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PubMed1999

Replantation of avulsed central incisor with advanced periodontal disease: a case report.

This paper describes the case of a 31-year-old woman with advanced periodontal disease who lost a tooth due to trauma. The avulsed tooth had minimal bony support of only 4-5 mm. The patient described was under good periodontal maintenance. The tooth was kept moist, and replantation occurred within an hour of avulsion. The tooth was returned to its position, splinted, and later endodontically treated. After 2 years the tooth appears and functions normally as it did before avulsion.

Adult↗
PubMed1990

A case report of chronic neutropenia: clinical and ultrastructural findings.

This case report of severe periodontitis concerns a young male patient with chronic idiopathic neutropenia seen between 1981 and 1983 by the School of Dental Medicine of Geneva and from 1984 to 1988 by the Eastman Dental Hospital of London. The patient was maintained by intermittent systemic antibiotics, subgingival chlorhexidine irrigation, conventional debridement, brushing, and wire-mesh and composite splinting of loose teeth. After leaving school, at the patient's express wish, the extreme downhill pattern of the periodontitis resulted in removal of affected teeth and overdenture construction. The extracted teeth and associated soft tissues were examined for relevant plaque and host response features. The intact morphotypes associated with the advancing front of the lesion were invariably Gram-negative or positive coccoid cells, or less commonly short rods, as in all documented forms of periodotitis. Connective tissue destruction was associated with a leucocyte accumulation comprising mainly polymorphonuclear neutrophils (PMN) and plasma cells. Both were observed degenerated more deeply than in routine adult periodontitis, including PMN lysosome loss and lymphocyte maturation within peripheral blood vessels. Only in one instance, one part of the superficial connective tissue of one block contained bacteria. It was concluded that the features of plaque and the lesion suggest a typical first line of defence response as in other forms of periodontitis. From the consideration of the 10 years clinical history of the patient, it is clear that non-surgical management is possible even in extreme cases, without any compromise of the patient's oral or systemic health, and in accord with the patient's wishes.

Adolescent↗
PubMed2006

Traumatic intrusion of permanent teeth. Part 3. A clinical study of the effect of treatment variables such as treatment delay, method of repositioning, type of splint, length of splinting and antibiotics on 140 teeth.

A prospective study of 140 intruded permanent teeth was examined for the following healing complications: pulp necrosis (PN), root resorption (RR; surface, inflammatory and replacement resorption), and defects in marginal periodontal bone healing (MA). The occurrence of these healing complications was related to various treatment factors such as treatment delay, method of repositioning (i.e. expecting re-eruption, orthodontic reposition and surgical reposition), type of splint (rigid, semirigid and flexible), length of splinting (days) and the use of antibiotics. Treatment delay, i.e. before and after 24 h, had no effect upon healing. Active repositioning in individuals with incomplete root formation (surgical or orthodontic) had a negative effect upon the three healing parameters compared with spontaneous eruption. In teeth with complete root formation and an age of 12-17 no repositioning was still the best treatment in regard to MA. In individuals older than 17 years of age, cases were not anticipated to spontaneously erupt and in these cases, the general choice of treatment was either active orthodontic or surgical repositioning. The former procedure appeared in this treatment scenario to slightly reduce the risk of MA complications. However, this treatment procedure was also found to be more time demanding (an average of 22 consultations for orthodontic repositioning compared with 17 consultations for surgical repositioning). If a surgical repositioning was performed, the type of splint (i.e. flexible, semirigid or rigid) appeared to have no significant effect on the type of healing. The same applied to the length of splinting time (shorter or longer than 6 weeks). No effect of dentin covering procedures for associated crown fractures (enamel-dentin fractures) could be demonstrated. Likewise, antibiotics had no apparent effect upon healing. In conclusion, in patients with intruded teeth with incomplete root formation, spontaneous eruption should be expected. In patients with completed root formation and with an age of 12-17 spontaneous eruption can still occur, but must be monitored very carefully. In older patients (i.e. >17 years) with completed root formation, either surgical or orthodontic extrusion should be attempted. The latter procedure appeared to lead to a slight reduction (not significant) in the risk of MA complications. The extent and direction of the intrusion may however favour surgical repositioning.

Adolescent↗
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↗