US elderly people, may be related to French specificities concerning oral health status and/or care policy, but also to the usually very old population.
An epidemiological study of traumatic intrusion of permanent teeth was performed on 216 teeth in 151 patients treated over a 50-year period at a major trauma center in Denmark (Copenhagen). This analysis showed that intrusion of permanent teeth was of rare injury only affecting 1.9% of traumatic injuries involving permanent teeth. The main etiologic factor appeared to be falling which resulted in axial impacts on maxillary or mandibular teeth. The most common injury patterns were intrusion without additional injuries (33.5%) and intrusion with crown fractures (60.5%). A few cases were combinations of intrusion and either crown/root-fractures or root fractures (6%). Most often one tooth was intruded (46.3%), followed by two teeth (32.4% ) and three or more teeth (21.3%). The majority of intruded teeth were displaced 2-8 mm. The age group of 6-12 years of age was most frequently involved and boys appeared to experience intrusion injuries more frequently than girls, and at an earlier age. Maxillary central and lateral incisors are the primary victims of intrusions and this seems to be identical to other trauma types and is possibly related to the known exposure to impacts of maxillary incisors. The reliability of clinical findings, such as lack of mobility (81.8%), metallic percussion tone (72.5%), and no pain to percussion (66%) was reasonably high, whereas a radiographic feature such as the obliteration of the periodontal ligament space appeared to be only a partly reliable diagnostic tool (52%).
OBJECTIVE: This study evaluated the effect of preparation utilization and design, and addition of resin composite to the bonding interface, on the fracture resistance of reattached incisal fragments. METHOD AND MATERIALS: Sixty bovine incisors were distributed among 1 control group and 5 experimental groups. Experimental specimens were sectioned 3.0 mm from the incisal edge with a 0.15-mm wafering blade at a 25-degree inclination apically in a faciolingual direction. Two groups received no further preparation. Specimens in the other 3 groups received either external bevels, internal bevels, or combined external and internal bevels. One preparationless group was reattached with dentin bonding agent alone. All other fragments were reattached with a dentin bonding agent-resin composite interface. After thermocycling and 4 weeks of bond weathering, specimens were sheared to failure in a universal testing machine. RESULTS: No significant differences in fracture strength were observed among any of the experimental groups, yet each displayed significantly less resistance to fracture than the control group. Reattachment of fragments in all groups restored approximately one half or one third the fracture strength of the control teeth for crown or root fractures, respectively. CONCLUSION: Compared to the simple, expedient regimen of using a dentin bonding agent alone, nonconservative tooth modification and the addition of resin composite to the bonding interface did not increase resistance to fracture and thus provided no retentive advantage.
The visibility of anterior teeth was studied in a population of 425 subjects. Scoring photographic data gave the percentages of anterior teeth that would not show a crown margin if it were placed in incisal, middle, or gingival sections. The results of this study indicate: their anterior teeth which would not show unless the lips were retracted.
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Falls and collisions are the most commonly reported causes of dental injuries. These accidents involve principally the maxillary central incisors, causing uncomplicated crown fracture. Many materials and techniques can be used to restore injured anterior teeth. Adhesive dentistry allows reproduction of the original beauty of the teeth and preservation of almost all dental tissues. The aim of this paper is to propose the use of adhesive composite partial crowns as a conservative approach for restoring injured teeth.
OBJECTIVE: The aim of this study was to measure and analyze the anatomic characteristics of the pulp chamber of Chinese permanent anterior teeth radiographically. METHODS: There were 137 human permanent anterior teeth to be used. The crown length, crown width and crown thickness were measured by vernier caliper. Labial-lingual and mesial-distal radiographs were obtained by parallel technique and Photoshop 8.0 was adopted for measuring the largest labial-lingual length, the largest mesial-distal length, the pulp chamber height and the distance between the lingual surface of the crown and the corresponding wall of the pulp chamber; the ratios of the largest labial-lingual length to the crown thickness, the largest mesial-distal length to the crown width and the pulp chamber height to the crown length were calculated. Finally the coefficients of variance were caculated. RESULTS: (1) The ratios of the largest mesial-distal length to the crown width of maxillary and mandibular canines were statistically different from those of the other anterior teeth. There was not statistically significant difference for those ratios either between maxillary and mandibular canines or among incisors. (2) Indexes of the pulp chamber had higher variance than those of the external morphology. (3) The distance between the lingual surface of the crown and the corresponding wall of the pulp chamber had the smallest coefficient of variance. (4) The largest mesial-distal length of the pulp chamber had the largest coefficient of variance, except for the mandibular canines. CONCLUSION: This study provided anatomical basis for clinical work; the distance between the lingual surface of the crown and the corresponding wall of the pulp chamber could be used as a depth reference for the endodontic access, and the access should not be extended excessively in mesial-distal direction.
The amount of posterior tooth visibility was analyzed in a population of 425 subjects. By scoring photographic data, the percentage of posterior teeth that could have a crown margin placed in their occlusal, middle, and gingival sections without showing were calculated. The results of this study indicate that: 1. For esthetic reasons, posterior margin placement should be handled on an individual basis. 2. The routine placement of either supragingival or subgingival margins for esthetics alone on posterior teeth may be over- or under-treating, respectively, a portion of the population. 3. A substantial percentage of the population studied had posterior gingival sections that were visible. A substantial percentage also had gingival sections that were not visible.
STATEMENT OF PROBLEM: The clinical performance of bonding human tooth fragments to either replace missing teeth or to restore defective teeth is unclear. Prospective studies can help to predict the success of such treatment options. PURPOSE: This study evaluated the feasibility of bonding tooth tissue homografts and allografts either to replace missing teeth or to restore defective teeth, and estimated the success rate of bonded allograft and homograft restorations 3 years after placement. METHOD AND MATERIAL: Twenty clinical cases were treated by bonding tooth fragments or crowns into 6 groups (Gp): Gp1, cervical erosion and abrasion lesions (6); Gp2, incisal edge fractures (4); Gp3, partially destroyed crowns (4); Gp4, teeth placed in a removable prosthesis (2); Gp5, missing tooth with no opposing tooth (2); and Gp6, temporary space maintenance (2). Restorations were examined using USPHS criteria every 2 months and whenever a patient called to report a failure. RESULTS: After a 3-year follow-up, the overall success rate was 80% for the 20 restorations. The 95% confidence interval was 63% to 94%. Four restorations failed by debonding (Gp2 [2]; Gp5 [1]; Gp6 [1]) during the first 4 months. The main cause of failure appeared to be excessive occlusal loading. CONCLUSION: Within the limitations of this clinical study, the results after a 3-year follow-up showed the success rate was not less than 63% for bonded allograft and homograft restorations.
To date, there has been no reliable method for treating bucco-palatal fractured maxillary molar teeth. We have developed a simple repositioning method to fix teeth fractured in this way using wire. The effectiveness of this new approach was evaluated in both in vitro experimental research and clinical studies.
Forced eruption offers a method of treatment of teeth fractured close to the alveolar crest. We introduce a modification of this common technique. The fractured fragment of a patient's crown is bonded to the adjacent teeth and used as anchorage, permitting the root extrusion while offering acceptable aesthetics. The bonded crown does not impede the eruption of the root so that the frequent occlusal adjustment of other methods is not required. The final result is acceptable and a low cost alternative to common techniques.
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