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The treatment of a patient with maxillary canine-central incisor transposition is presented. Treatment options were limited because the roots of the maxillary right lateral and central incisors had severe resorption and generalized shortening. The multidisciplinary approach and treatment sequence used to achieve an esthetic and functional result are discussed in this case report.
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OBJECTIVE: The aim of the study was to investigate the healing results of teeth replanted or transplanted in different indications and treated by extraoral root canal therapy. STUDY DESIGN: Extraoral root canal treatment was performed from a retrograde direction with posts made of ceramics or titanium. Preoperatively, the pulp status was classified as definitely infected (n = 47) or not infected/symptomless (n = 78), and the condition of the periodontal ligament (PDL) was classified as damaged (n = 50) or not damaged (n = 75) according to trauma type and extraoral storage. The healing after replantation or transplantation was diagnosed as functional, ankylosis, or infection depending on clinical and radiographic findings. RESULTS: In total, 125 teeth in 99 patients were replanted or transplanted. Mean observation period was 44.4 months. Teeth with a less damaged PDL in no case exhibited ankylosis/replacement resorption after a mean observation period of 53 months. Teeth without preoperative infection of the pulp in no case showed infection-related complications after a mean observation period of 30 months. Teeth classified as definitely infected before treatment had a high frequency of continuous periradicular bone and root resorption. CONCLUSIONS: The extraoral insertion of posts appeared to inflict no additional damage to the PDL that was clinically relevant. Infection-related complications were prevented. Teeth that were classified as definitely infected at the time of treatment had a low rate of healing and should undergo conventional root canal disinfection before this surgical procedure is applied.
The treatment of young patients with missing maxillary incisors poses a challenge to prosthodontists and orthodontists. The 2 principal treatment options are (1) the reopening or maintenance of space for future autotransplantation and/or prosthodontic restoration of the missing teeth, or (2) total orthodontic space closure, followed by prosthodontic modification of the lateral incisors to simulate the central incisors. This article discusses only the second option and describes 2 alternative methods for the modification of crown anatomy. These procedures facilitate the orthodontic closure of missing central incisor spaces to ensure satisfactory, esthetic results.
The aim of the investigation was to evaluate the effect of a treatment pause on teeth in which apical root resorption was discovered after an initial treatment period of 6 months with fixed appliance. Forty patients with initial apical root resorption in 62 upper incisors were included in the study. In 20 patients treatment continued according to the original plan and in 20 patients active treatment was interrupted during a pause of 2-3 months. After the pause active treatment was resumed. Assessment of apical root resorption was performed on standardized radiographs taken with individual film holders. The amount of root resorption was significantly less in patients treated with a pause than in those treated without interruption.
A retrospective study of 26 patients with maxillary incisor root resorption relating to the presence of an ectopic canine was undertaken from case records. The group consisted of nine male and 17 female patients with a mean age of 12.5 years. There was a total of 35 resorbed teeth, 26 lateral and nine central incisors, and these were related to 32 ectopic canines. The resorption tended to be extensive, 30 teeth had pulpal involvement. In two-thirds of cases the pattern of resorption involved both apical and middle thirds of the root. Despite the extensive nature of the involvement there were few clinical signs and symptoms reported by patients. 43.8 per cent of canines were lying palatal to the arch, 18.7 per cent were in the line of the arch and 37.5 per cent were buccal. Significantly 15.6 per cent were buccal and erupted. The path of canine eruption was mesio-horizontal in 21 cases. No relationship could be found between resorption and the retention or loss of the deciduous canine. The canine root formation was virtually complete in 31 of the involved canines. The study indicated that the problem is often diagnosed late both in relation to the patient's age and the extent of resorption present. It is suggested that the problem may be underestimated by dental practitioners.
The results of alveolar bone grafting carried out at The Hospital for Sick Children, Great Ormond Street, London, UK, between January 1982 and January 1989 were assessed. Cancellous bone from the iliac crest was grafted to alveolar cleft defects in 115 patients (63 male and 52 female). Eighty-seven unilateral (58 left and 29 right) and 28 bilateral clefts were operated on. The mean age at the time of operation was 11.5 years, with a range of 8.08-18.75 years. The cleft canine had erupted prior to bone grafting in 58.4 per cent. At the time of this study the cleft had erupted in 96.35 per cent and was unerupted in 3.65 per cent of sites. Radiographs were taken at regular intervals and assessed according to previously reported criteria. Eighty-six per cent were clinically successful (Type I and II). In Type III 10.95 per cent had less than three-quarters of the normal interdental septal height and 2.18 per cent failed (Type IV). In addition, 3.6 per cent of sites showed cervical root resorption affecting the adjacent incisor and 1.4 per cent internal resorption of the cleft canine.
The aim of this study was to evaluate the risk of root resorption during orthodontic treatment of patients with aplasia, and to analyse the relative importance of some anamnestic and treatment variables. The subjects comprised 68 orthodontically treated patients with 1-16 congenitally missing teeth. The age of the patients was 11-20 years (mean 15 years). All patients were treated with fixed edgewise appliances. The purpose of the orthodontic treatment varied: to create optimal conditions for prosthetic restorations or osseointegrated implants, or to achieve aesthetic and functional alignment of teeth in less severe cases. The degree of root resorption was assessed before and after treatment from intra-oral radiographs of the maxillary incisors using a scale of 0-4. In all, 186 maxillary incisors were evaluated. The degree of apical root resorption was significantly greater in cases of multiple aplasia (4-16 missing teeth) than in those with only one to three missing teeth. Root form, treatment time with rectangular wires and intermaxillary elastics, and total treatment time were significantly related to root resorption. Discriminant analysis disclosed that the following variables were the most important determinants of root resorption: number of missing teeth, root form, and time with rectangular archwires and intermaxillary elastics. It is concluded that there is a high risk of apical root resorption during orthodontic treatment in patients with multiple aplasia (four or more teeth), in particular in teeth with an abnormal root form and lengthy treatment with elastics and rectangular archwires.
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Explore the source record for details and available documents.
The purpose of this study was to elucidate a possible association between ectopic first molar eruption causing root resorption on the distal root of the primary maxillary second molar, and ectopic canine eruption causing root resorption on the permanent maxillary incisors. The subjects consisted of 30 patients, 22 females and eight males in the age range 8.3-15.0 years in whom root resorption of the permanent maxillary lateral and/or central incisor caused by the erupting permanent canine was diagnosed, and clinical and/or radiographic information concerning maxillary first molar eruption existed. It was found that of the 30 patients, seven (23.3 per cent) also had pathological root resorption of the second primary molar caused by ectopic molar eruption. It is suggested that patients with ectopic maxillary first molar eruption leading to pathological root resorption of the maxillary second primary molar are followed closely during the period of premolar and canine eruption, as the ectopic first molar could be an early warning of an increased risk of ectopic canine eruption leading to root resorption of the maxillary permanent incisors.
The aims of this study were to develop a three-dimensional (3D) mathematical model of a typical root resorption crater and to correlate two-dimensional (2D) surface area measurements to 3D volumetric measurements of root resorption craters created under light and heavy orthodontic forces. Data were obtained from a previous study of 36 first premolars from 16 subjects requiring extraction of these teeth as part of their orthodontic treatment. Buccal tipping forces of 25 or 225 g were applied for an experimental period of 28 days. After extraction, the samples were prepared for scanning electron microscopy (SEM) imaging, image processing and analysis. Surface area (2D) and volumetric (3D) measurements of all craters were obtained. A mathematical analysis of the 2D/3D relationship enabled the determination of an appropriate digital model for the shape, type and dimensions of resorption craters, which was also able to distinguish between a 'hemispheric' model versus a 'layered' model of craters. The results demonstrated that 2D and 3D measurements were strongly correlated (r = 0.991**). Within the light and heavy force groups, the measurements were also strongly correlated (r = 0.978** and r = 0.994**, respectively). For a 28 day experimental period, 2D measurements of root resorption craters were found to be as reliable as 3D measurements.
A case of multiple idiopathic apical root resorption in a 26-yr-old female patient is presented. A review of the literature revealed that extensive idiopathic root resorption is unusual. Neither local nor systemic etiological factors were found in our case. Examination of parents and siblings did not reveal a familiar tendency. Radiographs and clinical evaluation showed a very poor prognosis for most of the teeth present in the mouth of our patient.
A case is presented in which a previous partial root canal treatment on a mandibular molar developed internal resorption of the distal canal. The case was followed at the University of Oklahoma student clinic and endodontic treatment completed in the mesial canals, with calcium hydroxide placed in the distal canal for 10 months due to a pre-existing perforating defect of the root surface. Endodontics was then completed. A 17-month follow-up film showed osseous repair apically and also adjacent to the distal root surface where a slight overextension of filling material was evident.
The aim of this study was to evaluate the presence of bacterial biofilm on the external surface of the root apex in teeth with pulp necrosis, with and without radiographically visible periapical lesions, and in teeth with a vital pulp. Twenty-one teeth were extracted, eight with pulp necrosis and periapical lesions, eight with pulp necrosis without radiographically visible periapical lesions, and five with a vital pulp. The roots were sectioned, and the root apexes (+/- 3 mm) were processed for scanning electron microscope evaluation. The surface of the apical root was evaluated for the presence of microorganisms, root resorption, and biofilm. There were no microorganisms on the apical root surface of either teeth with pulp vitality or with pulp necrosis with no radiographically visible periapical lesions. Microorganisms were always present in teeth with pulp necrosis and radiographically visible periapical lesions. These included cocci, bacilli, and filaments and the presence of an apical biofilm. Apical biofilm is clinically important because microbial biofilms are inherently resistant to antimicrobial agents and cannot be removed by biomechanical preparation alone. This may cause failure of endodontic treatment as a consequence of persistent infection.
In a review of 100 consecutively performed bone grafts to the alveolar cleft, replacement resorption was found in 7 teeth adjacent to the cleft. Damage to the periodontal tissues during surgery is considered to be the main cause of this complication: granulation tissue from the bone graft may have some influence. Treatment of the affected teeth eventually includes extraction or surgical removal. To minimize the risk for this complication, we suggest that bone grafting should be done when the canine (or lateral incisor) is in an early stage of eruption and that orthodontic uprighting of the medial incisor should be done after surgery.
The capacity to bond to dental tissues, especially to dentine, their long-term fluoride release and their biocompatibility make glass ionomer cements (GICs) advantageous for use in endodontics, as well as in restorative dentistry. This review provides information on the basic properties of GICs, such as adhesion, antimicrobial effects and biocompatibility, particularly as they relate to use in endodontics. Indications for the use of GICs in endodontics are orthograde root canal sealing, root-end filling, repair of perforations and root resorption defects, treatment of vertical fractures and maintenance of the coronal seal. The paper includes a review on each of these indications. It is concluded that in spite of the critical handling characteristics and the inconclusive findings regarding sealing ability and antimicrobial activity, there is substantial evidence to confirm their satisfactory clinical performance. Both soft tissue and bone compatibility make them suitable for use during endodontic surgery.