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PubMed2001

Calcific metamorphosis: a challenge in endodontic diagnosis and treatment.

Calcific metamorphosis (CM) is seen commonly in the dental pulp after traumatic tooth injuries and is recognized clinically as early as 3 months after injury. Calcific metamorphosis is characterized by deposition of hard tissue within the root canal space and yellow discoloration of the clinical crown. Opinion differs among practitioners as to whether to treat these cases upon early detection of CM or to observe them until symptoms or radiographic signs of pulpal necrosis are detected. In this review, the clinical, radiographic, and histopathologic appearance of CM is described; a review of the literature is presented to address these issues in an attempt to establish a sound rationale for treatment. Approximately 3.8% to 24% of traumatized teeth develop varying degrees of CM. Studies indicate that of these, approximately 1% to 16% will develop pulpal necrosis. Most of the literature does not support endodontic intervention unless periradicular pathosis is detected or the involved tooth becomes symptomatic. It may be advisable to manage cases demonstrating CM through observation and periodic examination.

Dental Pulp Calcification↗
PubMed2005

Displacement of avulsed tooth into soft tissue of chin resulting from epileptic attack trauma.

Maxillofacial trauma is the main cause of emergency admittance to dental clinics. Mental retardation and epileptic status are important factors in an increase in the risk of dental injuries. Tooth avulsion, which is the total displacement of a tooth out of its socket, is an infrequently observed entity. Maxillary central incisors are the most commonly affected teeth. The case of a patient with severe dental injury resulting from an epileptic attack is presented. He had several teeth avulsed and displacement of a tooth into the soft tissue of the chin.

Adult↗
PubMed2006

Histochemical and immunocytochemical study of hard tissue formation in dental pulp during the healing process in rat molars after tooth replantation.

Dental pulp is assumed to possess the capacity to elaborate both bone and dentin matrix under the pathological conditions following tooth injury. This study was undertaken to clarify the mechanism inducing bone formation in the dental pulp by investigating the pulpal healing process, after tooth replantation, by micro-computed tomography (mu-CT), immunocytochemistry for heat-shock protein (HSP)-25 and cathepsin K (CK), and histochemistry for both alkaline phosphatase (ALP) and tartrate-resistant acid phosphatase (TRAP). Under deep anesthesia, the upper right first molar of 4-week-old Wistar rats was extracted and immediately repositioned in the original socket. In control teeth at this age, the periphery of the coronal dental pulp showed intense ALP-positive and HSP-25-positive reactions, whereas there were no TRAP-positive or CK-positive cells. Tooth replantation weakened or terminated ALP-positive and HSP-25-positive reactions in the pulp tissue at the initial stages. At 3-7 days after operation, the ALP-positive region recovered from the root apex to the coronal pulp followed by HSP-25-positive reactions in successful cases showing tertiary dentin formation. In other cases, TRAP-positive and CK-positive cells appeared in the pulp tissue of the replanted tooth at postoperative days 5-10 and remained associated with the bone tissue after 12-60 days. Immunoelectron microscopy clearly demonstrated that CK-positive osteoclast-lineage cells made contact with mesenchymal cells with prominent nucleoli and well-developed cell organelles. These data suggest that the appearance of TRAP-positive and CK-positive cells is involved in the induction of bone tissue formation in dental pulp.

Acid Phosphatase↗
PubMed1976

The influence of traumatic intrusion of primary teeth on their permanent successors. A radiographic and histologic study in monkeys.

Intrusion of maxillary central primary incisors was performed in 18 green vervet monkeys (Cercopithecus aethiops) with the purpose of studying early and late histologic changes in odontogenesis of permanent tooth germs and the effect of treatment of primary tooth injury. Immediate changes were studied in five monkeys where both maxillary central primary incisors were intruded. The monkeys were sacrificed 10-15 min after intrusion. The immediate changes in the permanent tooth germ consisted of contusion and displacement of the reduced enamel epithelium and slight displacement of the hard dental tissue in relation to the cervical loop, or Hertwig's epithelial root sheath. Late changes and effect of treatment were studied in 13 monkeys where both maxillary central incisors were intruded. One central primary incisor was removed 1 hour after intrusion while the other incisor was allowed to remain in the jaw. The monkeys were sacrificed 6 weeks after injury and the anterior portion of the maxilla was examined histometrically. The late changes consisted of metaplasia of the reduced enamel epithelium into a stratified squamous epithelium and, in most cases, changes in morphology of the dentin and enamel matrices. On the side where the injured tooth was preserved, significantly larger areas of epithelial metaplasia of the reduced enamel epithelium were present compared with the extraction side. Changes in morphology of the enamel matrix and dentin were found with the same frequency in the two groups, but tended to be less severe in the extraction group. It is concluded that more studies are needed on the effect of metaplasia of the reduced enamel epithelium on complete mineralization of the enamel before an optimal treatment of intruded primary incisors can be determined.

Animals↗
PubMed1997

Dental innervation and CGRP in adult p75-deficient mice.

Adult dental tissues have unusual neurotrophin biology. Pulpal fibroblasts express nerve growth factor (NGF) and the low-affinity p75 neurotrophin receptor, their sensory nerve fibers express p75 and trk A, and pulpal sympathetic fibers lack p75. Following tooth injury, there is increased pulpal NGF, sprouting of sensory nerve endings, and increased immunoreactivity for the sensory neuropeptide calcitonin gene-related peptide (CGRP). In the present study, we have analyzed tooth structure and innervation of pulp and periodontal ligament in young (6-8 weeks, 3 months) and older (5-12 months) adult mice carrying a null mutation in the p75 gene and compared the results with those of age-matched wild-type controls. Our hypotheses were that tooth structure would be abnormal and that pulpal innervation would be greatly reduced because it consists primarily of nociceptive fibers that have been found to be severely depleted in skin of p75(-/-) mice. Tissues were fixed, X-rayed for gross dental morphology, decalcified, and analyzed for immunoreactivity for CGRP and for a general nerve marker, protein gene product 9.5. Radiographs showed worn-down molar crowns in p75-deficient mice. Light microscopy confirmed the accelerated molar wear and showed intense CGRP immunoreactivity in pulp nerve endings of mutant mice, compared with a gradual decrease in CGRP intensity in controls during normal aging. The CGRP intensity in 5-12-month-old pairs of mice was threefold greater in the mutants (P < 0.03), and in younger mice the mutant always had more CGRP than its matched control. The innervation of molar ligament in all p75-deficient mice was similar to that of controls except there was nerve sprouting near bone loss in mutants. The incisors of mutant mice did not have unusual wear and their pulpal CGRP immunoreactivity remained normal, but their periodontal ligament had fewer thin branched nerve endings at all ages. Thus, most innervation of teeth and their supporting tissues developed normally, and the only neural changes in p75(-/-) mutant mice were the reduction of incisor ligament sensory receptors and increased molar CGRP. Sensory nerves in teeth gradually lose neuropeptide intensity during aging, but that did not happen in the mutant mice, suggesting that the accelerated molar wear stimulated persistent high levels of CGRP.

Animals↗
PubMed1975

Common dental emergencies which may be encountered by the family physician.

Dental emergencies are common in everyday practice, and the family physician may frequently be called upon to evaluate and, at times, to provide initial care for such problems. This article acquaints the family physician with diagnosis and treatment of the most common dental emergencies: disorders secondary to trauma, including soft tissue laceration, fracture or displacement of teeth, and bone fractures; and severe pain related to acute alveolar infection.

Alveolar Process↗
PubMed2004

Bone structure effect on root resorption.

OBJECTIVES: To explore if alveolar bone shape and density might promote external apical root resorption. SETTING AND SAMPLE POPULATION: Panoramic radiographs of 700 patients who had orthodontic treatment at Temple University were reviewed and 22 patients with radiographic evidence of root resorption on the lower incisors were selected for the study. Exclusion criteria included a history of systemic diseases, craniofacial abnormalities, tooth injury, endodontically treated teeth, and impacted teeth. METHODS: Pre-treatment (T1) and post-treatment (T2) cephalometric radiographs were converted into digital format and enhanced to reduce contrast variability and improve edge definition. Tooth length, root length, root area, alveolar area around the root including cortical area, area of medullary bone, and area of the symphysis were measured using an interactive software algorithm. A region of interest within the symphysis was also defined and trabecular space area and fractal dimension calculated as an estimate of bone density. RESULTS: Root area and tooth length were correlated negatively with changes in root area, tooth area, and root length. Larger teeth demonstrated a greater amount of root resorption. Dentoalveolar complex dimensions remained relatively unchanged during tooth movement. The amount of alveolar bone around the root, thickness of cortical bone, density of the trabecular network, and fractal dimension showed no significant correlation with the extent of the external apical root resorption. CONCLUSIONS: The results of this study suggest that the density and morphology of the dentoalveolar complex are not significant factors in the etiology of external apical root resorption.

Adolescent↗
PubMedDate not supplied

[Zinc and caries].

Zinc levels in dentin, enamel, tooth deposit, and mixed saliva in caries were under study. The enamel and dentin Zn levels were measured by means of neutron activation analysis in 244 permanent intact teeth and in 92 permanent carious teeth from subjects died after acute injury. Tooth deposit and mixed saliva Zn levels were measured by the atomic absorption technique in 10 patients with caries and in 10 normal subjects; the groups were matched for dietary habits. The menu of these subjects over a month was examined and the content of daily dietary zinc was determined, and the level of salivary Zn excretion as against Zn content in the food was calculated. The dentin and enamel Zn levels were found increased in caries. A tendency to an increase of Zn level in the saliva was detected; a large proportion of this dietary element was excreted with the saliva in caries patients. The authors suggest that remineralization effect can be achieved in the initial stages of caries by oral and local application of Zn preparations.

Dental Caries↗
PubMed2004

[Dentoalveolar traumatology].

The dentist will be confronted unexpectedly with a dentoalveolar trauma patient. This patient has to be seen immediately and has to be treated adequately. The risk of overlooking trauma-related signs when examining these patients, can be minimized by following a strict protocol. This article describes a protocol for examination and treatment of a patient with a dentoalveolar trauma. The prognosis after treatment of the trauma is discussed. Also some recommendations regarding aftercare and prevention are presented.

Alveolar Process↗
PubMed1990

[Preprosthetic periodontal examination. Clinical observations].

A detailed and comprehensive clinical examination is an important and fundamental basis for establishing a proper diagnosis for prosthetic treatment. It is important to make an accurate diagnosis, a rational treatment plan and establishing a prognosis. A careful examination of teeth and periodontium must be done and the prosthetic plan must consider the periodontal status of the teeth. The prosthetic treatment plan must take into consideration problems of appliance retention, iatrogenic tooth injuries and other factors. A classification based on 6 different clinical situations suggested and their therapeutic solution proposed.

Dentures↗
PubMed2001

Morphological variation in the tyrosine receptor kinase A-immunoreactive periodontal ligament epithelium of developing and mature rats.

Tyrosine receptor kinase A (trkA) is the high-affinity receptor for nerve growth factor. It has been found in several non-neuronal cell types, indicating biological roles independent of neural function, as well as in the nervous system. An initial study demonstrated that an antibody to the full extracellular domain did not label periodontal ligament epithelium (PLE; also known as epithelial rests of Malassez), but that another antibody which recognises a truncated 41-kDa form of trkA did label PLE. Thus, truncated trkA-immunoreactive (-IR) PLE was further investigated here in developing molars of young rats, and in its mature form in adult rat molars, for its reaction to moderate or deep molar injuries, and for its appearance along the continuously erupting incisors of mature rats. In some of the adult rat molars we also analysed the association of nerve fibres with PLE using antibodies for p75 neurotrophin receptor or peripherin. Rat jaws were fixed with 4% formaldehyde and demineralised, and bound antibody was detected with avidin-biotin-peroxidase and diaminobenzidine or fluorescence procedures. Light microscopy showed great variation in the appearance of trkA-IR PLE and considerable morphological changes during the eruption of molars and incisors. By electron microscopy it was shown that trkA-IR was not uniformly distributed in PLE cells but rather was concentrated in the peripheral zones of each cell cluster. Tooth injury did not influence the form or occurrence of PLE unless there was specific destruction of a ligament region. Qualitative analyses of nerve fibres showed that they only rarely innervated PLE in adult rats, indicating that the truncated receptor has non-neuronal functions in this epithelium. These results suggest that neurotrophin growth factors, acting via truncated trkA receptors, affect the interactions between PLE cells and the periodontal ligament, with fewer PLE interactions with nerves. Furthermore, the expression of these receptors on PLE supports the possibility that these cells are active during tooth development and eruption rather than being merely passive remnants of the degenerating tooth sheath. The similar trkA-IR of PLE and junctional epithelium, as well as their structural association, suggests interactions between these two epithelia.

Animals↗
PubMed2006

Assessment of intraoperative safety in transoral robotic surgery.

INTRODUCTION: Robotic technology has been safely integrated into thoracic and abdominopelvic surgery, and the early experience has been very promising with very rare complications related to robotic device failure. Recently, several reports have documented the technical feasibility of transoral robotic surgery (TORS) with the daVinci Surgical System. Proposed pharyngeal and laryngeal applications include radical tonsillectomy, base-of-tongue resection, supraglottic laryngectomy, and phonomicrosurgery. The safety of transoral placement of the robotic endoscope and instruments has not been established. Potential risks specific to the transoral use of the surgical robot include facial skin laceration, tooth injury, mucosal laceration, mandible fracture, cervical spine fracture, and ocular injury. We hypothesize that these particular risks of transoral surgery are similar with robotic assistance compared with conventional transoral surgery. METHODS: To test this hypothesis, we attempted to intentionally injure a human cadaver with the daVinci Surgical System by impaling the facial skin and pharyngeal and laryngeal mucosa with the robotic instruments and endoscope. We also attempted to extract or fracture teeth and fracture the cadaver's mandible and cervical spine by applying maximal pressure and torque with the robotic arms. Experiments were documented with still and video photography. RESULTS: Impaling the cadaver's skin and mucosa resulted in only superficial lacerations. Tooth, mandible, and cervical spine fracture could not be achieved. CONCLUSIONS: Initial experiments performing TORS on a human cadaver with the daVinci Surgical System demonstrate a safety profile similar to conventional transoral surgery. Additionally, we discuss several strategies to increase patient safety in TORS.

Cadaver↗