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Autotransplantation of third molars as treatment in advanced periodontal disease.

The aim of this study was to investigate the prognosis of replacing molars with advanced periodontitis by autotransplanted fully developed third molars. The patient sample consisted of 18 subjects, 24-58 years of age. The patients selected had at least 1 molar with advanced periodontal tissue destruction. After extraction of the diseased molar, autotransplantation of a third molar was immediately performed. After a splinting and healing period of 2-3 weeks, endodontic treatment was carried out. The follow-up included recordings of the clinical parameters, probing periodontal pocket depth, probing attachment level, percussion sound, and mobility. Radiographs were taken immediately after the surgical procedure, after 6 months, 1 year, and thereafter annually. The results of this study indicate that autotransplantation may be an alternative treatment procedure for molars with advanced periodontal disease.

Adult↗

Different approaches to anchorage: a survey and an evaluation.

Orthodontic treatment outcome is often compromised by the loss of anchorage. The forces acting on the anchorage unit have, however received surprisingly little attention, and the loss of anchorage is most frequently expressed in the sagittal occlusal relationship. The present paper discusses the interaction between vertical and sagittal components of dentofacial development, and the importance of taking vertical forces into consideration is stressed. The biological background for anchorage is reviewed, i.e., the impact on the cellular reaction of the periodontal ligament around the teeth of the anchorage unit from the orthodontic force system and from occlusion. A new rigid appliance consisting of two occlusal splints connected with transpalatal arches is introduced. The advantage of using the patient's sense of occlusion as part of anchorage by means of this appliance is demonstrated in a number of case presentations.

Adult↗

[Three-dimensional finite element analysis of the stress of mandibular incisor with different level of alveolar bone].

By three-dimensional finite element analysis,the present research inquired about the stress on the surface of alveolar bone of mandibular incisor with different level of bone loss under different loadings. For the mandibular incisor without bone loss, the maximums of the von Mises stress under vertical and 15 degree oblique loading were 13.171 and 14.315 MPa respectively, both located in the apical region, and the lingual displacement of the tooth were 0.056 and 0.197mm respectively; under 30 degree oblique loading, the maximum of the von Mises stress was 15.262 MPa, located not only in the apical region but also on the crest, and the lingual displacement of the tooth was 0.324 mm. However, when vertical loading was applied on the mandibular incisor with half of the alveolar bone loss, the maximum of the stress increased significantly, located in the apical regions. And under oblique loadings, the value of the stress of this model increased dramatically,being three to five times over that of mandibular incisor without bone loss. Both of them concentrated on the crest. The scope of its distribution decreased from area to point. The significant lingual displacement happened, amounting to 2.850 mm. So when the loss of alveolar bone is not less than half,occlusal adjustment and splinting should be considered during the initial treatment of periodontal disease in order to avoid the significant change of the stress and alleviate the damage to the periodontal tissues.

Alveolar Bone Loss↗

Intentional replantation of a mandibular molar with calcified canal: a case report.

Intentional replantation is an accepted endodontic technique for treating teeth in which both conventional and/or surgical endodontic treatments are not recommended. A rare case using intentional replantation technique on one mandibular molar has been successfully treated. This procedure was used owing to inaccessible calcified canal and pain intolerance of the patient. A thirty month post-operative evaluation revealed an asymptomatic, functional tooth with no radiographic signs of pathosis. The favorable results obtained in this case might be attributed to certain factors, such as occlusal adjustment prior to replantation, maintaining asepsis during replantation, no-damaging pressure during extraction, use of noneugenol periodontal packing, preservation of the vitality of the periodontal ligament, a minimal extraoral period, non-rigid splinting, apicoectomy and retrograde amalgam filling were done for hermetic apical seal. Intentional replantation may be limited to those cases when conventional endodontic therapy is not possible, but may be a treatment alternative to maintain the dentition and save an otherwise hopeless tooth.

Adult↗

[Injuries to the permanent teeth. Periodontal lesions].

Tooth luxations are relatively common. In case of concussion or subluxation the tooth is not displaced. The treatment will consist of relief of the tooth. Most frequent complications are pulp necrosis and obliteration of pulpal tissues. In case of extrusive luxation pulpal tissues and the periodontal ligament are injured. When tooth mobility is increased flexible splinting should be considered. Endodontic treatment is necessary after extrusive luxation of a tooth with completed root formation. Teeth with open apex often show pulpal obliteration after extensive luxation. Lateral luxation is more complex than extrusive luxation since the alveolar bone is also damaged. Repositioning and splinting of the tooth are necessary. When the apical foramen in closed, endodontic treatment will be necessary. Teeth with incomplete root formation will develop pulp obliteration. Following lateral luxation, external root resorption and loss of marginal bone are not infrequent. Intrusive luxation is the type of trauma with most unfavorable prognosis. All intruded teeth will become necrotic and external root resorption and marginal bone loss are frequent. There is no consensus regarding the therapeutic approach. Orthodontic extrusion or surgical mobilisation are possible options. In case of avulsion, both the pulpal tissues and the periodontal ligament are disrupted. Preservation of the vitality of the periodontal ligament covering the root will determine the prognosis of the reimplanted tooth. Therefore the tooth will be repositioned as soon as possible. When this is not possible, milk or a specific solution are most appropriate for tooth conservation. When the reimplanted tooth has complete root formation, devitalization will be performed one week after after repositioning. In case of a tooth with open apex revascularisation can be awaited. Healing of the periodontal ligament will determine prognosis. When a normal ligament is obtained during healing or when surface resorption is obtained, the tooth can be preserved for a long period. When progressive replacement resorption (ankylosis) develops, most teeth can remain in position for about 10 years. When inflammatory resorption develops, the tooth will be lost within a short time.

Dental Pulp Calcification↗

Splinting and replantation after traumatic avulsion.

A rational approach can be taken in the dental office to avulsion and replantation. Consideration must be given to: Extraoral time. During this critical time, the prognosis for successful replantation noticeably decreases as the out-of-mouth time increases. Transport. Preferably the tooth will be transported in the socket, but milk or water may be used to keep the tooth moist. The buccal vestibule may be recommended for adults and teenagers but not for young children. Root surface. The root surface must not be handled, scraped, brushed, or have any part removed; it can be rinsed with sterile water, saline, or tap water but not with caustic solutions, disinfectants, or medicaments to clean the surface. Endodontic treatment. A tooth with an open apex should be evaluated bimonthly for revitalization. A tooth with a fully formed apex should have the pulp removed in 7 to 14 days after avulsion. Status of the alveolar process. Alveolar fractures may require a modified splint design to provide additional strength for a longer splinting duration. Obturation materials. Calcium hydroxide paste is used for a minimum of 6 to 24 months before filling permanently with gutta-percha. Selection of a splint. Each case is different and should be treated as such. Special consideration must be given to splint design, which will directly influence the desired result. Although any number of splints may be effective, inherent advantages and disadvantages of each should be understood fully by the clinician. This is where the art, the clinical experience, and the common sense of endodontic therapy dictate the proper splint and appropriate duration of splinting for the patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗