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Mineralized tissue-formation in periodontal wound healing.

The purpose of the present study was to examine and compare the different mineralized tissues that are found on and around the dental root following treatment of different periodontal pathosis. The material has been compiled from previously published experimental studies on periodontal therapies and trauma treatments. 4 distinctly different appearances of the mineralized tissue layers on the marginal dentin surfaces were described; new cementum, non-attached bone-like tissue, partly attached bone-like tissue and ankylosis preceded by root resorption. It was concluded that, healing in the periodontal/root interface following periodontal therapy may yield different mineralized tissues, depending on a number of host-specific and external factors. The temporal pattern of such healing processes is schematically represented.

Alveolar Bone Loss↗

Repair processes in the periodontium following dentoalveolar ankylosis: the effect of masticatory function.

It has recently been shown that administration of the drug 1-hydroxyethylidene-1,1-bisphosphonate (HEBP) perturbs the homeostasis in the periodontal ligament resulting in an osteoid-mediated ankylosis between the alveolar wall and the root surface. In the present study, the events after discontinuing HEBP administration were investigated and the effect of function on repair of the periodontal ligament was evaluated. In mice, the maxillary left molars were extracted. They then received a daily subcutaneous injection of HEBP (10 mg P/kg b.w.) for a period of 50 days, were killed 24 h, 14, 28, 56 and 112 days after the last injection and their mandibles processed for light microscopy. HEBP administration caused a significant decrease of the width of the periodontal ligament space with localized ankylosis. In the period after discontinuing HEBP treatment, the newly-formed bone did first mineralize and was then partly resorbed resulting in the disappearance of the ankylotic areas. Furthermore, root resorption was seen. Finally, the periodontal ligament regained its normal architecture and width and a new layer of cementum was formed. Functional teeth showed more root resorption than hypofunctional ones and a more rapid repair of the periodontal ligament. It is concluded that in the period after HEBP treatment the periodontal ligament regains its normal width by a repair process including extensive root resorption, that seems to accelerate this process.

Alveolar Process↗

Periodontal manifestation of hypophosphatasia. A family case report.

Hypophosphatasia is a rare inherited disease, the 1st clinical sign of which is often a premature loss of deciduous teeth. We describe clinical, histological and SEM findings of 2 cases of hypophosphatasia from a single family and discuss the pathological mechanisms with reference to the literature.

Alkaline Phosphatase↗

Observations of root surfaces from patients with early-onset periodontitis and leukocyte adhesion deficiency.

The purpose of this investigation was to report observations of the root surfaces of teeth from 2 siblings with leukocyte adhesion deficiency (LAD). In previous publications, the clinical, radiographic and immunologic findings in the family were presented. 38 permanent teeth from the 2 siblings were prepared for microscopic examination, 11 for light microscopy (LM), and 27 for scanning electron microscopy (SEM). In addition, 8 healthy teeth obtained from 2 patients requiring extractions for orthodontic treatment served as controls. LM observations on healthy teeth revealed cementum with normal structural appearance which exhibited a mosaic or mogul-like pattern with SEM. In LAD specimens, cementum apical to the dentogingival junction exhibited resorption lacunae and areas of poor structural definition characterized by aplasia and hypoplasia (hypomineralization). Areas of hypoplasia presented as distinct irregular surfaces with a pebbly or globular-like appearance. Alteration in cementum formation and maturation may play a role in the etiology of early-onset periodontitis.

Adolescent↗

Periodontal repair in dogs: examiner reproducibility in the supraalveolar periodontal defect model.

BACKGROUND: Histometric assessments are routinely used to evaluate biologic events ascertained in histologic sections acquired from animal and human studies. The objective of this study was to evaluate the intra- and inter-examiner reproducibility of histometric assessments in the supraalveolar periodontal defect model. METHODS: Histometric analysis using incandescent and polarized light microscopy, an attached digital camera system, and a PC-based image analysis system including a custom program for the supraalveolar periodontal defect model was performed on histologic sections acquired from one jaw quadrant in each of 12 dogs. The animals had received an experimental protocol including implantation of a coral biomaterial and guided tissue regeneration (GTR) barrier devices, and were evaluated following a 4-week healing interval. Histometric parameters were recorded and repeated within a 3-month interval by two examiners following brief training. Intra- and inter-examiner reproducibility was assessed using the intra-class correlation coefficient (ICC). RESULTS: Most parameters showed high intra-examiner ICCs. Parameters including defect height, connective tissue repair, bone regeneration (height/area), formation of a junctional epithelium, positioning of the GTR device, ankylosis, root resorption, and defect area yielded an ICC> or 0..9. The ICCs for bone density and biomaterial density were somewhat lower (0.8 and 0.7, respectively). The inter-examiner reproducibility was somewhat lower compared to the intra-examiner reproducibility. Nevertheless, the ICCs were generally high (ICC range: 0.6-0.9). CONCLUSIONS: Histometric evaluations in the supraalveolar periodontal defect model yield highly reproducible results, in particular when a single examiner performs the histometric measurements, even when the examiner was exposed to limited training.

Animals↗

Periodontal repair in dogs: evaluation of a bioresorbable calcium phosphate cement (Ceredex) as a carrier for rhBMP-2.

BACKGROUND: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been shown to induce clinically relevant bone formation for orthopedic, craniofacial, and oral indications. It appears critical, in particular for onlay indications, that the associated carrier technology exhibits structural integrity to offset compressive forces in support of rhBMP-2-induced bone formation. The objective of this study was to evaluate a calcium phosphate (CP) cement, Ceredex, as a candidate carrier for rhBMP-2 in a defect model with limited osteogenic potential. MATERIALS: Bilateral, critical size, 6-mm, supra-alveolar, periodontal defects were created in six, adult, male, Hound Labrador mongrels. Three animals received rhBMP-2/Ceredex (rhBMP-2 at 0.20 and 0.40 mg/ml) in contralateral defect sites (implant volume/defect approximately 1 ml). One defect site in each of the three remaining animals received Ceredex without rhBMP-2 (control). The animals were euthanized at 12 weeks postsurgery for histologic and histometric analysis. RESULTS: Mean induced bone height exceeded 80% of the defect height for supra-alveolar periodontal defects receiving rhBMP-2/Ceredex without major differences between rhBMP-2 concentrations compared with approximately 40% for the control. The newly formed bone, a mixture of lamellar and woven bone in fibrovascular tissue, circumscribed relatively large portions of the residual Ceredex biomaterial. Inflammatory lesions were associated with limited bone formation in some sites. From a periodontal perspective, sites receiving rhBMP-2/Ceredex exhibited increased cementum formation compared with control, but without a functionally oriented periodontal ligament, and increased ankylosis and root resorption. Control sites exhibited early wound failure and exposure, loss of the Ceredex biomaterial, and limited bone formation. CONCLUSIONS: The Ceredex CP cement appears a potentially promising carrier technology for rhBMP-2 onlay indications. However, a slow resorption rate may prevent its wider use. This study does not support use of the rhBMP-2/Ceredex combination for periodontal indications.

Absorbable Implants↗

Dental and jaw changes in primary hyperoxaluria.

A case of teeth and jaw changes in primary hyperoxaluria is described. The patient, a 25-yr-old man, was treated by kidney transplantation twice, and finally by combined liver and kidney transplantation. The teeth and jaw changes consisted of deposition of oxalate crystals in the gingiva, in the pulp and in the vicinity of bone and dentin. The resorption of bone and dentin was extensive.

Adult↗

Light and ultrastructural studies of human chronic periapical lesions.

Forty clinically chronic periapical granulomas and cysts and their corresponding teeth were removed. Diagnosis was by light and transmission electron microscopy. Ultrastructural features of the root surfaces concerned and the corresponding soft tissue were detected by scanning electron microscopy. Chronic periapical inflammation had caused root resorption which affected the cementum and/or the dentin. There were no ultrastructural differences between granuloma- and cyst-induced root resorption. Resorption lacunae were devoid of epithelial and connective tissue attachment. However, root surface exposed to granulomas and cysts also indicated spontaneous cementum repair. Moreover, at their periphery, cellular debris, cells defined as fibroblasts, and cell projections and fibrils could be seen which were continuations of the periodontal ligament.

Adolescent↗

Effect of non-erupted third molars on roots of approximal teeth. A radiographic, clinical and histologic study.

This study was undertaken to evaluate clinically and histologically root resorption in extracted human second molars in close proximity to non-erupted third molars. The control group consisted of extracted second molars that were proximal to fully erupted third molars. Eight out of the 11 teeth in the study group presented different degrees of radiographic root resorption, nine presented clinical resorption, and all 11 had histologic evidence of root resorption. In the control group, no signs of root resorption were seen radiographically or clinically. Histologically, limited sites of resorption were identified in all teeth, which were partially repaired by cellular cementum. Histologic observation of study specimens revealed root surface resorption in 10 out of the 11 teeth, one showing replacement resorption as well. Inflammatory resorption was observed in the three most advanced cases in the study group. Reparative cementum partially lining resorbed areas was evident in all teeth with surface resorption. Within the limits of this study, radiographic identification of distal root resorption of second molars in close proximity to non-erupted third molars appears reliable. The findings may support the hypothesis that the presence of a non-erupted third molar in close proximity to the distal root of the second results in root resorption.

Adult↗

A 2-year follow-up of primary molars, pulpotomized with a gentle technique and capped with calcium hydroxide.

The prognosis for pulpotomy of primary molars with calcium hydroxide as wound dressing was evaluated clinically and radiographically. Thirty-three primary mandibular molars were amputated under the following conditions: (1) chronic coronal pulpitis, (2) the amputation was done with diamond instruments and a high-speed machine under aseptic conditions, and (3) application of calcium hydroxide in contact with the wound surface. After 1 year the treatment was regarded as successful for 22 of the teeth (67%); 11 teeth showed internal dentin resorption. After 2 years the frequency of success, allowing for drop-out, was 59%. Internal dentin resorption was seen in 14 root canals; in 10 of them within the first 6 months. A histologic study of nine root pulps with internal dentin resorption revealed an extra-pulpal blood clot on the wound surface in five.

Blood Coagulation↗

Oral aspects of osteopetrosis.

The characteristic feature of osteopetrosis is a lack of osteoclastic activity, leading to a series of somatic problems for afflicted persons. The life span of osteopetrotic patients has increased in recent years, thereby making oral aspects of the disease more evident. Four children with malignant osteopetrosis, born between 1967 and 1975, were examined. In all patients the anterior teeth were of normal shape, and erupted on schedule. Primary molars and all permanent teeth were greatly distorted, and remained totally or partly embedded in basal bone. Vertical growth of alveolar ridge was very limited. Where a fenestration of overlaying mucosa had occurred, a localized progressive osteitis developed, leading to soft tissue inflammation and, in two cases, extraoral mandibular fistulas. Peridontal attachment was very poor, spontaneous exfoliation had occurred in all patients. In two children tooth germs and necrotic bone were surgically removed. No beneficial effect of the treatment was observed. Large doses of antibiotics were needed to control recurring infections. No means of curing progressive osseous destruction of mandibular bone has been found. The general prognosis is poor.

Child↗

Criteria for diagnosis of pulp necrosis in traumatized permanent incisors.

Records and radiographs of 108 patients (6-18 years) with 134 root canal treated incisors were examined. Subluxation was the most common type of injury, followed by intrusive, extrusive or lingual luxation, exarticulation and uncomplicated crown fracture. Negative response to electric stimulation was noted in 107 teeth from the first examination. In 23 teeth an initial positive response changed to negative within 3 weeks to 9 months, whereas persistent positive reactions were recorded in four teeth. The diagnosis of necrosis was based on the following observations: negative vitality and radiographic changes (76 teeth), negative vitality and discoloration (45 teeth), negative vitality only (nine teeth), positive vitality and radiographic changes (four teeth). External inflammatory root resorption confirmed the diagnosis of necrosis in all replanted teeth and in 13 of 16 intruded teeth. Discoloration and periapical lesions were the most important diagnostic factors following subluxation, extrusive and lingual luxation. Necrosis was disclosed within 4 months in 117 teeth (87%). Diagnoses based on negative vitality and discoloration were made within 6 days to 3 months in all but one case. All external root resorptions and 37 of the 49 periapical lesions were observed within 3 weeks to 4 months of the injury.

Adolescent↗

A model for experimental endodontics by transplanting human dental roots subcutaneously to rats.

In 35 roots from extracted human teeth the pulp tissue was removed and the specimens autoclaved before being transplanted subcutaneously to rats. The animals were sacrificed 7, 14, 21, 90 and 140 d after transplantation and the skin and subcutaneous tissue containing the transplants were prepared for histologic examination. The human roots were well tolerated by the rats with a fibrillar connective tissue capsule surrounding the specimens. In the 90-d and 14-d groups a few root surfaces exhibited small resorption lacunae. The empty root canals became slowly occupied by a maturing granulation tissue occasionally containing foci of lymphocytes. After 140 d the canal tissue was still highly vascular with multinuclear giant cells occasionally located along the dentin walls but no internal resorption was recorded. It is concluded that this model may be useful for systematic testing of root filling materials concomitant with human studies.

Animals↗

Infraocclusion of primary molars: a histologic study.

In order to analyze the occurrence and character of ankylosis in primary molars in infraocclusion, 102 primary molars, 62 in infraocclusion and 40 in normal position, in children aged 3-17 yr, were studied histologically. Ankylosis was demonstrable in most of the infraoccluded teeth while ankylosis was not found in teeth with normal positions. The ankylosis was always located at the inner root surface. Progression of the resorption of the root with age was seen in both groups of teeth. In teeth of younger children, in contrast to teeth of older children, the ankylosis was never found in the cervical portion of the roots. In the mandible, a thicker buccal marginal bone crest could be found in infraoccluded teeth than in teeth in normal position. Bone biopsies revealed no pathologic changes. Pulps of infraoccluded teeth more often demonstrated degenerative changes like fibrosis and calcifications. It is suggested that ankylosis is a local phenomenon, most likely due to developmental disturbances of the periodontium, and that ankylosis in infraoccluded primary molars is not a static condition but part of an ongoing process during root resorption.

Adolescent↗

Panoramic screening for dental anomalies assessed by professionals with identical and different backgrounds.

The aim of the present study was to evaluate how dental professionals with identical and different backgrounds assess dental anomalies viewed on panoramic radiographs. 101 panoramic radiographs performed of 9-to-10-yr-old children were examined independently by three orthodontists and two radiologists. All observers agreed on the recording of number and identification of congenitally missing permanent teeth. The observers' assessments of malpositioned teeth, teeth in infraocclusion, and primary teeth with atypical/non root resorption varied, however, to a great extent. Two of the orthodontists seemed to report only major deviations from normality (in 38 and 51 of the children respectively) while one reported several more findings (in 85 children). The radiologists reported abnormal findings in 80 and 88 children respectively. In only three children were no dental anomalies reported by any observer. The inconsistent reporting of the majority of dental anomalies (except for agenesis) in children, even among members of subgroups with a similar educational background (e.g. orthodontists), substantiates the need for an evaluation of the expedience of panoramic screening.

Anodontia↗