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PubMed1988

Oral findings in Fanconi's anemia. A case report.

A case of fanconi's anemia was referred to the Dental School from the Department of Pediatrics. The patient was a 24-year-old male and a product of a consanguineous marriage. His chief complaint was loose and falling teeth, which has started at the age of 16 years. The first teeth to fall out were the first permanent molars followed by mandibular and maxillary anteriors. General examination showed that the patient was of normal intelligence and small for his age. He had no palmar plantar hyperkeratosis and was not diabetic. A total of 19 teeth remained in the mouth, most of them with grade three mobility. The remaining molars and first maxillary premolars had grade three furcation involvement. Most of the teeth had periodontal pockets more than 10 mm deep. Full mouth intraoral periapical radiographs and orthopantomographic views showed severe horizontal bone loss uncommensurate with the patient's age. In view of the patient's history and severe bone loss at an early age, the diagnosis was juvenile periodontitis associated with Fanconi's anemia.

Adult↗
PubMedDate not supplied

Clinical effect of etidronate on alveolar pyorrhoea associated with chronic marginal periodontitis: report of four cases.

Etidronate 200 mg daily was administered to four female patients with periodontitis and resultant alveolar pyorrhoea for periods of 2 weeks, followed by off-periods of 10 weeks or more, for 2-3 years. The macroscopic appearance of gingival mobility of the teeth, depth of periodontal pockets, and X-ray findings of alveolar bones improved markedly during this time. The effects were first observed after 6-12 months of treatment. These findings indicate that bisphosphonates may be effective in the treatment of periodontitis and resultant alveolar pyorrhoea. The effect may be mediated by the inhibitory action on bone resorption and the anti-inflammatory action of etidronate. Concomitant conventional dental management is also required.

Bone Resorption↗
PubMed1985

Effect of abutment mobility, site, and angle of impact on retention of fixed partial dentures.

Fixed partial dentures cemented to dies of adjustable mobility were subjected to repeated impacts at three different sites. Immobile abutments retained their prostheses longer than mobile abutments. Impacts that fell between the centers of rotation of the abutments were withstood longer than impacts that fell nearer the ends of the prostheses. This study failed to show a significant difference between the effect of impacts perpendicular to the occlusal plane and impacts angled 45 degrees toward the lingual plane. The results of this study suggest that (1) crowns that anchor rigid prostheses to mobile teeth require greater retentive ability than crowns on relatively immobile abutments and (2) occlusal impacts are best withstood when they fall on the areas of the fixed partial denture over and between the centers of rotation of the abutment teeth. If a fixed partial denture must withstand loading outside these areas, as is the case with cantilevered pontics and some tilted abutments, the retainer furthermost from the anticipated eccentric load must have exceptionally good retention.

Dental Abutments↗
PubMed1981

Occlusal trauma. An evaluation of its relationship to periodontal prostheses.

Occlusion and local irritants are two factors in the etiology and pathogenesis of periodontal disease. Moreover, occlusal trauma and periodontal inflammation may act as codestructive agents in periodontal disease. Mobility as well as radiographic changes, including a widened PDL space, decreased definition of the lamina dura, bone loss, and altered bone trabeculation, are diagnostic for trauma from occlusion. When periodontitis is present in conjunction with occlusal trauma, the inflammatory condition should be resolved first. If the inflammatory process is controlled and the patient still suffers from impaired function, diminished comfort, or unacceptable esthetics, then occlusal equilibration may be employed. If this treatment modality is not successful, adjunctive appliances or splinting should be contemplated.

Dental Occlusion, Traumatic↗
PubMed1999

Long-term effect of mandibular midline distraction osteogenesis on the status of the temporomandibular joint, teeth, periodontal structures, and neurosensory function.

PURPOSE: This study retrospectively evaluated the long-term effects of transverse symphyseal distraction osteogenesis (DO) on the temporomandibular joint (TMJ) symptoms, periodontal health, tooth vitality, and nerve injury after surgery. PATIENTS AND METHODS: Twenty-three patients were treated with symphyseal DO during a 4-year period. Fifteen patients were available for follow-up from 7 to 45 months postoperatively (ave, 24.5 months). The patients were clinically evaluated for TMJ symptoms, periodontal pocket formation, tooth vitality and mobility, crestal bone loss, and attached gingival tissue changes. Radiographs of the mandibular anterior teeth were used to evaluate for periodontal bone loss, periapical lesions, or widening of the periodontal ligament (PDL). RESULTS: Preoperatively, 47% of the patients had TMJ symptoms. No patient had symptom worsening or developed new symptoms postoperatively. Five patients' TMJ symptoms improved, and 3 experienced complete resolution of symptoms. No periodontal bone loss or soft tissue recession were evident. Tooth vitality was maintained in 13 patients. Two patients developed Class II mobility of 1 mandibular central incisor, 1 patient had tooth pain and a widened PDL adjacent to the osteotomy/corticotomy site, and 1 patient experienced mental nerve paresthesia. CONCLUSIONS: DO can be used to treat transverse discrepancies of the mandible with limited morbidity.

Adolescent↗
PubMedDate not supplied

Dental findings in Lowe syndrome.

This paper presents the dental findings of a child with the oculocerebrorenal syndrome of Lowe. The genetic abnormality in this condition results in an inborn error of inositol phosphate metabolism. Renal tubular dysfunction leads to metabolic acidosis and phosphaturia. At 4 years, generalised mobility of all primary teeth was noted. It is postulated that a defective inositol phosphate metabolism was responsible for the periodontal pathology found in this case. This is in direct contrast with previous reports of prolonged retention of primary teeth in children with this condition. Histology of extracted primary incisors demonstrated enlarged pulp chambers and mildly dysplastic dentin formation. This is consistent with a chronic subrachitic state, a known feature of Lowe syndrome, but no prominent interglobular dentin was present.

Child, Preschool↗
PubMed1993

A national study of periodontal assessment by dental hygienists.

PURPOSE: Periodontal examination is one of the most frequently performed dental hygiene diagnostic services. This examination is the basis for effective dental hygiene treatment throughout long-term care. The purpose of this investigation was to examine how dental hygienists across the United States assess the periodontal status of three patient types: patients new to the practice, periodontally healthy recall patients, and periodontally unhealthy recall patients. METHODS: A two-stage cluster sampling method was used to select a random sample of dental hygienists from each of two states randomly selected from four regions of the United States. Questionnaires were mailed in 1989 to 2,618 dental hygienists. Individual responses were scored according to criteria derived from dental literature for conducting seven components of a comprehensive periodontal examination. Results were calculated and analyzed for each state and region, and across regions for each patient type. RESULTS: Responses were received from 1,429 subjects, resulting in a 57.5% response rate of deliverable questionnaires. Overall mean scores (possible 0-7) across all regions were 3.68-new patients, 3.22-healthy patients, and 2.67-unhealthy patients. Of the seven assessment components, three-gingival inflammation, furcation involvement, and radiographs-were performed according to the scoring criteria for all patient types by a majority of respondents. The criterion for periodontal pockets was met by a majority for new patients only. Three assessment component criteria were met by less than 40% of the sample for all patient types-attachment levels, mobility, and plaque control. Differences in the mean scores of certain states were found to be statistically significant. CONCLUSION: Specific dental hygiene standards are recommended for initial diagnostic and recall monitoring periodontal examinations. Additionally, dental hygiene administration and management of long-term preventive and supportive periodontal therapy programs should assist in improving effectiveness of care and further delineate the profession of dental hygiene.

Dental Care↗
PubMed2005

Correlations between periodontitis and loss of mandibular bone in relation to systemic bone changes in postmenopausal Japanese women.

A new method of measuring mandibular alveolar bone mineral density (BMD) was applied to 40 postmenopausal Japanese women aged 50-69 years exhibiting minimal to mild periodontal diseases. Lumbar spine BMD was measured by dual X-ray absorptiometry (DXA) and calcaneus speed of sound (SOS) by quantitative ultrasound (QUS). There were age-related decreases of alveolar BMD, calcaneus SOS and vertebral BMD. There were significant correlations between two of the respective bone mass values. Correlations between clinical dental findings and bone mass data including alveolar BMD, SOS and lumbar spine BMD were investigated. Significant correlations were demonstrated between alveolar BMD and calcaneus SOS or vertebral BMD. Alveolar BMD showed significant correlation with clinical dental findings including periodontal pocket depth and mobility as well as calcaneus SOS and lumbar spine BMD. Using multivariate analysis combinations of univariate predictors, including deoxypyridinoline (DPD), significantly predicted attachment levels. The SOS value was useful combined with other predictors for predicting attachment level. It was concluded that the new method of evaluating alveolar BMD is useful to predict systemic bone mass and strength as well as dental clinical findings.

Absorptiometry, Photon↗
PubMed1994

Multiple cantilevers: an alternative to dental implants.

A solution to the problem of missing posterior teeth is presented. The prerequisite for solving this problem is that the remaining teeth must be positioned in one form or another in a triangle, as one can see in Figs. 2, 3 and 4. The tripod effect, in connection with the controlling effect of the mechano-receptors in the periodontal ligaments of the remaining abutment teeth, permit us to construct a functional fixed prosthesis. The feather-edged or knife-edged preparation technique creates long axial walls. Together with the parallel prepared abutment teeth, this must be viewed as the main-retentive feature for fixed prostheses with multiple cantilevers. In extreme situations, where one is uncertain about the outcome of a case, provisional laboratory fabricated restorations are excellent for evaluating the stability of the cross-arch splinted teeth. The whole bridge occasionally shows some mobility. As long as the mobility shows no increase over a period of time, and does not interfere with the patient's chewing ability, a permanent bridge with multiple cantilevers can be inserted. I usually include no more than three cantilevered pontics on each side of the arch in a multiple cantilevered bridge. A second molar is not replaced by a third cantilevered pontic. Its position in the arch may cause an overly strong lever action on the fixed prosthesis.

Biomechanical Phenomena↗
PubMed1980

Bruxism and trauma from occlusion. An experimental model in Macaca monkeys.

The present study describes an experimental approach for inducing bruxism and trauma from occlusion in animals. Gold occlusal cap splints overlaying the maxillary premolar and molar teeth were inserted in eight Macaca irus monkeys. The cap splints were designed to raise the vertical dimension of occlusion by 3--4 mm and were adjusted to a balanced occlusion with the mandible in an unstrained retruded position. The splint on the right side (test side) was given a tight occlusion with the opposing mandibular teeth, whereas the splint on the left side (reference side) had only small occlusal contact areas. Before insertion of the splints, the monkeys had slight gingivitis but no alveolar bone loss. The cap splints were in situ for 4 weeks. During this period the monkeys showed distinct signs of bruxism. The mandibular teeth on the test side showed increased mobility and there was radiographic evidence of breakdown of marginal and interradicular alveolar bone. Mean GI increased significantly on the test side and in two animals gingival abscesses developed. Deep intrabony pockets persisted adjacent to these teeth. Only slight gingival and radiographic changes were seen adjacent to the teeth on the control side. From the present experimental study there was no overall clinical or histological evidence that bruxism had caused a progression of gingivitis to destructive, chronic marginal periodontitis.

Animals↗
PubMed1981

Oral symptoms in histiocytosis X.

Histiocytosis X, a term comprising three well-known disease complexes, may have dental mobility as a prodromal or major symptom. In each of three patients described, an oral finding predated the other symptoms. The earliest symptom in one patient was loosened teeth; in another, periodontosis-like symptoms were documented ten years before the patient's report of pelvic pain which led to a diagnosis of eosinophilic granuloma; in the third patient, premature eruption of the primary teeth the gingival bleeding was the prodromal symptom. The clinician should understand the significance of each finding and investigate them until a confirmatory diagnosis is made.

Adult↗
PubMed2004

Influence of occlusal height for an implant prosthesis on the periodontal tissues of the antagonist.

The purpose of this study was to investigate a suitable occlusal height for an implant prosthesis by examining the responses of the periodontal tissues around a natural antagonist. The subjects were three Japanese females with two posterior missing teeth restored by ITI system implants (Straumann). Two kinds of experimental implant prostheses were adjusted as follows; one was adjusted in heavy clenching (HC), and the other was adjusted in light clenching (LC). The periodontal pulsation, displacement during biting an occlusal force meter and the mobility of the antagonist were measured before and one week after temporary cementing HC and LC, and one week after removal. In each prosthesis, there was no significant difference in the amounts of the pulsation and mobility of the antagonist before and one week after cementing, and one week after removal (p>0.05). The displacement of the antagonist during biting the occlusal force meter did not change much during the conditions. The results of this study suggested that an implant prosthesis adjusted not only under heavy clenching but light clenching like crown restorations for natural teeth did not affect the periodontal tissues of the antagonist in a harmful manner.

Adult↗
PubMed1989

[A rare case of congenital dentin dysplasia in a child aged 8 years].

In the reported case the authors observed a considerable mobility of all milk teeth and permanent teeth. The degree of this mobility varied. The crowns of milk and permanent teeth had a normal size, shape and colour. All teeth were unresponsive to thermal and electric stimulation. Radiological examination showed a nearly complete lack of roots and complete absence of pulp chambers and root canals. This was confirmed by histological examinations demonstrating that the inner part of the teeth in the crown and root was filled with hard masses which in light microscopy resembled newly forming compact bone with Haversian structures. The absence of resorption sinuses in the rudimentary roots was noted. Paediatric examination failed to demonstrate any abnormalities.

Child↗
PubMed2006

Mechanical interactions of an implant/tooth-supported system under different periodontal supports and number of splinted teeth with rigid and non-rigid connections.

OBJECTIVES: This study investigated the mechanical interactions of implant-teeth splinting systems under different periodontal supports and number of splinted teeth with rigid and non-rigid connectors using non-linear finite element (FE) approach. METHODS: Two FE models with normal and compromised periodontal supports containing a Frialit-2 implant splinted to the first and second premolars were constructed. Non-linear contact elements were used to simulate a realistic interface fixation within the implant system and the sliding function of the non-rigid connector. ANOVA was used to test for relative importance of the investigated factors and main effects for each level of the three investigated factors (periodontal supports, teeth splinting and connector designs) in terms of the stress values were performed. RESULTS: The simulated results indicated that the cross-interaction of the periodontal support and the splinting situation was a major factor affecting the stress value in alveolar bone. An additional splinting decreased the stress values of bone significantly for a compromised periodontal support. The individual factor of periodontal support also influenced the stress found in the alveolar bone (28%) and implant (72%), and the stress values increased when the periodontal support was reduced. Using different connectors affected the stresses found in bone (15%), implant (21%) and prosthesis (99%). The stress values of the implant and prosthesis increased, but were decreased in bone when the splinting system used non-rigid connectors. The mobility of natural teeth and the implant system between non-rigid and rigid connections showed only small differences. CONCLUSIONS: A non-rigid connector should be used with caution since it breaks the stress transfer and increases the unfavorable stress values in the implant system and prosthesis. The tooth/implant-supported system with an additional splinting is more efficient in compromised periodontal supports.

Alveolar Process↗
PubMed1996

Idiopathic progressive osteolysis of craniofacial bones.

We present the case report of a diabetic 51-year-old male, who presented with painless mobilization of the superior incisor teeth. The X-ray study showed osteolysis, without any soft tissue mass, in craniofacial and orbital bones. In the control X-ray studies performed during the 2 years' evolution, a progressive increase in the intensity and extension of the osteolysis was observed. The diagnosis of progressive idiopathic osteolysis is one of exclusion, based mainly on clinico-radiological findings, evolution and compatible histological findings.

Facial Bones↗
PubMedDate not supplied

Perceived need for dental care among dentate older individuals in Sri Lanka.

The authors assessed the perceived need for dental care among 585 older individuals, of whom 235 received a clinical oral examination. Of the 235 participants, only 171 were dentate. The present analysis is limited to this group. Of these 171 dentate adults, 43 percent perceived a need for dental care. Of this sample section, 53 percent perceived a need for dentures. Age, perceived oral health status, presence of mobile teeth, three impact items of the Oral Health Impact Profile-14 (OHIP-14) scale--namely "had a painful aching in the mouth, had difficulty in eating and that the diet had been unsatisfactory due problems with teeth, mouth or dentures"--and the total OHIP-14 score showed significant associations with perceived need for dental care in bi-variate analysis. Poor perceived oral health status emerged as the strongest predictor of perceived need for dental care in logistic regression.

Aged↗
PubMed1999

The periodontal response to cantilevered resin-bonded bridgework.

This study investigated 84 cantilevered resin-bonded bridges (CRBB) in 60 patients. These CRBB (single retainer, single pontic) had been in place for an average of 43.6 months. Periodontal health was assessed on abutment teeth and contralateral control teeth. Periodontal indices utilized were Plaque Index (PI), Gingival Index (GI), Bleeding Index (BI), Pocket Depth (PD) and mobility. The marginal adaptation, the gingival extension of the retainers and the presence or absence of caries around each retainer margin were also assessed. Information about the history of debonding was collected and a success rate of 93% was reported. PI, GI and mean PD compared statistically significantly, less favourably, with scores of the control teeth. Marginal adaptation of the retainers was of a high standard and caries did not appear to be a problem.

Adolescent↗
PubMed1997

Therapy-resistant periodontitis (I). Clinical and treatment characteristics.

The aim of this study was to evaluate the clinical criteria for classification of 2 different patient groups. From retrospective comparisons of pocket probing depth (PPD) charts, we classified 22 patients as either non-responding or responding to periodontal treatment. The non-responding patient group, in comparison with the responding patient group, showed a profile over time of less PPD reduction in response to periodontal treatment. Information registered in each patient's file regarding clinical periodontal conditions, as well as treatment procedure characteristics, was gathered. Bivariate analyses were performed. 3 clinical variables (frequency of mean PPD > or = 6 mm during the treatment period; at final registration; and the mobility score at the final registration) indicated that 2 separate patient groups had been identified. Although the patient groups exhibited advanced periodontitis at the beginning of treatment, both groups at the end of treatment had lost very few (1-2) teeth, probably as a result of regular supportive treatment. The characteristics of the selected clinical criteria warrant the use of these 2 patient groups in further analysis of the relation of psychosocial stress and microbiological characteristics of therapy-resistant periodontitis.

Adult↗