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PubMed1987

Ability of edentulous human beings to adapt to changes in vertical dimension.

The ability of ten edentulous patients and one patient with a full upper removable denture and a full arch (16-26) lower fixed denture to adapt to sudden change of the interocclusal distance was tested. An upper acrylic bite splint was inserted which, on average, increased the vertical dimension of the face by approximately twice the mean interocclusal distance during relaxation. After this procedure all patients quickly acquired an unstrained new postural position of the mandible. Directly after insertion, when instructed to relax, all patients hit the lower surface of the splint. They seemed, however, to need only one such experience to adapt to the increased interocclusal distance. The second time they repeated the procedure none of them touched the splint. Instead a new postural position was established with a mean interocclusal distance of 3.3 mm. This fast re-programming of jaw muscle tonus and length is assumed to be a response to different peripheral receptor discharge converging to the cerebellum and other programming centres. The present study on edentulous patients shows that afferent discharge from periodontal receptors is not a necessary prerequisite. It also confirms that the old concept of consistency of the mandibular postural position (Thompson, 1946) is erroneous.

Adaptation, Physiological↗
PubMed2003

Intentional replantation for periodontally involved hopeless teeth.

The aim of this study was to evaluate the clinical and radiographic results of intentional replantation of periodontally involved teeth after conditioning of root surfaces with tetracycline-HCl. Thirteen patients (seven female, six male; age range: 35-52 years) with 15 periodontally involved hopeless teeth were included in this study. During the replantation procedure, the affected teeth were gently extracted, then the granulation tissues, calculus, remaining periodontal ligament and necrotic cementum on the root surfaces were removed. Tetracycline-HCl, at a concentration of 100 mg ml(-1), was applied for 5 min to the root surfaces. The teeth were then replaced into the socket and splinted. Patients were clinically and radiographically evaluated at baseline (time of surgery) and 6 months after the surgery. The following measurements were recorded: probing depth (PD), gingival recession (R), the amount of bone loss (BL) and bone gain (BG). Results indicated a reduction in PD and in the amount of bone loss and healthy gingiva. Mean PD was decreased from 5.25 to 2.36 mm, gingival recession was increased from 3.73 to 4.0 mm, and BL was reduced from 73.20 to 56.86%. At the end of 6 months, no root resorption or ankylosis was observed radiographically. Even during the short period of evaluation, it may be suggested that intentional replantation can be an alternative approach to extraction in cases where advanced periodontal destruction is present and no other treatments could be considered.

Adult↗
PubMed1975

Craniomaxillary orthopedic correction with en masse dental control.

Craniomaxillary (high-pull) traction is a well-established part of today's orthodontic armamentarium. It is useful in a wide range of problems involving excessive anterior and/or downward displacement of one or more components of the maxillary complex. Such growth-related problems are most amenable to correction during the active growing period; in fact, optimum improvement is often attainable only during this period. Attachment of these devices by means of cemented orthodontic appliances is limited in some developmental stages by the teeth available for banding. It is limited at all ages by the tolerance of the periodontal ligament of the attachment teeth. In terms of over-all maxillary change, the locations of the banded teeth further restrict the orientation and application of therapeutic forces. A rigid splint precisely engaging all or part of the upper dentition expands the potential applications of this form of traction in terms of age range, force levels, and force orientation. This is basically an orthopedic applicance with concurrent orthodontic effects. In contrast to the gross destructive effects experienced in early applications of the Milwaukee brace, the application of force with this appliance can be planned to redirect maxillary growth and occlusal relationships from often progressively dysplastic patterns to a more harmonious over-all functional relationship among all facial structures. The resultant interplay of orthopedic and orthodontic effects makes close orthodontic supervision and care essential throughout the treatment and post-treatment periods. This is especially important because some of the orthodontic side effects may be unfavorable. Failure to anticipate and plan for control of these effects could be disastrous. Occasions for its use as the sole therapeutic measure are rare. The nature of treatment with this appliance is such that in most cases it must be used as a discrete stage of a comprehensive treatment plan, either before or after other orthodontic measures or both. It is poorly suited to simultaneous combination with other orthodontic appliances operating on the same teeth. Its value lies in careful coordination with the other phases, using each where and when it will be most effective. The cases reported here illustrate only the changes accomplished during such isolated treatment stages; they do not represent the total orthodontic effort required for these patients.

Acrylic Resins↗
PubMed1989

[Effects of a modified Bonwill clasp on the marginal gingiva].

The effects of a modified Bonwill clasp on periodontal health have been studied for an observation period of 2 years. The results indicate that oral hygiene is more important than the dimensions of the clasp. It was only in cases with less than 2 mm distance between clasp and gingiva that a direct effect could be recognized. At the same time, this modified clasp seems to have a splinting effect, due to the superior transmission of masticatory forces. Further studies on clasp dimensions and the indications for this modified Bonwill clasp will, however, be necessary.

Dental Abutments↗
PubMed1990

Modification of osseointegrated implants for distal-extension prostheses.

The use of a distal implant abutment splinted to a natural tooth by a fixed partial denture has been employed for distal-extension prostheses. There is a differential difference between the viscoelastic deflection of a natural tooth by its periodontal ligament, and the almost negligible elastic deformation of an osseointegrated implant. This difference may induce a fulcrum-like effect and overstress the implant. In this study a new modification of osseointegrated implants was proposed to counteract this problem. This modification was achieved by using a resilient layer material under the superstructure of the implant. Finite element modeling (FEM) was used to examine stresses and displacement distribution around a commercially available implant and one experimental implant with a resilient layer material. The results of this study showed that the new modification is a simple and efficient way to mimic the structural natural tooth unit. It also showed that it allowed movement of the superstructure without movement of the implant three times that of the nonresilient model.

Alveolar Process↗
PubMed1993

The immediate effect of the variation of anteroposterior laterotrusive contacts on the elevator EMG activity.

A unilateral maxillary splint divided into three occlusal blocks was built for eight healthy young adults. The three blocks allowed the anteroposterior location of the laterotrusive contacts to vary and to distribute the occlusal force over equivalent periodontal surfaces. The ipsilateral masseteric and temporalis electromyogram (EMG) activities were recorded with surface electrodes during maximal voluntary clenching. The elevator EMG activity with the anterior occlusal block in place was significantly lower than with the intermediate or posterior blocks. The reduction for both elevators with the intermediate block in place did not show a significant variation in comparison to the posterior block of the three blocks inserted. The elevator activity with the three occlusal blocks did not differ from that recorded with the posterior block alone. Neurophysiologic and biomechanical explanations are given related to this laterotrusive elevator muscular behavior.

Adult↗
PubMed2006

Immediate surgical repositioning following intrusive luxation: a case report and review of the literature.

This report presents a case of severe intrusive luxation of mature maxillary lateral incisor in a 10-year-old boy. The intruded tooth was immediately repositioned (surgical extrusion) and splinted within 2 h following injury. Tetracycline therapy was initiated at the time of repositioning and maintained for 10 days. Pulp removal and calcium hydroxide treatment of the root canal was carried out after repositioning. Splint was removed 1 month later. Definitive root canal treatment with gutta percha was accomplished at the second month recall. Clinical and radiographic examination 28 months after the surgical extrusion revealed satisfactory apical and periodontal healing.

Child↗
PubMed1977

Lack of effect of trauma from occlusion on the recurrence of experimental periodontitis.

The experiments were performed in 15 dogs fed a diet which allowed dental plaque accumulation. A phase of experimental periodontal breakdown was initiated on day 0. After 210 days five dogs were sacrificed. In the remaining 10 dogs the periodontal pockets around the fourth lower premolars (4P and P4) were eliminated. During surgery a notch was prepared in the root at the level of the marginal termination of the alveolar bone in order to facilitate measurements in histological sections. From day 210 to day 450 the teeth of the animals were brushed twice daily. After 60 days of healing, i.e. on day 270, five of the dogs were sacrificed. Trauma from occlusion of the jiggling type was on day 270 produced in the P4 region of the remaining dogs by the installation of a cap splint and a bar device. The final five dogs were sacrificed on day 450. Following sacrifice, tissue sections comprising 3P, 4P, 1M and P3, P4, M1 were produced and subjected to microscopic analysis. The experiments revealed that, in the dog, forces produced by occlusal trauma are unable to induce a phase of progressive destruction of the periodontal tissues in tooth regions where the supporting tissues are markedly reduced but non-inflammatory.

Alveolar Process↗
PubMed1991

Orthognathic surgery and pulpal blood flow: a pilot study using laser Doppler flowmetry.

The purpose of this study was to analyze the effect of Le Fort I osteotomy on pulpal circulation. A laser Doppler flowmeter was used to measure pulpal blood flow of maxillary right and left central incisors and a randomly selected mandibular canine in 14 volunteers prior to surgery and at various intervals during the 6 months following surgery. Custom-made splints allowed accurate and reproducible positioning of the measurement probe. The data showed a significant reduction in vascular supply at the final observation. However, a high variability of individual blood flow patterns was found. In some patients, transient periods of ischemia were observed shortly after surgery. Also, numerous teeth demonstrated hyperemia at later intervals. One patient developed discoloration of a central incisor, and another lost marginal periodontal support around both central incisors. However, in none of the 14 subjects was pulpal blood flow found to be absent following surgery.

Adolescent↗
PubMed1975

[Methods and results of dental and prosthetic care following mandibular hemignathectomy].

By inserting auxiliary prosthetical means (anchored dental replacement with splinting elements) functional failures can be reduced. By using molding surfaces in the one-piece model cast denture the displaced mandibular stump is repositioned and the occlusal relationship between upper and lower teeth reconstructed largely without periodontal damage to the residual dentition.

Dental Occlusion↗
PubMed2000

The relationship between peripheral levels of leukocytes and neutrophils and periodontal disease status in a patient with congenital neutropenia.

BACKGROUND: Congenital neutropenia is characterized by an almost total absence of neutrophils and increased susceptibility to infection. Oral manifestations include ulcerations of mucous membranes, acute gingival inflammation with focal necrosis, and rapid loss of attachment. Treatment with recombinant human granulocyte colony-stimulating factor (rhG-CSF) increases neutrophil numbers and ameliorates the periodontal status. METHODS: We report the treatment of a 22-year-old male with congenital neutropenia (Kostman syndrome), referred to us due to periodontal disease, and the effect of treatment on peripheral neutropenia. Diagnosis of neutropenia was made at year 1; at age 15, the patient started to receive injections of rhG-CSF, reducing the occurrence of infection and improving neutrophil count, although levels remained below normal. The patient underwent extraction of a molar at age 8; scaling, root planing, and modified Widman flaps at age 9; and oral hygiene maintenance every 2 to 3 months from age 18 to 21. At age 23, he initiated treatment at our periodontal clinic. The patient's gingiva was severely inflamed, and the dentition was covered with plaque and calculus. Attachment loss was advanced, all teeth were mobile, and bone loss was approximately 75% in most sites. Neutrophil counts were below normal, but other hematologic parameters were normal. Scaling and root planing were performed and the patient received antibiotics and chlorhexidine rinses twice each day for 2 weeks. Extracoronal splinting was performed, fluoride varnish was used to desensitize cervical areas, and tooth FDI #46 was restored. Root planing and deplaquing were repeated, and the patient received subgingival chlorhexidine irrigation 13 times over one year. Assessments were made on presentation, after the initial treatment, and at 1 and 2 years post-treatment. RESULTS: Mean probing depth was reduced posttreatment with a further reduction during the maintenance period. This was correlated with an increase in attachment levels. Total white blood cells increased, due in part to an increase in neutrophils, reaching normal levels. CONCLUSIONS: This report demonstrates for the first time that periodontal therapy, resulting in decreased bacterial load, may result in restoration of normal levels of circulating neutrophils in individuals with congenital neutropenia under treatment with rhG-CSF. The results also suggest that periodontal pathogens may be associated with depressed neutrophil levels, even when patients receive treatment for neutropenia.

Adult↗
PubMed1976

The implantation of natural tooth form bioglasses in baboons. A preliminary report.

This report describes a 6-month screening study comparing the tissue responses of several bioglass natural tooth implants in adult female baboons. The dental implants were designed to elicit osteogenesis at the interface of the implant and the oral tissues. This is in contrast to those types of implant materials that are merely biologically acceptable. Incisor teeth were extracted, dupplicated in bioglass, returned to the natural sockets, and splinted to the adjacent natural tooth, where they remained splinted for 3 months and then free standing for an additional 3 months. Microscopic evaluation revealed distinct histopathologic characteristics with certain bioglass formulas, such as ankylosis, a pseudofibrous capsule with fibers running parallel to the root surface, or an apparently true periodontal membrane with properly oriented Sharpey's fibers. True cementogenesis was not found.

Animals↗
PubMed2004

Surgical extrusion technique for clinical crown lengthening: report of three cases.

Although a number of techniques have been proposed for clinical crown lengthening procedures, all have some limitation in terms of function and esthetics. This report presents the clinical and radiographic results of a surgical extrusion technique for clinical crown lengthening. Atraumatic surgical extrusion using a specially designed instrument (Periotome) was performed in three cases in which it was expected that extensive resective osseous surgery would have to be used for crown lengthening. Full-thickness mucoperiosteal flaps were raised both labially and palatally. The tooth was carefully luxated and extruded to the desired position without damaging the marginal bone area or root apex. No rigid splint was applied. Clinical examinations performed for more than 1 year after surgery revealed probing depths < or = 3 mm around the teeth at all sites, without bleeding on probing. The teeth functioned normally, with near-normal mobility. Radiographs showed normal periodontal contour consistent with new bone formation in the periapical area. Radiographic analysis did not show any evidence of root or crestal bone resorption or endodontic problems. The technique presented could constitute an alternative surgical approach to performing crown lengthening; it does not induce functional or esthetic deformities, especially in the anterior region.

Adult↗
PubMed1986

Effect of lyophilized autologous plasma on periodontal healing of replanted teeth.

The purpose of this histologic and autoradiographic study of replanted teeth was to evaluate the beneficial effect, if any, of lyophilized autologous plasma (LAP) application on periodontal healing and to re-examine rates of repair in different areas of the associated periodontium following replantation. Maxillary and mandibular incisors and premolars of three rhesus monkeys were used. Teeth were extracted with forceps and placed in sterile physiologic saline. After 5 minutes each tooth was returned to its socket and immobilized by interproximal acid-etch splints. Splints were removed after 1 week. Of the 48 replants performed, 24 (controls) were replanted as described. Of the 24 experimental teeth, during the 5 minute interval between tooth extraction and replantation, the root surface and the inner socket walls were bathed with 1 ml of the reconstituted LAP-saline solution (800 mg/ml). Replants and animal sacrifice were scheduled to provide observations at 1, 3, 7, 14, 28 and 45 days following replantation. One hour prior to sacrifice, each monkey received an intravenous injection of tritiated thymidine, 1 microCi/gm body weight. Tissue specimens were processed for evaluation following standard procedures. Eight replanted teeth were available for evaluation for each of the six time-points. Four teeth were treated with LAP and four without it. Histologically, tissue sections were examined for epithelial proliferation and attachment, periodontal fibers organization and maturation, inflammatory cell types, presence or absence of cementum resorption and dentoalveolar ankylosis and degree of vascularity of the tissues. For autoradiographic evaluation, the periodontium associated with the replanted tooth was divided into nine spatial cell compartments. In each compartment, labeled tissue cells, epithelial or connective, were counted and recorded. Differences between the control (untreated) replanted teeth and the LAP-treated teeth, at each time-point and within each compartment, were analyzed for significance using the paired t-test. The findings of this study indicate that LAP use enhanced healing by early replacement of the fibrin clot, increased connective tissue cell proliferation, reduction of the inflammatory response and inhibition of root cementum resorption. Periodontal healing and repair occurred more rapidly in the supracrestal or transseptal connective tissue region than within the periodontal membrane space.

Alveolar Process↗