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Effect of calcium phosphate ceramic implants on tooth eruption.

This study evaluated the effects of calcium phosphate ceramics, hydroxylapatite, and tricalcium phosphate implants on tooth eruption and development. Forty kittens, three to four months of age, had their primary right second and third mandibular premolars extracted and the sockets packed with either hydroxylapatite, tricalcium phosphate, autogenous cancellous marrow, or nothing. The results of this study indicated that the use of a nonresorbable hydroxylapatite for grafting resulted in impediment of tooth eruption and distortion of crown development. This was in contrast to the tricalcium phosphate, which had minimal effect on tooth eruption and development.

Alveolar Process↗

Cellular renewal in the enamel organ and the odontoblast layer of the rat incisor as followed by radioautography using 3H-thymidine.

Renewal of the cell populations of the incisor was studied in 100 gm male rats injected with a single dose of 3H-thymidine and sacrificed at various times from one hour to 32 days after injection. Radioautographs showed that a cohort of labeled cells within the enamel organ, odontoblast layer, and pulp was carried passively with the erupting incisor from the apical end towards the gingival margin where the life cycle of these cells was terminated. Labeled cells in the upper and lower incisor, although traversing different absolute lengths, were found in approximately the same functional stage of their life cycle at similar times after the injection. Thus, by one and on-half days labeled ameloblasts began inner enamel secretion and, by eight days (upper) or nine days (lower), complement outer enamel secretion. By 32 days labeled ameloblasts had traversed the entire enamel maturation zone and were located at the gingival margin. Labeled odontoblasts followed closely the movement of labeled ameloblasts. The mean rate of ameloblast migration was 567 mum/day on the upper incisor and 651 mim/day on the lower. For the odontoblasts this rate was 55 mum/day (upper) and 631 mum/day (lower). Finally, it was found that as the rat age, the duration of the life cycle for epithelial and pulp cell populations of the incisor increased because of growth within the lonitudinal axis of the tooth. It was concluded that the apical end of the incisor literally "grows backward" in the bony socket, and hence, the duration of the life cycle becomes greater simply because it takes cells longer to physically reach the gingival margin.

Ameloblasts↗

Guided tissue regeneration ensures osseointegration of dental implants placed into extraction sockets. An experimental study in monkeys.

The aim of the present study was to explore the possibility of achieving osseointegration of dental titanium implants, inserted into alveoli immediately after tooth extraction, by covering the recipient site with a teflon membrane. In each of 7 monkeys, mucoperiosteal flaps were raised on the buccal and palatal aspects of the maxillary molars in both sides of the jaw. The second molars were then extracted and self tapping titanium implants of the screw type (Astra Dental Implants) were inserted into the sockets of the largest roots. In the coronal portion of the sockets, a void was always present between the implant and the socket walls. In one side of the jaw, a membrane (Gore-Tex Augmentation Material) was adjusted to cover the implant. The implant in the other side of the jaw served as control and was only covered by the tissue flaps. Microscopic analysis after 3 months of healing revealed that soft tissue was facing the coronal portion of the implants to a varying degree in the control side, while osseointegration was consistently observed to the top of the membrane-covered implants which remained submerged throughout the experimental period. The results suggest that the membrane technique can secure complete osseointegration of implants inserted immediately into extraction sockets.

Alveolar Process↗

Orthodontic tooth movement in the mixed dentition. Histological study of a human specimen.

MATERIAL AND METHOD: We present a retrospective analysis of periodontal tissue reactions and clinically relevant phases of permanent tooth eruption and deciduous tooth resorption after half a year of orthodontic tooth movement in the upper and lower jaw of a deceased male (age 9 years 3 months). Specimens of the horizontal plane (lower jaw) and sagittal plane (upper jaw) were prepared by the ground microsection technique without prior decalcification. RESULTS: Histologically, reactions in the periodontal ligament presented as characteristic appositional/resorptive metaplastic processes in the areas of tension and pressure, with side effects such as root resorption and periodontal necrosis being only minor. In the upper jaw, an erupting permanent canine was closely associated with the tooth germ of the first premolar. Resorptive follicle activity had resulted in extensive erosion of the interradicular bone and root resorption in the area of the first premolars. CONCLUSION: These findings suggest that it might prove useful to take critical topographic findings as parameters for differential therapeutic decisions. Follicle-driven deciduous tooth resorption presenting partly as resorption lacunae and partly with linear characteristics was accompanied by resorptive/appositional remodeling of the alveolar socket as well as regressive changes in the supracrestal fibers of the marginal gingiva.

Child↗

Healing after dental extractions in men with HIV infection.

To determine the incidence of delayed healing after dental extractions in men with HIV infection, a retrospective audit was conducted of all extractions performed in a dedicated dental clinic over a 26-month period. The incidence of delayed healing in patients with HIV was compared with the incidence in those patients without HIV. Eighty men with HIV had 163 teeth extracted, which resulted in five dry sockets (3.01%). Thirty-six men thought not to have HIV had 70 extractions and three dry sockets (4.28%). All three dry sockets in the control group occurred in men who had tested negative for HIV antibodies in the year before their extraction. There were no other incidents of delayed healing. These findings contrast with other reports since they reveal no increase in delayed healing after extractions in men with HIV and do not support recommendations that prophylactic antimicrobials are required for extractions in this group of patients.

Acquired Immunodeficiency Syndrome↗

A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars.

We randomised 128 patients who required operations on mandibular third molars and who had radiological evidence of proximity of the third molar to the canal of the inferior alveolar nerve to one of two operations: extraction [n=102], and coronectomy [n=94]. Some roots were dislodged during intended coronectomy and were therefore removed, resulting in two subgroups (successful coronectomy n=58, and failed coronectomy n=36). The mean (S.D.) follow up was 25 (13) months. Nineteen nerves were damaged (19%) after extraction, none after successful coronectomy, and three (8%) after failed coronectomy (p=0.01). The incidence of dry socket infection was similar in the three groups (10/102, 10%, 7/58, 12%, and 4/36, 11%, respectively). No root required removal or reoperation. To our knowledge this is the first clinical trial of the efficacy of coronectomy in preserving the inferior alveolar nerve. The length of follow up was about 2 years, which for the assessment of delayed eruption of the root fragments is not sufficient as this process may continue for up to 10 years. However, it seems that coronectomy reduces the incidence of injury to the inferior alveolar nerve without increasing the risk of dry socket or infection.

Adult↗

A clinical study of "dry socket".

A total of 1274 extractions carried out by the author resulted in a dry socket incidence of 2.6%. There was no sex predilection in the occurrence of dry socket. Incidence of dry socket formation was highest in the first and second molar region. Forceful infiltration of an extra 2 ml of local anesthetic into the tissues resulted in a higher incidence of dry socket; however this difference was not statistically significant. Dry sockets occurred more frequently in difficult extraction cases as compared to routine extractions; this difference was statistically significant. However, when 20 teeth in difficult extraction cases were removed by the open surgical method there were no cases of dry socket formation. Teeth removed principally due to a periodontal involvement did not give rise to a single case of dry socket. Treatment of dry socket with intra-alveolar dressings did reduce the pain; however, the healing time was invariably prolonged. The best results, in the form of reduction of pain and rapid healing, were obtained with the surgical method of reflection of a flap and debridement of the socket.

Anesthetics, Local↗

Immunodetection of osteopontin at sites of resorption in the pulp of rat molars.

Osteopontin (OPN) has been proposed to act as a substrate for osteoclast adhesion during bone resorption. The aim of the present study was to examine the presence and distribution of OPN at sites of resorption in traumatized radicular pulp. The upper first molars of 6-week-old male Sprague-Dawley rats were luxated and then repositioned in the original sockets. The animals were sacrificed by intracardiac perfusion at 10 and 14 days after tooth reimplantation. The teeth were decalcified in EDTA and then processed for embedding in paraffin for histochemistry or LR White resin for immunocytochemistry. Odontoclasts were identified by their multinucleated morphology and expression of tartrate-resistant acid phosphatase (TRAP). Osteopontin was immunolocalized using postembedding colloidal gold labeling with a chicken egg yolk anti-rat OPN antibody. After reimplantation of the teeth, TRAP-positive cells were present along the pulp dentin wall. Osteopontin was not consistently detected at exposed predentin/dentin surfaces. However, gold particles were often found at the margin of resorption lacunae. Labeling was also seen over the Golgi region and cytoplasmic vesicles of odontoclasts and of neutrophils and fibroblast-like cells. The results suggest that accumulation of OPN at the predentin/dentin surface is not a prerequisite for adhesion of odontoclasts to the wall substance and that recruited odontoclasts produce OPN locally to mediate cell and/or matrix events within the resorption lacuna.

Animals↗

[Comparative clinical and histological studies on extraction wounds with and without local application of a salicylic acid preparation (Apernyl)].

Selected patients with extraction wounds served to experiment with Apernyl-styli of Bayer. Contralateral alveoli were used as controls. 10 days following operation biopsies were taken from treated and untreated alveoli. Histologically, a morphometric study was made, and clinically healing was judged by the frequency of complications and the initial physiologic pain. The results show that Apernyl does not influence histological healing, positively or negatively. Thus, the results obtained by Nordenram and Band (1970) and Satoh et al. (1973) could be confirmed. Clinically, there were significanlty less p.o. complications in patients with Apernyl prophylaxis; 2 of 51 treated alveoli compared to 8 of 45 untreated ones. Pain was significantly reduced: 17 of the 19 patients complained of pain in the untreated half of the jaw, while only 4 suffered pain on the treated side. This confirms the findings of Neuner and Panzera and Neuner and Schegg (1972 and 1969 resp.).

Alveolar Process↗