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PubMed1999

Surgically assisted rapid palatal expansion: orthodontic preparation for clinical success.

Close root proximity between the maxillary central incisors presents a problem in the surgical management of a maxillary palatal expansion. During the surgical fracture of this interdental area, the possibility exists for a separation to occur between the root surface and the bone. If this does occur, it is paramount that the gingival attachment remain intact. Asymmetric separation places more stress on the mesial gingival attachment because of the anatomy of the gingival fiber apparatus. Gingival detachment results in epithelial downgrowth in an apical direction, which in turn prevents bone apposition in a coronal direction. The resulting osseous defect is difficult to treat with an osseous graft procedure, as there are few if any intrabony walls. Treatment planning should include analysis of a recent periapical radiograph of the incisor roots to determine the need for orthodontic root separation before surgery. A postsurgical periapical radiograph should be taken to determine where the interdental separation has occurred. The expansion schedule should be adjusted depending on the symmetry of the separation and the health of the gingival attachment.

Adult↗
PubMed1994

A long-term, follow-up, radiographic evaluation of asymptomatic impacted third molars in orthodontically treated patients.

Long-term follow-up orthopantomographs of 251 adult orthodontically treated former patients showed 113 clinically asymptomatic impacted third molars in 58 patients. Radiographic assessment revealed contact of impacted third molars with the second molars, resorption of maxillary and mandibular second molars, as well as pathologically widened pericoronal spaces of the maxillary and mandibular third molars. The comparison of the sagittal third molar position in 52 impacted teeth revealed a sagittal change in all third molars from post-treatment to follow-up: maxillary and mandibular third molars had rotated to a more upright position and showed an increase in mesio- or distoangulation or a change of axial inclination. The lack of predicting factors such as age, period of impaction, extent of space deficiency, developmental stage, level of eruption, and bone conditions leads the authors to recommend that former orthodontic patients be recalled at regular intervals for assessment of changes in the condition and position of erupting or impacted third molars.

Adult↗
PubMed1991

Periodontal healing after impacted lower third molar surgery in adolescents and adults. A prospective study.

The effects of impacted lower 3rd molar surgery on periodontal tissues in the adjacent 2nd molar area have been investigated in a prospective study comprising 176 cases from 2 age groups: less than or equal to 20 years (n = 93) and greater than or equal to 30 years (n = 83), respectively. The preoperative and 1-year postoperative examinations included both clinical and radiographic variables. All patients were subjected to a standardized surgical procedure and optimal plaque control pre-, intra- and postoperatively. Early removal of impacted lower 3rd molars with large angulation and close positional relationship to the adjacent 2nd molar proved to have a beneficial effect on periodontal health.

Adolescent↗
PubMed1992

Long-term clinical and radiologic evaluation of autotransplanted teeth.

The purpose of the present study was to investigate the radiologic results of 40 autotransplantations (20 molars and 20 premolars) performed in the orthodontic department of the University of Geneva between 1979 and 1990. The sample demonstrated persistence of pulp vitality and continuous root development, followed, however, in most cases by replacement root resorption. The data were in accordance with previously published studies and point to an ideal developmental stage for molar and premolar transplantation to ensure pulpal and periodontal survival.

Adolescent↗
PubMed1987

Allotransplantation of human teeth. A retrospective study of 73 transplantations over a period of 28 years.

An assessment was made of the postoperative fate of 73 allotransplanted human teeth carried out by 3 surgeons between 1956 and 1980 to determine the clinical and radiographical course of immunogenetically unmatched allotransplanted human teeth. The mean ages of recipients and donors were 34.1 and 15.2 years, respectively; 47 of the grafts had incomplete root-formation at time of transplantation. Mean observation period was 7.8 years with a maximum of 28 years. The study was terminated December 1985. The mean functional time of the grafts (function of graft without symptoms) was 6.8 years (max. 28.5 years). No signs of pulpal survival were found in any graft. Root resorption was found in 91.6% of grafts within a mean of 8.8 months after transplantation, causing a high frequency of graft loss within the first 2 years (34.1%). Recipients older than 45 years of age retained the grafts significantly longer than young patients. The major causes of graft loss were replacement (60.3%) and inflammatory resorption (24.4%). Graft loss due to marginal periodontitis was minor (2.7%). Inflammatory resorption, which was found more frequent in young recipients (P = 0.02), usually caused rapid rejection, whereas the survival time after ankylosis was significantly longer. In conclusion, no clinical or radiographical evidence of long-term survival of the pulpal or periodontal tissues of the unmatched allografts were found. However, despite a progressing replacement resorption frequently present, the allografts seem to function clinically sufficient, symptomless and often with clinically normal gingival condition for many years. Increasing age of the recipient at time of transplantation significantly increased the function time of the graft. Younger recipients showed more inflammatory resorption of the grafts.

Adolescent↗
PubMed2003

Histological study of deposited cementum in human deciduous teeth with pathological root resorption.

Physiological root resorption is a characteristic feature of human deciduous teeth. Pathological root resorption due to apical periodontitis, dental trauma or excessive orthodontic force is also observed in deciduous roots. The root resorption is not continuous, and has resting periods. In the resting period, cementum deposits in resorbed root surface. The deposited cementum in permanent teeth has been reported in detail. However, the deposited cementum in deciduous teeth is unclear. The present study examined apices of roots of human deciduous incisors with apical periodontitis and roots of sound deciduous incisors by light and transmission electron microscopy. Root dentin and original cementum had a severe irregular caved surface. Cementum was partially deposited on the caved root surfaces. The deposited cementum had made the caved root surface relatively flat. The cementum was lax and had some defects. The deposited cementum was belt-like in shape and had a stratified structure. Each layer had various structures consisting of abundant microfibrils and fine granular materials, microfibrils, granular materials, and collagen fibrils, a few fibrils and granular materials and a relatively homogeneous structure. The original cementum had many collagen fibrils, such as intrinsic and extrinsic fibers, and no granular materials or homogeneous structure. Therefore, structure of the deposited cementum was very different from that of original cementum in deciduous teeth and from that of deposited cementum in permanent teeth.

Child↗
PubMed1991

Secondary alveolar bone grafting in clefts of the lip and palate.

A short review of the literature is presented outlining the role of alveolar bone grafting in cleft patients. An analysis of a series of 47 secondary alveolar bone grafts in 34 patients is presented. The age range was 7-24 years. At the time of evaluation, 30 canines were in final occlusion and good alveolar bone levels were present in 83% of patients. Of the 13 bilateral cases (26 clefts), 14 canines were in final occlusion and all cases had good alveolar bone levels. No major complications were encountered. The graft was completely resorbed in 3 cases (6.4%) only.

Adolescent↗
PubMed1990

The case for postoperative orthodontics in orthognathic surgery.

In patients with orthognathic problems, in whom a combination of surgery and orthodontics is required, it seems to us better to defer orthodontic treatment until after surgery has been completed and a possible relapse tendency has petered out. This conclusion is reached on the basis of arch instability and the incidence of root resorption as reported in the orthodontic literature. The soundness of "permanent retention" after orthodontic therapy is questioned. The author's concepts are illustrated with a few case reports.

Humans↗
PubMed1998

Etiology and sequelae of root resorption.

This article reviews the current status of investigation into apical root resorption within the context of orthodontic treatment. Treatment and patient factors that have traditionally been investigated are discussed, along with the results of current research in this area. The need for rethinking traditional research strategies in the quest for identifying both control and causative mechanisms is explored. Finally, proposals for key areas of future interest are highlighted.

Animals↗
PubMed1998

The nature and extent of jaw involvement in Gaucher disease: observations in a series of 28 patients.

A wide variety of osteoarticular pathoses plague the clinical course of many patients with Gaucher disease. Osseous lesions involving the jaws have been described, usually as isolated case reports. The purpose of this study was to ascertain the nature and extent of mandibulo-maxillofacial pathosis in 28 patients with documented Gaucher disease by means of panoramic radiography. Twenty-five of the 28 patients displayed radiographic evidence of jaw involvement. The most prevalent finding was gross widening of marrow spaces; frank radiolucencies, endosteal scalloping, cortical thinning, root resorption, and inferior displacement of the mandibular canal or effacement of its cortices were also seen. A previously unreported finding was delayed eruption of permanent teeth, which was seen in more than one half of the patients who were under 20 years of age. Osseous changes throughout the jaws may be more common than previously suspected and may alert the dentist to the presence of the disease.

Adolescent↗
PubMed1999

Dental root resorption.

This article presents a review of physiologic mechanisms involved in various types of root resorption that may be encountered clinically. Included is a brief overview of suggested homeostatic mechanisms of the periodontal ligament and the role of the intermediate cementum in inhibiting root resorption. Root resorption (surface, inflammatory, and replacement) associated with traumatic injuries is discussed, with emphasis on etiology and the ability to provide treatment. The final discussion relates to other types of resorption, based on a classification of internal, cervical, and external resorption associated with periradicular pathosis and resulting from pressure in the periodontal ligament.

Humans↗
PubMed1999

Periodontal repair in dogs: histologic observations of guided tissue regeneration with a prostaglandin E1 analog/methacrylate composite.

This report describes observations of healing following guided tissue regeneration (GTR) including surgical implantation of the prostaglandin E1 analog misoprostol with calcium-layered methacrylate particles. Critical size, supra-alveolar periodontal defects were surgically created around the 3rd and 4th mandibular premolar teeth in 4 beagle dogs. Wound management included soaking with a 24 microg/ml misoprostol solution and implantation of the misoprostol/methacrylate composite. One jaw quadrant per animal was prepared for GTR using expanded polytetrafluoroethylene membranes. The gingival flaps were coronally advanced and sutured to submerge the teeth. The tissues covering the surgical sites daily received topical misoprostol in an oral adhesive over the 4-week healing interval. Upon euthanasia, tissue blocks were prepared for histometric analysis of regeneration of alveolar bone and cementum, root resorption and ankylosis. The defect area underneath the membrane and the density of methacrylate particles were recorded for the GTR defects. The methacrylate particles appeared encapsulated in a dense connective tissue without signs of an inflammatory reaction, some in contact to newly formed bone. Alveolar bone regeneration height averaged (+/-SD) 1.2+/-1.0 and 1.0+/-0.6 mm for GTR and non-GTR defects, respectively. Corresponding values for bone regeneration area were 1.3+/-1.0 and 0.7+/-0.5 mm2. Cementum regeneration was confined to the apical aspect of the defects. Small areas of root resorption and ankylosis were observed for all teeth. Bone regeneration area correlated positively to the defect area and negatively to the density of methacrylate particles in the GTR defects. The histologic observations suggest that the methacrylate composite has marginal potential to promote bone and cementum regeneration under provisions for GTR.

Alveolar Bone Loss↗
PubMed1999

Periodontal repair in dogs: effect of rhBMP-2 concentration on regeneration of alveolar bone and periodontal attachment.

The objective of this study was to evaluate the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) concentration on regeneration of alveolar bone and cementum, and on associated root resorption and ankylosis. Contralateral, critical size, supra-alveolar, periodontal defects were surgically produced and immediately implanted with rhBMP-2 in an absorbable collagen sponge (ACS) carrier in 8, young adult, male, beagle dogs. 6 animals received rhBMP-2/ACS (rhBMP-2 at 0.05, 0.10, or 0.20 mg/mL; total construct volume/defect approximately 4.0 mL) in contralateral defects following an incomplete block design. 2 animals received rhBMP-2/ACS (rhBMP-2 at 0 and 0.10 mg/mL) in contralateral defects (controls). The animals were euthanised at 8 weeks post-surgery and block sections of the defects were collected for histologic and histometric analysis. Supra-alveolar periodontal defects receiving rhBMP-2 at 0.05, 0.10, or 0.20 mg/ml exhibited extensive alveolar regeneration comprising 86%, 96%, and 88% of the defect height, respectively. Cementum regeneration encompassed 8%, 6%, and 8% of the defect height, respectively. Root resorption was observed for all rhBMP-2 concentrations. Ankylosis was observed in almost all teeth receiving rhBMP-2. Control defects without rhBMP-2 exhibited limited, if any, evidence of alveolar bone and cementum regeneration, root resorption, or ankylosis. Within the selected rhBMP-2 concentration and observation interval, there appear to be no meaningful differences in regeneration of alveolar bone and cementum. There also appear to be no significant differences in the incidence and extent of root resorption and ankylosis, though there may be a positive correlation with rhBMP-2 concentration.

Absorbable Implants↗
PubMed2001

Generalized cervical root resorption associated with periodontal disease.

UNLABELLED: BACKGROUND AND DESCRIPTION OF CASE: The etiology and pathogenesis of generalized cervical root resorptions is not well understood. In the present report, a case of severe cervical root resorption involving 24 anterior and posterior teeth is presented. The lesions developed within a period of 2 years after the patient had changed to an acid-enriched diet. They extended far into the coronal dentin and were associated with gingival inflammation and crestal bone resorption. However, no generalized clinical attachment loss had occurred. Culturing of subgingival plaque revealed the presence of several putative periodontal pathogens among which Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. Treatment consisted of mechanical debridement supported by systemic antibiotics (amoxycillin plus metronidazole) and dietary advice. RESULTS: Within 1 year after the onset of treatment, all resorptive lesions had repaired by ingrowth of a radio-opaque mineralized tissue. The crestal areas showed radiological evidence of bone repair. 3 years after the onset of therapy, one premolar was extracted and examined histologically. It appeared that irregularly-shaped masses of woven bone-like tissue had invaded into the domain of the resorbed coronal dentin and were bordered by thin layers of acellular cementum. CONCLUSION: It is concluded that, in this patient, the cervical resorptions were likely the result of an osteoclastic response extending into the roots because the root-protective role of the junctional epithelium did not develop. We hypothesize that this was due to the combined effects of a periodontopathogenic microflora and a dietary confounding factor.

Acids↗
PubMed2003

Expression and role of RANKL in periodontal ligament cells during physiological root-resorption in human deciduous teeth.

Although important roles of receptor activator of NF-kappaB ligand (RANKL) and its receptor (RANK) have been established for osteoclastogenesis and bone resorption, their expression and roles during physiological root resorption remain uncertain. Physiological root resorption for shedding of human deciduous teeth is mediated by osteoclast-like cells (odontoclasts). In this study, we examined the expression of RANKL and osteoprotegerin (OPG), a decoy receptor that prevents RANKL from binding to RANK in human periodontal ligament (PDL) cells during physiological root resorption using immunocytochemistry and reverse transcriptase polymerase chain reaction. The effect of RANKL on root resorbing activity of odontoclasts was evaluated by measuring the size of dissolved area on calcium phosphate-coated coverslips. The PDL cells isolated from either non-resorbing deciduous teeth or permanent teeth abundantly expressed OPG, but not RANKL. In contrast, PDL cells derived from resorbing deciduous teeth dominantly expressed RANKL. Human odontoclasts derived from resorbing deciduous teeth expressed both RANKL and RANK. It was observed that RANKL increased odontoclast actin ring formation and resorbing activity in a dose-dependent manner. These results indicate that PDL cells during the root-resorbing state express RANKL but decrease OPG expression. Expression of RANKL likely participates in odontoclastogenesis and activates physiological root resorption.

Actins↗
PubMed2002

Clinical and epidemiological study of traumatic root fractures.

The aim of this work was to study the prevalence and clinical presentation of root fractures in a series of patients with dental trauma. Treatment strategies were classified and outcomes after a 6-month period presented. The study population comprised 76 patients (between the ages of 2 and 55 years) with 93 root fractures in their teeth (18 primary, 75 permanent). Data were collected following the taking of a detailed clinical history, objective clinical examination and photographic and radiological investigation. Since most of the primary teeth were extracted, only cases with root fracture of permanent teeth were followed-up: in all, 24 patients with 31 teeth with root fractures. The prevalence of root fractures in permanent teeth was 7.7% of all injuries, while in primary teeth it was 3.8%. The most frequently involved teeth were the maxillary incisors with a percentage of 75% in permanent teeth. Moreover, 40% of root fractures in permanent teeth were associated with fracture of the alveolar bone and of the soft tissues and in 45% of cases, the adjacent teeth were also injured. The results of this study reaffirm the necessity for scrupulous diagnosis of teeth after a traumatic injury. Adjacent teeth and those in the opposing arch should not be ignored. Treatment is multidisciplinary, requiring surgical, orthodontic, operative and prosthetic compliance. Periodic check-up is essential.

Adolescent↗
PubMed2003

Effect of minocycline on healing of replanted dog teeth after extended dry times.

Minocycline is available as a locally administered tetracycline derivative antibiotic (Arestin, OraPharma, Inc., Warminster, PA, USA) which demonstrated antibacterial activity and anti-inflammatory action that may slow down resorptive processes after severe traumatic injuries to the dentition. A total of 48 premolar roots of six mongrel dogs were instrumented in an aseptic fashion with rotary nickel-titanium files and obturated with vertically condensed warm gutta percha. All accesses were sealed with glass ionomer, the roots extracted and then allowed to bench dry for 60 min. Group 1 consisted of 15 roots that were coated with minocycline and replanted and nine roots that were replanted without minocycline. Group 2 consisted of 24 roots, all of which were prepared with a uniform cemental defect down to sound dentin along the lateral aspect of the root, with a high-speed bur following the 60-min dry time. Half of the roots (12) were then coated with minocycline and replanted, and the other 12 roots were replanted without minocycline. After 4 months, the dogs were killed and the roots prepared for histological evaluation. About 5- microm thick cross-sections of the root and surrounding tissue taken every 90 microm were evaluated for healing. In addition, residual root mass was also measured in the roots of group 1 to determine the extent of root structure loss for each treatment method. The roots with and without minocycline treatment showed no significant differences between the remaining root mass or the percentage of favorably healed root surfaces. The use of minocycline is not currently recommended for prevention or attenuation of external root resorption following avulsion in a dog trauma model.

Animals↗
PubMed2001

Radiographic diagnosis of root resorption in relation to orthodontics.

The literature regarding external root resorption in relation to orthodontics and its radiographic diagnosis is reviewed, including a summary of the more common radiographic techniques available. Sample cases are presented which demonstrate the need for good radiographic technique and an awareness of the limitations of certain radiographs. A provisional diagnosis of external root resorption may need to be confirmed by further radiographic views where appropriate.

Humans↗