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Prosthodontic rehabilitation after traumatic tooth and bone loss: a clinical report.

Traumatic injuries from motor vehicle accidents may cause anatomic deficiencies in soft and hard tissues. Successful treatment of patients with such deficiencies may include preprosthetic surgery using osseointegrated implants to increase prosthesis retention and stability. This article describes the treatment of a motor vehicle accident victim whose anterior teeth and supporting tissues were lost.

Accidents, Traffic↗

Congenital insensitivity-to-pain with anhidrosis (CIPA): a case report with 4-year follow-up.

Congenital Insensitivity-to-pain with anhidrosis (CIPA) is a rare disorder in which pain perception is absent from birth, despite the fact that all other sensory modalities remain intact or minimally impaired and tendon reflexes are present. The challenge in dentistry is to manage the self-mutilation behavior avoiding serious damages especially to oral structures, hands and fingers. A Brazilian case of CIPA is presented and discussed with clinical documentation of the oral-related problems over a 4-year follow-up. A conservative treatment (mouthguard-like appliance) was proposed with the objective to avoid full mouth extraction.

Consanguinity↗

Unusual pattern of pulp canal obliteration following luxation injury.

Pulp canal obliteration can occur as a result of tooth injury. A case report is presented in which a 6-yr-old patient developed partial pulp canal obliteration of a maxillary central incisor 9 months after luxation injury. The mineralization created unusual canal morphology which presented some difficulty in endodontic treatment of the tooth.

Child↗

Surgical extrusion of a completely intruded permanent incisor.

This report presents a case of a completely intrusive luxation of a mature permanent central incisor in a 10-yr-old boy. The intruded tooth was repositioned by using surgical extrusion and stabilization with interdental sutures. Endodontic treatment was performed with calcium hydroxide paste as the intracanal medication and a calcium hydroxide-based root canal sealer. This treatment mode was observed at 18 months and was successful at that time.

Calcium Hydroxide↗

Facial injuries sustained during sports and games.

This study is an investigation into the number and type of facial injuries due to sports and games, because no detailed information on these dental misfortunes could be found in the literature. The group investigated consisted of 319 patients, treated at the Department of Oral and Maxillo-Facial Surgery, Nijmegen in the period January 1, 1971-December 31, 1978. Facial injuries were classified into different types of fractures according to site as also were further series of associated injuries. Males were shown to be more prone to facial injuries than females (2.4:1). In the age group 15-40 years, males proved to be more prone to such injuries than the age group under 15 years. The major part of the injuries is due to fractures of the alveolar process and/or luxation of teeth (59.6%), the zygomatic bone and arch (24.2%) and the mandible (15.3%). Fractures of the maxilla and the nose were rarely seen.

Adolescent↗

Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept.

The outcome of vertical callus distraction of a segment of tooth-supporting alveolar process might be functionally and esthetically unsatisfactory because of the unidirectional impact of intraoral distraction devices. In this case report, we describe how, with a shortened consolidation phase and application of the floating bone effect, the tooth-supporting osteotomy segment can be successfully aligned 3 dimensionally. We applied orthodontic force systems that went beyond the unidirectional vector preset by the mechanical properties of the distraction device.

Alveolar Process↗

An American Board of Orthodontics case report: the nonsurgical orthodontic correction of a Class III malocclusion.

A case report about the orthodontic treatment of a Class III malocclusion in a black man 22 years 8 months old. The patient's chief complaint concerned the space left by the traumatic loss of the maxillary left central incisor. Not desiring changes in facial appearance, the patient sought an orthodontic solution to his problem. An acceptable result was achieved through maxillary expansion and the reduction of mandibular space. [This case was presented to the American Board of Orthodontics in partial fulfillment of the requirements for the certification process conducted by the Board.]

Adult↗

The use of implants for orthodontic correction of an open bite.

This case illustrates the integration of maxillofacial surgery, orthodontics, prosthodontics and periodontics in the treatment of an adult male. A traumatic injury to the lower jaw was the stimulus for the patient to seek orthodontic correction of a severe malocclusion including crossbites and an anterior open bite. The loss of a large portion of the anterior alveolar process of the lower jaw including six teeth was corrected with an implant bearing prosthesis which was subsequently used as anchorage to correct the malocclusion. Through the combined efforts of the above disciplines, properly orchestrated, this patient was treated in an effective and successful manner.

Adult↗

Occlusion of the incisal canal with bone chips. A procedure to facilitate insertion of implants in the anterior maxilla.

In 4 patients, who had lost one or both central maxillary incisors due to trauma, the incisal canals were filled with autogenous cancellous bone harvested from the chin. After a healing period of 4-5 months implants were inserted. At the time of implant surgery in all cases the canal appeared to be replaced by cancellous bone and the implants were placed partially into the grafted area. After another 6 months abutments were connected and crowns made. After follow-up of between 12 and 15 months no fixture has been lost.

Adolescent↗

Aspiration of a bridge and a tooth.

This is a rare and unusual case in its presentation, the patient having aspirated a three unit bridge into the right bronchus and a central incisor being found in the stomach following maxillo-facial trauma. This paper also emphasizes the necessity of careful intra-oral examination before proceeding to any therapeutic manoeuvres.

Adult↗

Regeneration of bone graft donor sites.

When crestal volume is greatly insufficient for the placement of dental implants, bone grafting is usually the most reliable ridge augmentation procedure. The grafts are most often taken in parietal or mandibular symphysis regions. Though not too noticeable, it seems contra-indicated and even potentially dangerous to leave zones like the cranium to repair spontaneously. Guided bone regeneration techniques have shown their ability to regenerate new bone under difficult conditions in jaws. Their use in bone graft donor sites is simple and the results are consistent. This report shows that 2 types of resorbable membranes are equally as efficacious in terms of new-bone formation.

Adult↗

The role of endodontics in the treatment of luxated permanent teeth.

Pulp necrosis is a common complication following traumatic dental injuries and is related to the type and severity of the injury, as well as to the stage of development of the injured tooth. Endodontic intervention is required when there are clinical and radiographic signs of pulpal infection and its sequelae. Arrested tooth development with periradicular pathosis, external inflammatory root resorption, sinus tract formation and pain on percussion are indicative of root-canal infection in the post-traumatized teeth, and require immediate endodontic treatment. The use of calcium hydroxide in the treatment of teeth with post-traumatic pulp necrosis and its sequelae has been shown to be extremely beneficial for the long-term retention of the injured teeth. Calcium hydroxide has been shown to arrest and repair external inflammatory root resorptive defects, eliminate the endodontopathic microorganisms from the root canal system and induce hard-tissue barrier formation at the apex of non-vital immature teeth. This paper reviews the endodontic treatment required by post-traumatic non-vital permanent teeth.

Calcium Hydroxide↗

Influence of surgical repositioning of mature permanent dog teeth following experimental intrusion: a histologic assessment.

The aim of this study was to evaluate, through histologic examination, the effect of surgical repositioning of intruded dog teeth upon the pulpal and surrounding tissues. Thirty teeth in 10 adult dogs, aged 2-3 years, were used. Fifteen teeth were intruded, surgically repositioned and fixed using orthodontics wire, composite resin, and enamel acid conditioning. All these teeth served as the experimental group. The remaining intruded teeth were not treated (control group). The animals were sacrificed to allow observations at 7, 15, and 30 post-operative days. The maxillary and mandibular arches were removed and processed for histologic exam. Based on the methodology and observed results, we concluded that: pulpal necrosis, external root resorption and ankylosis were common sequelae to severe traumatic intrusion; a careful immediate surgical repositioning of severed intruded permanent tooth with complete root formation has many advantages with few disadvantages.

Animals↗