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Exposure to 2,3,7,8-tetrachlorodibenzo-para-dioxin leads to defective dentin formation and pulpal perforation in rat incisor tooth.

A single dose of 1000 micrograms 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)/kg body weight was given to TCDD-resistant (Han/Wistar) young adult male rats. Changes in the skulls and the continuously erupting incisor teeth were evaluated 16 weeks after the administration of TCDD. The skulls of the experimental rats (N = 11) were significantly smaller than those of the control rats (N = 11), and the upper and lower incisor teeth of all experimental rats were significantly thinner than the control rat teeth. The pulps of the lower incisors of all experimental rats were lingually exposed to the oral cavity at their incisal ends. Also in 3 cases the pulps of the upper incisors were exposed, but never in the control rats. Whereas the labial surfaces of the incisors of the control rats were brown, those of the experimental rat teeth appeared greyish and mottled. Histological examination revealed that the pulp chambers in the incisal halves of the affected teeth were larger than normal, at the expense of the thickness of dentin. Towards the incisal tooth ends, odontoblasts gradually lost their polarity and the pulp tissue became necrotic. A dentin zone next to the pulp chambers was irregular. Lingual tapering of the teeth was pronounced, which gave them a mesiodistally flattened appearance. The superficial zone of the otherwise regular enamel was poorly pigmented. In conclusion, a single injection of TCDD was shown to impair normal growth of the skull and incisor tooth formation in rats. The small size of the incisors, their aberrant shape and the defective dentin (and enamel) formation could be mediated by vitamin A metabolism, known to be interfered with by TCDD.

Animals↗

A study of the relationship between incisor intrusion and root shortening.

Apical root shortening is one of the most common complications of orthodontic treatment. Force magnitude has been suggested as an important factor. Studies on the occurrence of root resorption show equivocal results. The aim of the present study was to evaluate the relationship between intrusion with low forces (25 gm) using utility arches in the bioprogressive technique and root shortening. Age, sex, facial type, treatment time, extraction versus nonextraction therapy, width of the symphysis, and the angle of the incisors to skeletal reference planes also were studied for their relationship to intrusion and root shortening. Root shortening was found to average 1.84 mm for maxillary incisors and 0.61 mm for mandibular incisors subjected to intrusive force. Intrusion of incisors in a population exhibiting growth was found to be one of "holding against growth" and in the upper arch to a change in angulation of the maxillary incisors. Furthermore, when extraction was a part of the orthodontic treatment, it was related to intrusion of maxillary incisors but not to intrusion of mandibular incisors. No relationship was found between the amount of root shortening and degree of intrusion achieved. However, a long treatment time was significantly correlated to root shortening. None of the other characteristics studied were related to either intrusion or root shortening. In the present study, it was found that intrusion with the utility arch type of technique is not related to amount of root shortening. The degree of root shortening was markedly higher in the maxilla than the mandible. In general, treatment time was the most significant factor for occurrence of root shortening.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Resorbed lateral incisors adjacent to impacted canines have normal crown size.

The importance of detecting maxillary canine impaction is that it may compromise dental health, particularly since a small but significant proportion of impacted canines is associated with the resorption of the roots of neighboring teeth. It has been shown that the existence of small and peg-shaped lateral incisors is highly correlated with maxillary canine palatal impaction. To date, however, it has not been established whether the root resorption that occurs has a similar correlation or a predilection for one or other types of lateral incisor crown structure. Accordingly, a group of patients with buccally or palatally impacted canines, in which root resorption of the lateral incisor could be diagnosed roentgenographically, was examined and compared with a group of cases with palatally impacted canines, none of which showed root resorption, which served as controls. The mesiodistal crown dimension of the lateral incisor in the experimental group was found to be normal in all patients except three (13%), which was significantly different from the distribution of lateral incisor size in the control group (p < 0.001). In the majority of the cases, aggressive root resorption of the lateral incisor root had occurred. We would speculate that in these cases, the normal-sized and early developing lateral incisor root obstructs the deviated eruption path of the canine and consequently stands a considerably greater chance of being damaged by resorption.

Adolescent↗

Distributions of magnesium and sulphur in defect layers of incisor dentine in magnesium-deficient rats.

This study examined the mechanism governing the occurrence of defect layers of incisor dentine in Mg-deficient rats by X-ray microanalysis. Young (5 weeks of age) Wistar male rats were pair-fed semi-synthetic diets containing either control (0.05% Mg) (N = 8) or Mg-deficient (0.001% Mg) (N = 8) ingredients for 17 days. All animals were time marked with a combination of 0.1 mol nitrilotriacetato lead and 0.1 mol nitrilotriacetato zinc (2mg Pb/kg body weight) on days 0, 7 and 14 into incisor dentine. Blood samples were obtained on days 10 and 17 in order to measure Ca, Mg, P and alkaline phosphatase activity levels in serum; moreover, hypomagnesaemia and hypercalcaemia were confirmed. After the 17th day, rats were sacrificed humanely under anaesthesia and mandibular incisors were removed. Dentine formation of right mandibular incisors was assessed (time marking lines); furthermore, Ca, P, Mg and sulphur (S) concentrations as well as Ca/P molar ratio were determined in left mandibular incisors based on contiguous measurement points at 2 microm intervals from dentine pulp to dentine of the lingual aspect via X-ray analysis. Additionally, proteoglycan distribution was observed in other Mg-deficient rat dentine. These findings demonstrated decreases in body weight, incisor formation and incisor length in Mg-deficient rats. Mg and S levels increased in the defect layers, whereas proteoglycan decreased. This phenomenon was possibly attributable to condensation of Mg and S contents consequent to decreased dentine formation during Mg-deficiency and a transient increase in Mg due to transport of Mg as a result of inhibition of cell proliferation in soft tissues.

Alkaline Phosphatase↗

Root resorption of upper permanent incisor caused by impacted canine. An analysis of 23 cases.

Unusual root resorption of 12 central and 11 lateral upper permanent incisors in 11 patients is described. The degree of resorption ranged from loss of the apical 1/4 to almost complete loss of root structure. Excepting 1 case, permanent canines were partially or completely impacted and their crowns were in close apposition to the resorbed surfaces of the incisors. The roots of the canines were either in the process of formation or completely formed. The findings suggest that the pressure from the canine which persists in moving downward despite the lack of space to permit normal eruption could cause root resorption of adjacent incisors even in the absence of systemic factors. Of 14 extracted incisors, 10 were replaced orthodontically by the impacted canines, whereas the spaces of the extracted incisors were restored by prosthetic means in the 4 other cases. 6 incisors were preserved without any treatment and 2 with the aid of a sapphire dento-osseous anchor pin. Since the resorbed incisors were mostly free of pain, early detection by radiographic examination is essential to establish a proper diagnosis.

Adolescent↗

Outcome of orthodontic space closure with a missing maxillary central incisor.

Orthodontic space closure is one of the treatment alternatives when a maxillary central incisor is missing. Because no systematic analysis of such treatment results is available, a sample of 20 consecutively treated patients was examined in a follow-up study. All patients had received orthodontic treatment with the objective of closing the space for the missing central incisor. Biologic features and the clinical appearance of the recontoured lateral incisor (test tooth) replacing the missing tooth were compared with the neighboring intact central incisor, which served as control tooth. The patients' opinions regarding the treatment and the result were recorded in a questionnaire. The position of the examined teeth and the appearance of the surrounding soft tissues were similar in the test and control teeth. However, in some patients (25%), certain aspects of the recontoured incisor crown (such as the width at the gingival margin) mismatched the appearance of the controls. A somewhat increased mobility and probing pocket depth on the mesial aspect was recorded for some test teeth. No obvious detrimental effects were observed on the radiographs. Most patients expressed satisfaction with the treatment result. It is concluded that orthodontic mesialization of the lateral incisor to replace a missing central incisor is a valid treatment modality, if the indications for such treatment are present and careful attention to detail in orthodontic and restorative treatment is exercised.

Adolescent↗

Effect of ultrasound on rabbit mandibular incisor formation and eruption after mandibular osteodistraction.

Therapeutic ultrasound is known to enhance bone-fracture healing. The purpose of this article was to study the effect of therapeutic ultrasound on mandibular incisor development and eruption in 15 skeletally mature male New Zealand white rabbits undergoing mandibular osteodistraction. The surgical cuts were made anterior to the molars and consequently transected the mandibular incisors. The animals were divided into 3 groups of 5 rabbits each. Group I received ultrasound on both sides of the mandible every other day. Group II received ultrasound on the left side of the mandible every day. Group III did not receive ultrasound. Ultrasound was given for 20 minutes per application. Mandibular incisor eruption was measured directly on the rabbits and on lateral head radiographs. The animals were killed 4 weeks after surgery, and dissected mandibular specimens that contained the incisor segments were evaluated histologically. The lengths of the tooth segments increased in the ultrasound-treated animals, compared with the controls (group III). However, the rabbits in group II had greater increases in length of the mandibular incisor segments than those in group I. Histologic examination showed that the newly formed tissues at the distraction site and at the cut ends of the incisor segments consisted of osteodentin-like tissue and cementum. Thus, therapeutic ultrasound combined with distraction enhanced mandibular incisor growth and eruption.

Animals↗

Moments with the edgewise appliance: incisor torque control.

Traditional edgewise orthodontic mechanics are significantly limited in their ability to provide incisor torque control because of the limitations of bracket-to-bracket mechanics and the poorly defined reciprocal actions inherently produced. Attempts to address this issue clinically have been largely empirical. The science of mechanics dictates that all incisor torque control mechanisms must act through one of two basic principles: the moment of a couple or the moment of a force. The torquing arch is a modification of the traditional edgewise system and employs the moment of a couple to achieve incisor torque control and precise definition of reciprocal effects. The torquing arch force system includes a large moment to rotate incisors in a crown facial/root lingual direction, and concurrent equilibrium forces to extrude incisors and intrude molars. Alternatively, the base arch uses the moment of a force to also rotate incisors in a crown facial/root lingual direction. The base arch, however, includes a large moment to rotate molars in a crown distal/root mesial direction, and concurrent equilibrium forces to intrude incisors and extrude molars. Depending on how they are employed, torquing arches and base arches may also rotate molars in a faciolingual direction, enhance or diminish posterior anchorage, and increase or conserve arch perimeter. Contemporary quality orthodontic care requires an awareness and control of all of the forces created by orthodontic appliances.

Biomechanical Phenomena↗

Effects of mandibular incisor extraction on anterior occlusion in adults with Class III malocclusion and reduced overbite.

The aim of this study was to assess the treatment outcome and changes in mandibular incisor position after extraction of one single incisor in 36 adult orthodontic cases with combined Class III and open bite tendencies. The cases consisted of 21 female and 15 male patients with an average age of 27.8 years (standard deviation [SD], 11.1 years) at the start. Fixed 0.018-inch Edgewise appliances were used in both arches in 19 patients and in the mandibular arch in 17 patients. Average treatment time was 18 months (SD, 7.1 months). Pretreatment ANB was 0.5(o) (SD, 2.7 degrees), overjet 1.4 mm (SD, 1.9 mm), and overbite 1.5 mm (SD, 1.1 mm). The lower incisors were 3.6 mm (SD, 2.8 mm) in front of the APg-line, and the Averaged Irregularity Index was 1.1 mm (SD, 0.6 mm). Records representing pretreatment (T1), posttreatment (T2), and average 4.3 years (SD, 2.3 years) retention (T3) included cephalograms, panoramic films, intraoral and extraoral photographs, and plaster models. All cast measurements were made with digital calipers. On the cephalograms, the lower incisor tips moved posteriorly 1.7 mm (SD, 2.0 mm) and occlusally 1.5 mm (SD, 1.8 mm) from pretreatment to posttreatment. Relative to the x-axis, they tipped lingually 5.9(o) (SD, 5.6 degrees). On the cast analysis, overjet increased 1.0 mm (SD, 1.9 mm) and 1.5 mm (SD, 1.5 mm) for the maxillary central and lateral incisors, respectively, whereas overbite increased 0.6 mm for both the central and lateral incisors. The intercanine width was reduced by 3.3 mm (SD, 2.0 mm), while the intermolar width was unchanged. The Average Irregularity Index was reduced from 1.1 to 0. 2 mm. Arch-length was reduced 3.6 mm from pretreatment to posttreatment, and another 0.3 mm from posttreatment to 4.3-years retention. Other changes from posttreatment to 4.3-years retention were slight. No loss of the interdental gingival papillae was normally observed. It is concluded that the extraction of one mandibular incisor can lead to satisfactory treatment results in adults with mild Class III malocclusion and reduced overbite, particularly when coupled with a large mandibular intercanine width and minor crowding, and some mandibular tooth size excess. However, the orthodontic treatment frequently became more complicated and time-consuming than expected at the start.

Adult↗

Risk factors associated with incisor injury in elementary school children.

This study examined risk factors associated with incisor injury in 3396 third and fourth grade school children in Alachua County, Florida. One of six orthodontists completed a standardized examination form for each child to assess severity of incisor injury, gender, age, race, skeletal relationships, morphologic malocclusion, incisor exposure, interlabial gap, TMJ sounds, chin trauma, and history of lower facial trauma. One in five (19.2%) exhibited some degree of incisor injury. This was limited to a single tooth in 73.1% of those with injury, while enamel injury predominated (89.4%). The majority of the injuries (75.4%) were localized in the maxillary arch, with central incisors the most frequently traumatized. Chi-square tests of association indicated that gender, race, school, orthodontist, history of lower facial trauma, chin trauma, profile, and maxillary and mandibular horizontal positions were associated with incisor injury (P < 0.05). Wilcoxon rank sum tests identified differences in age, overjet, time of screening, and interlabial gap between those with and without injury (P < 0.05). Results of logistic regression analyses indicated risk of incisor injury was greater for children who had a prognathic maxilla, a history of trauma, were older, were male, and had greater overjet and mandibular anterior spacing.

Age Factors↗

Correlation between mandibular central incisor proclination and gingival recession during fixed appliance therapy.

The purpose of this study was to determine whether proclination of mandibular central incisors during fixed appliance therapy results in gingival recession. Complete records of 67 patients (39 female and 28 male patients; mean age, 16.4 years; age range, 10-45 years) were used in this retrospective case-control study. Using pretreatment and posttreatment lateral cephalograms, the change in mandibular central incisor inclination was measured to divide the patients into an experimental group (proclination) and a control group (no proclination). Changes in clinical crown length were determined from pretreatment and posttreatment study models, and changes in gingival recession were determined from intraoral slides. Eight of the 67 patients exhibited a measurable increase in gingival recession of at least 0.5 mm, and 27 patients had an increase in clinical crown length of at least 0.5 mm. Statistical analyses showed no correlation between mandibular central incisor proclination and gingival recession or clinical crown length. A t-test analysis showed no statistically significant difference in gingival recession or change in clinical crown length between patients whose mandibular central incisors were proclined and those whose incisors were not proclined. Multiple regression analysis demonstrated that age, sex, race, treatment duration, extraction, treatment type, Angle classification, and proclination were not related to gingival recession or change in clinical crown length of mandibular central incisors. We conclude that the degree of proclination of mandibular central incisors during fixed appliance therapy was not correlated to gingival recession in this sample.

Adolescent↗

Periodontal status of mandibular incisors after pronounced orthodontic advancement during adolescence: a follow-up evaluation.

The purpose of this study was to analyze whether pronounced orthodontic advancement of the mandibular incisors during Class II correction in the mixed dentition results in gingival recession. Through mandibular superimposition of the pretreatment and posttreatment cephalograms of 67 Class II patients who were treated with reverse headgear to the mandibular dentition, 45 patients with a minimum of a 1-mm advancement of the cementoenamel junction (CEJ; mean, 2.18 +/- 0.87) and a minimum of a 2-mm advancement of the incisal edge (mean, 3.87 +/- 1.34) were identified. Using the same protocol in Class II patients, 30 individuals who finished treatment at a similar time and age, but without reverse headgear and with no advancement of the CEJ (mean -0.43, SD 0.53) and a maximum of 1-mm advancement of the incisal edge (mean -0.26, SD 1.15) were identified. Before treatment, the mandibular incisors were more retruded, relative to the line from point A to pogonion and relative to the mandibular plane in the patients with pronounced advancement than in those with no advancement of the mandibular incisors; no differences were found at the time of appliance removal. A total of 30 patients with pronounced advancement and 21 patients with no advancement could meet for a follow-up examination a mean period of 7.83 years (SD, 4.44) and 9.38 years (SD, 4.39) after treatment, respectively. Clinical examinations at the time of follow-up revealed no differences in the amount of recession, the width of attached gingiva, the length of supracrestal connective tissue attachment, the probing pocket depth, and gingival bleeding index or visible plaque index of the mandibular incisors between the patients in the 2 groups. An examination of color slides demonstrated no differences in the number of mandibular incisors that developed recession from before treatment to after treatment and from after treatment to follow-up. Measurement of mandibular incisor crown height on the study models demonstrated no difference in the increase in clinical crown height from after treatment to follow-up between the patients in the 2 groups. It was concluded that pronounced advancement of the mandibular incisors may be performed in adolescent patients with dentoalveolar retrusion without increasing the risk of recession.

Adolescent↗

Influence of post placement in the fracture resistance of endodontically treated incisors veneered with direct composite.

STATEMENT OF PROBLEM: Veneer preparations are considered to weaken endodontically treated maxillary incisors. Prefabricated posts have been controversially indicated to reinforce endodontically treated teeth before final restoration. PURPOSE: This in vitro study evaluated whether (1) veneer preparation in enamel or in enamel/dentin weakens endodontically treated maxillary incisors, (2) bonding of direct composite veneer restores the original strength of the unprepared teeth, and (3) use of prefabricated metal posts increases fracture resistance of prepared and restored teeth. MATERIAL AND METHODS: Ninety extracted human maxillary central incisors were submitted to conventional root canal treatment. Specimens were randomly divided into 8 experimental groups (veneer preparation in enamel or dentin with/without post and with/without direct composite veneer restoration) and a control group (n = 10). Specimens were loaded to fracture, and the data were analyzed statistically. RESULTS: Statistical analysis revealed that a conservative veneer preparation does not significantly reduce maxillary incisors' fracture resistance. For prepared incisors, bonding of direct composite veneer restored their original strength, and the use of posts did not increase their fracture resistance. CONCLUSION: Conservative veneer preparations involving enamel and enamel/dentin did not significantly reduce the fracture resistance of endodontically treated maxillary incisors. In addition, restoration of the intraenamel preparations with direct composite resulted in teeth more resistant to fracture than teeth having restorations in dentin. The use of posts did not improve fracture resistance of endodontically treated maxillary incisors reduced and veneered with direct composite.

Analysis of Variance↗

Early treatment of Class III incisor relationship using the chincap appliance.

Twenty-three patients (10 male, 13 female), with Class III relationships of the incisor teeth at the mixed dentition stage, were treated with the chincap appliance associated, where appropriate, with an upper removable appliance to procline upper incisors and to free the occlusion. Cephalometric analyses at the beginning and at the end of active treatment were compared with those in a carefully matched untreated control group selected from the Belfast Growth Study. At the beginning of treatment patients differed significantly from the controls in the SNB was larger, ANB was negative, Wits' analysis was negative, and the intermaxillary angle significantly reduced. The overjet was reversed, the lower incisors were ahead of A-Po, and the upper lip was far behind the E line. Significant changes brought about by the treatment were improvement in the Wits' relationship (but there was no significant change in the ANB angle), increases in the intermaxillary angle and lower facial height, improvement in the overjet, proclination of upper incisors and retroclination of lower incisors, backward movement of the lower incisors in relation to A-Po, and backward movement of the lower lip. The efficacy of the chincap appliance can be attributed to retroclination of lower incisors and downward movement of the mandible which may improve the jaw relationship without affecting the ANB angle. There were marked changes in the lip posture.

Case-Control Studies↗

The association between spontaneous reversal of gingival recession in mandibular incisors and dentofacial changes in children. A 3-year longitudinal study.

In a previous 3-year longitudinal study, reversal of gingival recession in mandibular incisors was observed for 16 out of 28 participating children aged 6-13 years (Andlin-Sobocki et al., 1991). In the present report various dentofacial conditions that might be associated with this reversal were evaluated from dental casts and cephalometric radiographs by comparing the 16 children with spontaneous reversal of gingival recession (Group Rev) to the 12 children with persisting gingival recession (Group Per). Dental casts and cephalometric radiographs were obtained at baseline and after three years. The findings indicate that the children with persisting gingival recession tended to have a particular facial morphology and incisor pattern. They were likely to have a larger basal bone discrepancy between the maxillary and mandibular jaws, with somewhat more proclined and more irregularly positioned mandibular incisors. Although a reduction in incisor irregularity and a slight increase in anterior arch widths occurred for both groups during the observation period, the tooth alignment situation in Group Per at the end of the observation period was similar to that of Group Rev at baseline. Additionally, in Group Rev all facially deviating incisors with recession at baseline had self-corrected at 3 years. This was not the case for Group Per. Thus, spontaneous reversal of gingival recession in mandibular incisors seem to be related to developmental changes in the dentition favouring incisor alignment.

Adolescent↗

Surgical repositioning of a developing maxillary permanent central incisor in a horizontal position: spontaneous eruption and root formation.

This report describes the surgical repositioning of a developing maxillary permanent central incisor in a horizontal position, followed by spontaneous eruption and root formation without orthodontic traction. Surgical exposure of the right central incisor was achieved. A 7-year-old boy referred for orthodontic consultation. Radiographic examination showed the crown of a maxillary right central incisor to be positioned horizontally with root formation at the initial stage. The surgically repositioned incisor (by a close-eruption surgical flap technique) spontaneously erupted into correct alignment after 2 years 3 months. The erupted incisor remained vital and responded normally to percussion, mobility and sensitivity testing. The soft tissue, periodontal attachment, gingival contour and probing depths were normal. Follow-up radiographs confirmed the continued development of the root, with revascularization of the pulp and a normal appearance of the periodontal space and lamina dura. There was, however, shorter root formation and a narrower root cavity compared with the contralateral incisor. As a result, no orthodontic traction and alignment were required. This method of surgical repositioning is a viable alternative to the traditional approach of extraction or surgical exposure followed by orthodontic traction for a developing maxillary permanent central incisor in a horizontal position.

Child↗

Dense incisors (din): a new mouse mutation on chromosome 16 affecting tooth eruption and body size.

Dense incisors (din) is a new autosomal recessive mutation in the mouse that interferes with complete eruption of the incisors. The initial eruption of incisors through the gingiva does not differ in mutants and normal littermates, but subsequent further eruption of incisors is arrested in mutants. Radiographic examinations show that, because the incisors do not erupt, continued dentin formation gradually occludes the pulp chambers of these teeth creating as dense incisor. The arrested eruption of the incisor results in an anterior open bite. The pleiotropic phenotype of din/din mutant mice also includes small body size, reduced ear pinna size, and coat color dilution. The din mutation was mapped to Chr 16 near the pituitary transcription factor gene Pit1, but din is not a mutation in Pit1.

Animals↗

Periodontal status of secondary crowded mandibular incisors. Long-term results after orthodontic treatment.

The present study was undertaken to examine whether secondary crowded mandibular incisors experience more periodontal breakdown than aligned lower incisors long-term after orthodontic treatment. Patients from 19 to 35 years after active treatment were selected. 2 groups were established: 1 with crowded mandibular incisors and 1 with aligned incisors. The groups were matched according to age, time after treatment, gender and periodontal disease classification. A separate group with crowded and aligned incisors within the same individual was established. Accumulation of plaque, gingival inflammation, probing pocket depth and probing attachment level were registered at 6 locations around each incisor. Among the patients studied, the oral hygiene level was high. In both groups, the loss of connective tissue attachment was largely due to periodontal pocket formation in interproximal areas and gingival retraction in buccal and lingual areas. A small but statistically significant difference in probing attachment level was found between crowded and aligned interproximal areas within the same individual (P less than 0.05). No differences in accumulation of plaque or in gingival inflammation were found. No differences were found for any of the dependent variables between the groups with crowded and aligned incisors.

Adult↗