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PubMed1996

Radiographic reconstruction of root morphology in skeletonized remains: a case study.

This is a case study in the application of a laboratory technique first described by Dr. Brion C. Smith in the Journal of Forensic Sciences in January 1992. Our study evaluated a human skull that showed perimortem and/or postmortem tooth loss. It was discovered in 1991 and deemed to have no usable dental information due to severe alveolar bone destruction. In 1994, using minor modifications of Dr. Smith's technique, we sealed off the open tooth sockets and injected a radiopaque material which, after radiographic analysis, revealed previously unobserved dental information. This report demonstrates that root morphology can be reconstructed. This yields radiographic information that may be useful in the identification of unknown human remains.

Adult↗
PubMed2005

Hyperbaric oxygen therapy for late radiation tissue injury.

BACKGROUND: Cancer is a significant global health problem. Radiotherapy is a treatment for many cancers and about 50% of patients having radiotherapy with be long-term survivors. Some will experience LRTI developing months or years later. HBOT has been suggested for LRTI based upon the ability to improve the blood supply to these tissues. It is postulated that HBOT may result in both healing of tissues and the prevention of problems following surgery. OBJECTIVES: To assess the benefits and harms of HBOT for treating or preventing LRTI. SEARCH STRATEGY: We searched The Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2004, MEDLINE, EMBASE, CINAHL and DORCTHIM (hyperbaric RCT register) in September 2004. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the effect of HBOT versus no HBOT on LRTI prevention or healing. DATA COLLECTION AND ANALYSIS: Three reviewers independently evaluated the quality of the relevant trials using the guidelines of the Cochrane Handbook Clarke 2003) and extracted the data from the included trials. MAIN RESULTS: Six trials contributed to this review (447 participants). For pooled analyses, investigation of heterogeneity suggested important variability between trials. From single studies there was a significantly improved chance of healing following HBOT for radiation proctitis (relative risk (RR) 2.7, 95% confidence Interval (CI) 1.2 to 6.0, P = 0.02, numbers needed to treat (NNT) = 3), and following both surgical flaps (RR 8.7, 95% CI 2.7 to 27.5, P = 0.0002, NNT = 4) and hemimandibulectomy (RR 1.4, 95% CI 1.1 to 1.8, P = 0.001, NNT = 5). There was also a significantly improved probability of healing irradiated tooth sockets following dental extraction (RR 1.4, 95% CI 1.1 to 1.7, P = 0.009, NNT = 4). There was no evidence of benefit in clinical outcomes with established radiation injury to neural tissue, and no data reported on the use of HBOT to treat other manifestations of LRTI. These trials did not report adverse effects. AUTHORS' CONCLUSIONS: These small trials suggest that for people with LRTI affecting tissues of the head, neck, anus and rectum, HBOT is associated with improved outcome. HBOT also appears to reduce the chance of osteoradionecrosis following tooth extraction in an irradiated field. There was no such evidence of any important clinical effect on neurological tissues. The application of HBOT to selected patients and tissues may be justified. Further research is required to establish the optimum patient selection and timing of any therapy. An economic evaluation should be also be undertaken. There is no useful information from this review regarding the efficacy or effectiveness of HBOT for other tissues.

Humans↗
PubMedDate not supplied

[Tooth extraction in patients suffering from hemophilia A under the cover of cryoprecipitates and epsilon-aminocaproic acid].

Tooth extractions were carried out in 75 patients with haemophilia A after infusion of a single dose of cryoprecipitate and 4 g of epsilon-aminocaproic acid. During the 7-10 day period of follow-up, the patients received epsilon-aminocaproic acid by mouth. In 32 of 44 patients with severe or moderate haemophilia and in 22 of 31 patients with mild haemophilia, healing was uneventful and no bleeding complications occurred. Only in 5 patients with severe haemophilia and in 1 patient with mild heamophilia bleeding from tooth sockets was extensive enough to require further replacement therapy. The results show that epsilon-aminocaproic acid in conjunction with a single infusion of cryoprecipitate can insure hemostasis after dental extraction in patients with haemophilia A.

Adolescent↗
PubMed2001

The importance of drug delivery to optimize the effects of bone morphogenetic proteins during periodontal regeneration.

Bone morphogenetic proteins (BMPs) include a large number of proteins belonging to the TGF-beta superfamily which are characterized by their ability to induce bone and cartilage formation. Since the isolation and purification of BMPs by recombinant technology, the effects of single BMPs can now be evaluated in animal models. Subcutanous placement of a single recombinant BMP, such as recombinant human (rh) BMP-2, in a rat ectopic assay shows recruitment of undifferentiated mesenchymal cells, cartilage formation, followed by replacement with bone, formation of its own bone marrow and physiological bone remodelling. The therapeutic use of recombinant BMPs in the treatment of periodontal disease (destruction of the tooth ligaments, surrounding bone and tooth cementum, the latter of which anchors the ligaments to the tooth surface from the adjacent tooth socket) has attracted considerable interest due to their potent ability to stimulate intramembranous bone formation without an endochondral intermediate. Their predictability in stimulating new bone may provide an alternative that has greater osteogenic potential than autogenous bone, other growth factors and bone substitutes. The biological processes and the potential role of growth factors involved in promoting regeneration are complicated by the involvement of different cell types each with their different growth rates and responses to various stimuli. The major cell types involved in periodontal regeneration include osteoblasts, cementoblasts and fibroblasts. Here, the formation of the new mineralized layers on the tooth and bone surfaces by cementoblasts and osteoblasts respectively are a prerequisite before periodontal ligament formation and attachment by fibroblasts can occur. In this regard, BMPs are likely candidates to stimulate periodontal regeneration because of their ability not only to promote osteogenesis but also to stimulate cementogenesis (new cementum formation). However, understanding when to manipulate each of the various cells differentiation pathway with the application of single or multiple doses of BMPs at the appropriate concentration is dependent upon a suitable delivery system that can be modified in order to optimize its effect during periodontal wound healing. Furthermore, treatment of intrabony periodontal defects with BMPs are likely to not only require appropriate temporal release of the agent, but also adaptation of a carrier that is robust enough to maintain its integrity around the coronal aspect of the root in order to provide space maintenance and support the mucoperiosteal flap. This review evaluates the effects of different delivery systems upon BMP-induced periodontal regeneration.

Animals↗
PubMed1989

Intra-oral tumours presenting after dental extraction.

If the symptoms for which dental extraction is performed do not rapidly resolve, or if the tooth socket fails to heal, it is likely that there is further pathology in the alveolus or gingiva. A series of four cases is presented, in which, following dental extraction, a tumour was found to be the cause of the original symptoms.

Adult↗
PubMed1983

Dental formulae and dental eruption patterns in Parapithecidae (Primates, Anthropoidea).

The eruption sequence for the lower teeth of Apidium phiomense based on 18 juvenile specimens is dP3, dP4, M1, M2, P2, P4, (P3, M3), C. Only five specimens of Parapithecus grangeri show developing lower teeth. P2, M1, and M2 all erupted before P3 and P4; C and M3 were the last cheek teeth to erupt. Late eruption of the lower canines in parapithecids is a possible shared derived resemblance linking these species with Anthropoidea and Adapidae and distinguishing both from Omomyidae, Tarsiidae, and tooth-combed lemurs. Late eruption of M3 in parapithecids is a shared derived resemblance with Anthropoidea alone. The lower dental formula of Apidium phiomense is confirmed as 2 X 1 X 3 X 3 by additional specimens which show the incisors. Based in part on tooth socket counts, the deciduous lower dental formula was 2 X 1 X 3. New specimens of Parapithecus grangeri now demonstrate an adult mandibular dental formula of 0 X 1 X 3 X 3 (not 2 X 1 X 3 X 3 as previously thought) and a juvenile formula of 1 X 1 X 3. The number of incisors possessed by Parapithecus fraasi is again open to debate. Material is insufficient to judge whether this species had a pair of incisors in each lower jaw quadrant, by analogy with Apidium, or had undergone reduction to just one incisor. In any event, the presence of two incisors in another parapithecid Apidium shows anterior tooth reduction of Parapithecus grangeri occurred independent of, and should not be considered a shared derived similarity with, Tarsiidae, as was once thought.

Animals↗
PubMed1994

The efficacy of locally applied morphine in post-operative pain after bilateral third molar surgery.

1. Recent evidence has hinted at a peripheral site of action of morphine analgesic efficacy. 2. Previous studies by the same authors have developed a model for testing local analgesic efficacy by placing drugs into tooth sockets after third molar surgery. 3. The present studies test the hypothesis of local morphine activity at two dosage concentrations, 100 ng ml-1 and 100 micrograms ml-1 after third molar surgery. 4. No significant analgesic efficacy was found at either dose when compared with placebo.

Administration, Oral↗
PubMed1993

The use of third molar surgery in clinical pharmacology.

This review discusses the various sequelae that arise after third molar surgery and their use for assessing the efficacy of a variety of therapeutic measures. The surgical procedure provides an opportunity to investigate onset, depth, duration and possible systemic effects of local anaesthetic solutions. Also, the anxiety which often accompanies such surgery lends itself to the appraisal of different anxiolytic agents and sedation techniques. The immediate postoperative sequelae of pain, buccal swelling and trismus provides a useful clinical model for evaluating the efficacy of analgesics and anti-inflammatory drugs. Third molar tooth sockets are susceptible to infection and this propensity enables the assessment of different antibiotic regimens. A further advantage of the third molar model is its application for crossover studies, with the patient acting as their own control. Very few surgical procedures afford this facility, which further adds to the value of this model in clinical pharmacology.

Analgesics↗
PubMed2000

Fetal cleft lip and palate detection by three-dimensional ultrasonography.

OBJECTIVES: To demonstrate a standardized approach for the evaluation of cleft lip and palate by three-dimensional (3D) ultrasonography. DESIGN: This was a retrospective study of seven fetuses with confirmed facial cleft anomalies. Post-natal findings were compared to a blinded review of 3D volume data from abnormal fetuses with seven other normal fetuses that were matched for gestational age. Upper lip integrity was examined by 3D multiplanar imaging. Sequential axial views were used to evaluate the maxillary tooth-bearing alveolar ridge contour and anterior tooth socket alignment. Alveolar ridge disruption suggested cleft palate. Premaxillary protrusion, either by multiplanar imaging or surface rendering, indicated bilateral cleft lip and palate. RESULTS: Post-natal findings confirmed bilateral cleft lip and palate (four cases), unilateral cleft lip and palate (one case), and unilateral cleft lip (two cases). Multiplanar review identified all three fetuses with unilateral cleft lip, three of four fetuses with bilateral cleft lip, one fetus with unilateral cleft palate, and three of four fetuses with bilateral cleft palate. Surface rendering correctly identified all cleft lips, with the exception of one fetus, who was thought to have a unilateral cleft lip and palate, despite the actual presence of a bilateral lesion. One cleft palate defect was directly visualized by 3D surface rendering. No false-positives occurred. CONCLUSION: Interactive review of standardized 3D multiplanar images allows one to evaluate labial defects, abnormalities of the maxillary tooth-bearing alveolar ridge, and presence of premaxillary protrusion for detecting cleft lip and palate anomalies. Surface rendering may increase diagnostic confidence for normal or abnormal studies. This technology provides an array of visualization tools that may improve the prenatal characterization of facial clefts, particularly of the palate.

Cleft Lip↗
PubMed1997

Effects of fibrin adhesive material (Tissucol) on alveolar healing in rats under stress.

The effects of Tissucol on alveolar healing following stress were evaluated histologically, comparing three groups of 28 male albino rats each. Stress was applied and their right upper incisors were extracted. Group A served as an empty control site. In Group B, Tissucol was applied into the alveolar cavity. Group C received local antifibrinolytic treatment (alveolar irrigation with epsilon-aminocaproic acid solution) before implant of Tissucol into the tooth socket. Four animals in each group were killed at 1, 3, 6, 9, 15, 21 and 24 days after surgery. Results showed that: 1) Tissucol did not interfere with connective and osseous tissue formation; 2) Tissucol allowed new bone formation; 3) Tissucol residues in Group B in sections of 24-day specimens did not impair healing; 4) Tissucol was usually completely resorbed and healing was complete 24 days after surgery in Group C.

Alveolar Process↗
PubMed1989

Primary wound closure in haemophiliacs undergoing dental extractions.

215 teeth were extracted in 62 haemophiliacs following a single infusion of factor VIII supplemented with antifibrinolytics. Tooth sockets were packed with Sorbacel gauze soaked with an antifibrinolytic. 1 group was sutured and the other left open. Primary closure of the extraction wound did not show direct effect on haemostasis. However, the size of the clot showed a statistically significant difference between the primary closure and open wound groups. The authors conclude that primary closure of the extraction wound protects the blood clot, makes the postoperative period more comfortable for patients and may subsequently decrease the risk of postoperative bleeding.

Administration, Topical↗
PubMed1978

A histologic study of age changes in the adult human periodontal joint (ligament).

This study evaluated the histological age changes in 80 periodontal joints from 24 human cadavers ranging in age from 20 to 90 years. The limitations of such a descriptive study were reviewed to prevent overextrapolation of the findings to whole populations. In the young speciments, the bone surface of the tooth socket was smooth and regular with the insertion of Sharpey's fibers evenly distributed in the woven bone. Interstitial lamellae were found between secondary osteons in the alveolar bone. Copious periodontal fibers passed around small vascularized interstitial spaces to insert evenly into the cementum as Sharpey's fibers. Numerous cells, probably fibroblasts, were present within and between the fiber bundles. Like the bone surface, the cemental surface was smooth and regular. Both cellular and acellular cementum were present. Cemental splits were found both intracementally and at the cemento-dentinal junction. In the older specimens, the periodontal surface of the alveolar bone was jagged and uneven with Sharpey's fibers inserting irregularly into the woven bone. Subjectively an increased amount of internal remodeling was seen in the periodontal bone. A relative decrease in both suspensory fibers and cellular content was noted in the periodontal ligaments of the older specimens. Large vascularized interstitial spaces encroached upon areas formerly occupied by periodontal fibers and bone. Fat cells also were observed replacing the suspensory fibers. The cementum showed an irregular surface into which Sharpey's fibers were unevenly inserted. Both cellular and acellular cementum were present, and cemental splits were seen with the same frequency as in the young specimens. There was a tendency for greater cemental apposition, particularly in the apical region of the tooth. In many respects the aging periodontal joint showed atrophic and degenerative changes similar to those in cranio-facial sutures. However, these changes did not include either bony ankylosis or osteoporosis related to increasing age. In summary, the periodontal joints of the younger specimens were well organized while those of the older specimens showed a more irregular structure and a decrease in fiber and cellular content. Intermediate changes were seen in the intermediate age groups.

Adult↗
PubMed1992

Influence of anticoagulation on blood loss following dental extractions.

The coagulation activity level at which oral surgery procedures can be performed in anticoagulated patients without triggering bleeding complications and without enhancing the risk of developing thrombo-embolic events remains controversial. The objective of the present study was to evaluate blood loss following dental extractions at different levels of anticoagulation and to determine its effect on wound closure rates. Blood loss was measured following the removal of four front teeth in warfarinized rabbits. Immediate blood loss was evaluated by determining the tooth socket bleeding times and by using a technique based on hemoglobin determinations. Long-term blood loss was assessed by comparison of labeled red-blood-cell disappearance curves. The results showed that blood loss following dental extractions was significantly greater in animals anticoagulated at a therapeutic level than in non-anticoagulated control animals. Determination of blood loss at different levels of anticoagulation clearly demonstrated that complete correction of the coagulation activity was unnecessary. Partial correction (INR values of 1.6-1.8) allowed extractions to be performed without extensive blood loss. With this technique of partial correction, the period of interruption of the anticoagulation could be kept very short, and the risk of postoperative bleeding complications was minimal. Wound closure rates were negatively influenced in anticoagulated animals.

Analysis of Variance↗
PubMedDate not supplied

Osseointegrated dental implants as alternative therapy to bridge construction or orthodontics in young patients: seven years of clinical experience.

Young patients often require fixed bridgework or orthodontic therapy in cases of traumatic tooth loss or congenitally missing teeth. Dental implants represent an alternative to the more conventional treatment methods. We report positive experience over a seven-year period with 42 titanium Ha-Ti implants in 34 patients aged 9 to 18 years. Fourteen implants were placed into prepared tooth sockets immediately after traumatic luxation of anterior teeth in 12 patients aged 9 to 18 years (median age 16). An additional 22 patients (median age 15.5, range 11 to 18) also received implants (N = 28), but these were placed only after healing of extraction sites, or as substitutes for congenitally missing teeth. Implants remained in situ for an average of 7.7 months before loading. During the healing period, three implants were lost due to additional trauma and one became infected. The 38 remaining implants osseointegrated and since have been loaded for five to 79 months in successful function. There was no difference between immediate and delayed implants in clinical success. These experiences demonstrate that appropriate, versatile, osseointegrated implants can provide a successful treatment method for young patients, without damaging adjacent teeth.

Adolescent↗
PubMed2005

Effects of essential fatty acid deficiency on periodontal tissue adaptation to spontaneous tooth migration.

Essential fatty acids (EFAs) play a significant role in bone metabolism. Herein we studied the adaptation of alveolar bone to physiologic tooth drift in young rats deprived of essential fatty acids from birth. Reductions in femur size and trabecular bone volume reflected body growth impairment. Along the alveolar wall, osteoclastic resorption and bone formation were depressed, disrupting the adaptive deformation of the tooth socket to ongoing migration. As a result, the periodontal ligament narrowed considerably, and further adaptation was achieved through root resorption. Essential fatty acid deficiency (EFAD), did not affect precursor recruitment or differentiation in the periodontal ligament (PDL), but caused redistribution of nonspecific-esterase (NSE)-positive osteoclast precursors and tartrate-resistant acid phosphatase (TRAP)-positive pre-osteoclasts between the bone compartment (which was depleted) and the root compartment (which was enriched). EFAD had also a marked effect on the PDL vasculature; the number of vessels was reduced, whereas their size was markedly increased. As a whole, our results show that EFAD disturbs alveolar bone adaptation to drift, but that a reaction (detrimental to root integrity) prevents root collision with the bone surface, thereby preserving the PDL as a source of precursor cells for bone and cementum homeostasis. Moreover, our results confirm that although alveolar bone resorption is arachidonic acid-dependent, the factors activating root resorption are different.

Animals↗
PubMed1992

Three-dimensional finite element stress analysis of the dentate human mandible.

The biomechanical events which accompany functional loading of the human mandible are not fully understood. The techniques normally used to record them are highly invasive. Computer modelling offers a promising alternative approach in this regard, with the additional ability to predict regional stresses and strains in inaccessible locations. In this study, we built two three-dimensional finite element (FE) models of a human mandible reconstructed from tomographs of a dry dentate jaw. The first model was used for a complete mechanical characterization of physical events. It also provided comparative data for the second model, which had an increased vertical corpus depth. In both cases, boundary conditions included rigid restraints at the first right molar and endosteal cortical surfaces of the articular eminences of temporal bones. Groups of parallel multiple vectors simulated individual masticatory muscle loads. The models were solved for displacements, stresses, strains, and forces. The simulated muscle loads in the first model deformed the mandible helically upward and toward its right (working) side. The highest principal stresses occurred at the bite point, anterior aspects of the coronoid processes, symphyseal region, and right and left sides of the mandibular corpus. In general, the observed principal stresses and strains were highest on the periosteal cortical surface and alveolar bone. At the symphyseal region, maximum principal stresses and strains were highest on the lower lingual mandibular aspect, whereas minimum principal stresses and strains were highest on its upper labial side. Subcondylar principal strains and condylar forces were higher on the left (balancing or nonbiting) side than on the right mandibular side, with condylar forces more concentrated on the anteromedial aspect of the working-side condyle and on the central and lateral aspects of the left. When compared with in vivo strain data from macaques during comparable biting events, the predictive strain values from the first model were qualitatively similar. In the second model, the reduced tensile stress on the working-side, and decreased shear stress bilaterally, confirmed that lower stresses occurred on the lower mandibular border with increased jaw depth. Our results suggested that although the mandible behaved in a beam-like manner, its corpus acted more like a combination of open and closed cross sections due to the presence of tooth sockets, at least for the task modelled.(ABSTRACT TRUNCATED AT 400 WORDS)

Computer Simulation↗
PubMed1986

Epithelial differentiation at the edentulous alveolar ridge in man. A stereological study.

The epithelial lining of the mucosa of the edentulous, maxillary alveolar ridge was subjected to an ultrastructural and stereological analysis. Four biopsies collected from the non-inflamed crest, i.e., the center over former tooth sockets, in non-denture-wearing female patients 30 to 55 years of age were processed for light and electron microscopy. At the light-microscopic level, epithelial thickness was determined histometrically. Electron micrographs were sampled at two levels of magnification, from five strata in regions of epithelial ridges and from three strata over connective tissue papillae. Standardized stereological point-counting techniques were employed to analyze a total of 990 electron micrographs. Observations and data revealed that at the alveolar ridge the oral epithelium is truly keratinizing and comprises four strata including a 40 +/- 5 micron-thick stratum corneum, which displays the oral keratin pattern. The histo- and cytodifferentiation were peculiar: (1) Compared to the neighbouring gingival and hard palate epithelium, that of the alveolar crest was markedly thicker, with elongated rete ridges indicating acanthosis. (2) The cytoarchitecture was identical neither to the gingival nor to the hard palate epithelium but revealed a mixture of features typical for either of these two epithelia. Reasons for this are explained on the basis of factors, possible genetic, inherent in epithelial cells that are possibly derived from both the gingival and the palatal environment.

Adult↗
PubMed1999

Interleukin-1beta-induced release of matrix proteins into culture media causes inhibition of mineralization of nodules formed by periodontal ligament cells in vitro.

The mechanism by which interleukin-1beta (IL-1) inhibits the formation of mineralized tissue nodules by periodontal ligament (PDL) cells in vitro was investigated through the processes of morphological analysis, immunoprecipitation, and Northern blot analysis. PDL cells were obtained from a 2-day-old coagulum in tooth socket and cultured in Dulbecco's Modified Eagle Medium (DMEM) containing 10% fetal bone serum (FBS) and antibiotics. Confluent cells were grown for up to 3 weeks in the presence of ascorbic acid (AA), beta-glycerophosphate (GP), and dexamethasone (Dex), or IL-1. PDL cells cultured in the presence of GP and AA did not differentiate, but those treated with Dex, GP, and AA (Dex group) underwent differentiation, showing four stages (confluent, multilayer, nodule, and mineralization) of disparate morphological characteristics. In contrast, the cells treated with IL-1, Dex, GP, and AA (IL-1 group) did form multilayers but failed to form mineralized nodules. Electron microscopy demonstrated that the Dex-induced mineralized nodules contain multilayers of fibroblastic cells, numerous collagen fibrils, and dense globular as well as fused electron dense patches that are associated with numerous apatite crystals. The nodule-like structures in the IL-1 group were also comprised of multilayered fibroblastic cells, but they contained only a small number of collagen fibrils, and no dense globular or fused patches. Von Kossa staining confirmed the presence of numerous mineralized nodules in the Dex group and their scarceness in the IL-1 group. Northern blot analysis of IL-1-treated cells, however, revealed the presence of mRNAs for type I collagen (Col I), secreted protein, acidic and rich in cysteine (SPARC), osteopontin (OPN), alkaline phosphatase (ALP), bone sialoprotein (BSP), and osteocalcin (OC), whose expression patterns and levels were comparable to those of the Dex group. Immunoprecipitation analysis of OPN and BSP in the cell/matrix layers and the culture media after [35S]-methionine labeling showed their deposition primarily in the mineralized nodules of the Dex group, and their release into the media in the IL-1 group. Immunogold labeling demonstrated the location of OPN and BSP in mineralized nodules of the Dex group, but no significant labeling occurred in the nodule-like structures from the IL-1 group. Interestingly, IL-1 treatment increased the expression of collagenase mRNA by sevenfold, compared with that of the Dex group. These data suggest that the IL-1-induced formation of unmineralized nodules by PDL cells results not so much from the downregulated formation of matrix proteins, which plays a crucial role in the mineralization process, as from their release into the culture media. Finally, collagenase synthesis upregulated by IL-1 may be involved in this process.

Animals↗