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Lead exchange in teeth and bone--a pilot study using stable lead isotopes.

Stable lead isotopes and lead concentrations were measured in the enamel and dentine of permanent (n = 37) and deciduous teeth (n = 14) from 47 European immigrants to Australia to determine whether lead exchange occurs in teeth and how it relates to lead exchange in bone. Enamel exhibits no exchange of its European-origin lead with lead from the Australian environment. In contrast, dentine lead exchanges with Australian lead to the extent of approximately 1% per year. In one subject, trabecular bone from the tooth socket exchanged almost all its European lead with Australian lead over a a 15-year period (turnover of approximately 6% per year), similar to the approximately 8% per year proposed for lead turnover in trabecular bone. The repository characteristics of intact circumpulpal dentine were investigated by analyses of four sets of contiguous slices from six teeth: 1) a set consisting of slices with intact circumpulpal dentine and cementum; 2) a set in which these areas were removed; 3) another set consisting of slices with intact circumpulpal dentine and cementum; and 4) a set without cementum. These analyses show relatively small differences in isotopic composition between contiguous slices except that circumpulpal dentine appears to be the dominant control on lead concentration. There is a significant correlation (R2 = 0.19, p = 0.01, n = 34) of dentine lead concentration and rate of exchange with residence time from the country of origin and Australian lead, but there is no such correlation with enamel lead concentration. Analyses of permanent and deciduous teeth of subjects from other countries who have resided in Australia for varying lengths of time should resolve some of the questions arising from this pilot study.

Adult↗

Management strategies of the unsalvageable tooth.

UNLABELLED: A tooth is deemed unsalvageable when it can no longer be preserved for use of function or aesthetic purposes. If proper treatment planning is done, tooth extraction can be performed with adjunctive procedures, to provide a more predictable restorative outcome for the patient. This review paper summarizes the possible treatment strategies available for the management of a tooth with a poor prognosis, so as to manage the patient better before the restorative treatment phase commences. CLINICAL RELEVANCE: The management of an unsalvageable tooth using interdisciplinary approaches offers the clinician strategies for providing a more favourable restorative outcome.

Alveolar Bone Loss↗

Assessment of three-dimensional X-ray images: reconstruction from conventional tomograms, compact computerized tomography images, and multislice helical computerized tomography images.

Three-dimensional X-ray images (3D images) were used for imaging diagnosis in the oral and maxillofacial region. These images could be fundamentally reconstructed from various tomograms, though clinical 3D images were mainly reconstructed from computerized tomography (CT) images. In this investigation, 3D images were reconstructed from conventional tomograms with a panoramic unit, compact CT images, and multislice helical CT images, and the usefulness of each system was subjectively assessed for dental implant treatment. Three hemilateral dried human mandibles were used and were examined by linear tomography with a panoramic unit, compact CT, and multislice helical CT, and 3D images were reconstructed by using the rendering software for each system. The 3D images were visually evaluated on a 5-point scale covering the alveolar ridge, buccal and lingual bone surface, mental foramen, and tooth sockets. As a result, 3D images reconstructed from conventional tomograms with the panoramic unit were assessed as fair to unsure, compact CT 3D images were assessed as unsure to good, and multislice helical CT 3D images were assessed as good to excellent. It was concluded that compact CT 3D images and multislice helical CT 3D images were useful in dental implant treatment.

Dental Implantation, Endosseous↗

Mitogenic, chemotactic, and synthetic responses of rat periodontal ligament fibroblastic cells to polypeptide growth factors in vitro.

The mitogenic, chemotactic, and synthetic responses of rat periodontal ligament (PDL) fibroblastic cells to epidermal growth factor (EGF), transforming growth factor-beta (TGF-beta), recombinant human platelet-derived growth factor (rhPDGF)-AB, rhPDGF-BB, natural (n) PDGF-AB, and insulin-like growth factor-I (IGF-I) were examined in vitro using PDL cells obtained from the coagulum of healing tooth sockets. PDGFs and IGF-I have potent and comparable mitogenic effects on PDL fibroblastic cells. The maximum mitogenic effect of PDGFs was observed at the concentration of 10 ng/ml, whereas that of IGF-I was seen at concentrations higher than 100 ng/ml. In contrast, EGF induced moderate, and TGF-beta inhibitory mitogenic responses. The combination of rhPDGF-AB with either EGF or TGF-beta demonstrated comparable mitogenic potency, equivalent to the level of PDGF alone regardless of the mitogenic effect of other growth factors. The combination of rhPDGF-AB and IGF-I, however, showed a synergistic effect revealing the highest mitogenic effect among all individual growth factors as well as any combinations of the growth factors tested. Similarly, PDL fibroblastic cells demonstrated strong chemotactic responses to both IGF-I and PDGFs. The maximum effect was observed by IGF-I at concentrations higher than 10 ng/ml, followed by rhPDGF-BB at 0.1 ng/ml, rhPDGF-AB and nPDGF at concentrations ranging from 0.1 to 1 ng/ml. TGF-beta revealed no, and EGF slightly increased, chemotactic effects. IGF-I slightly enhanced the synthesis of total protein, whereas other factors had no significant effect. However, both rhPDGF-AB and TGF-beta stimulated collagen synthesis. On the other hand, IGF-I showed no effect on collagen synthesis, while EGF suppressed collagen synthesis. These findings suggest that rhPDGF-BB and IGF-I stimulate proliferation and chemotaxis of PDL fibroblastic cells. In addition, the combination of these growth factors further increases the mitogenic effect. rhPDGF-AB also stimulates collagen synthesis by PDL fibroblastic cells. Thus, rhPDGF-BB and IGF-I may have important roles in promotion of PDL healing, and consequently, may be useful for clinical application in periodontal regenerative procedures.

Animals↗

Pathologic changes in the pericoronal tissues of unerupted third molars.

OBJECTIVE: The purpose of this study was to determine whether the incidence of pathologic conditions affecting the pericoronal tissue of unerupted third molars justifies their routine removal. METHOD AND MATERIALS: The pericoronal tissue associated with completely unerupted third molars was submitted for histologic examination after surgical tooth removal was performed in 37 males and 55 females, aged 13 to 63 years. The 104 unerupted third molars comprised 68 mandibular third molars (65.38%) and 36 maxillary third molars (34.62%). RESULTS: The incidence of normal tissue of a dental follicle was 41.35%, and the incidence of pathologic tissue was 58.65% (dentigerous cyst, 50.96%; chronic nonspecific inflammatory tissue, 4.81%; odontogenic keratocyst, 1.92%; ameloblastoma, 0.96%). The incidence of pathologic conditions was higher than that of normal conditions in all third molar positions. In younger patients, normal tissue was more commonly found, but in patients older than 20 years, the incidence of pathologic tissue was higher than the incidence of normal tissue. CONCLUSION: Unerupted third molars should be removed before pathologic changes can occur in their pericoronal tissues. This justifies routine removal of unerupted third molars from patients older than 20 years.

Adolescent↗

Retrospective case series analysis of the factors determining immediate implant placement.

Implant placement at the time of extraction has become an acceptable treatment option. The formation of a restorative treatment plan frequently requires the removal of questionable and hopeless teeth. This retrospective case series analysis reports the reasons for tooth removal before immediate implant placement and provides a rationale for removing questionable and hopeless teeth. Root length is also analyzed as related to tooth loss. Between September 1986 and December 1998, 460 teeth were removed from 282 patients. Reasons for removal were advanced periodontal disease, endodontic complications, nonrestorable caries, roots fractures, short roots (< 14 mm in length), root resorption, and loosened posts. Implants were placed at the time of extraction. Tallies, frequency distributions, and percentages were used to determine individual and multiple reasons for extraction. For teeth with short roots, computerized measurements were made from periapical x-rays. Advanced periodontal disease and restored endodontically treated teeth with posts were the primary reasons for tooth extraction. Dental implants replaced 305 maxillary and 155 mandibular teeth.

Adolescent↗

Immediate total tooth replacement.

Successful implant placement at the time of extraction has been documented. Implant placement at the time of extraction was initially performed as a two-stage procedure often with barrier membranes and sophisticated second-stage surgical uncoverings. The authors describe the next generation of this technique, including atraumatic tooth removal with simultaneous root form, implant placement, and temporization at one appointment. This technique of "Immediate Total Tooth Replacement" allows for the maintenance of the bony housing and soft-tissue form that existed before extraction, while at the same time establishing a root form anchor in the bone for an esthetic restoration.

Dental Implantation, Endosseous↗

Quantification of the lamina dura and dentin density in children.

This study used 150 periapical radiographs of primary mandibular molars along with an aluminum stepwedge consisting of 5 steps from 2 to 10mm which were exposed and developed under standard conditions. A Mustek (Taiwan, R.O.C.) flatbed scanner with transparency adapter was used to digitize the radiographs. A 600 dpi, 10 bit gray level scanning transparency scanning mode were used. The thickness of the lamina dura was measured with the electronic ruler whereas density of dentin was calculated using the density function of a software program (Image Tool 2.0). Dentin density of the bifuraction area was calculated as 7.42 +/- 37 mm=A1 in primary second molars and 11.02 +/- 1.37mm = A1 for permanent first molar teeth. Differences in the thickness of the lamina dura in primary posterior teeth ranged from 0.23 +/- 0.01mm to 0.42 +/- 0.01mm.

Alveolar Process↗

Accidental displacement of impacted maxillary and mandibular third molars.

Displacement of impacted third molars is frequently mentioned in oral and maxillofacial surgery textbooks, but rarely reported. However, should this complication arise in general practice, the clinician should not embark on potentially complicated and hazardous surgical procedures to retrieve the displaced tooth. Administration of prophylactic broad spectrum antibiotics and urgent referral to an oral and maxillofacial surgeon, is recommended.

Adolescent↗

Immediate Osseotite implant placement and immediate loading of a provisional restoration of maxillary lateral incisors.

This article describes the immediate replacement of two maxillary lateral incisors teeth after extraction of the left lateral deciduous incisor at the same time with immediate Osseotite implants and immediate restoration. A traumatic dental extraction of a deciduos (b) lateral incisor was performed and a 4mm diameter x 15 mm 3i tapered Osseotite (Implants Innovations, Palm Beach, CA, USA) implant was immediately placed. The other lateral incisor place was treated at the same time and provisional temporary crowns were placed at the same surgery. The provisional crowns did not have any occlusal contact to reduce negative lateral forces. Final impression for definitive restoration was made five months after implant placement veneer ceramic crowns were bonded to the Gingihue abutment (3i, Implants Innovations, Palm Beach, CA) one month later. This article describes the use of immediate implants with immediate loading of Osseotite combined with provisional crowns resulted in an excellent outcome after a two-year follow up period.

Adult↗

[Gorham-Stout syndrome of the mandible].

A 16-year-old female complained of loosening of several teeth in the lower jaw. Radiography revealed bone resorption of the tooth sockets. The osteolytic process extended throughout the alveolar crest of the mandible and caused a complete loss of teeth within 2 years. Microscopic sections showed angiomatous tissue of Gorham-Stout-syndrome. Radiotherapy with 35 Gy controlled the mandibular osteolysis. Recurrent meningitis and osteolytic defects of the frontal skull base hint at an additional manifestation of the disease at this site.

Follow-Up Studies↗

[An unusual case of a foreign body in the maxillary sinus].

An unusual case of a foreign body in the maxillary sinus was presented with a 13-year-old boy. The boy led a sewing needle into the maxillary sinus through a tooth destroyed by caries. Trying to remove the needle, the boy broke it. The existence of the foreign body was proved by an X-ray picture. The operation was conducted according to the Caldwell-Luc's method. A two centimeter piece of the needle was extracted. The interior of the sinus was cleaned and inflammated mucous membrane, and granulation were removed. The cause tooth was extracted. The tooth-socket was sewn and the fistula at the bottom of the sinus was covered with a peduncular layer of mucous membrane of the nasal duct. Post-operational conduct without any complications.

Adolescent↗

Structure, attachment, replacement and growth of teeth in bluefish, Pomatomus saltatrix (Linnaeus, 1776), a teleost with deeply socketed teeth.

Tooth replacement poses many questions about development, pattern formation, tooth attachment mechanisms, functional morphology and the evolution of vertebrate dentitions. Although most vertebrate species have polyphyodont dentitions, detailed knowledge of tooth structure and replacement is poor for most groups, particularly actinopterygians. We examined the oral dentition of the bluefish, Pomatomus saltatrix, a pelagic and coastal marine predator, using a sample of 50 individuals. The oral teeth are located on the dentary and premaxillary bones, and we scored each tooth locus in the dentary and premaxillary bones using a four-part functional classification: absent (A), incoming (I), functional (F=fully ankylosed) or eroding (E). The homodont oral teeth of Pomatomus are sharp, deeply socketed and firmly ankylosed to the bone of attachment. Replacement is intraosseus and occurs in alternate tooth loci with long waves of replacement passing from rear to front. The much higher percentage of functional as opposed to eroding teeth suggests that replacement rates are low but that individual teeth are quickly lost once erosion begins. Tooth number increases ontogenetically, ranging from 15-31 dentary teeth and 15-39 premaxillary teeth in the sample studied. Teeth increase in size with every replacement cycle. Remodeling of the attachment bone occurs continuously to accommodate growth. New tooth germs originate from a discontinuous dental lamina and migrate from the lingual (dentary) or labial (premaxillary) epithelium through pores in the bone of attachment into the resorption spaces beneath the existing teeth. Pomatomus shares unique aspects of tooth replacement with barracudas and other scombroids and this supports the interpretation that Pomatomus is more closely related to scombroids than to carangoids.

Animals↗

Treatment of external inflammatory root resorption after autogenous tooth transplantation: case report.

This paper describes a case of autogenous tooth transplantation. An external inflammatory root resorption developed in a 30-year-old female patient and was successfully treated with the placement of calcium hydroxide-based intracanal dressings. Autotransplantation of tooth 32 into the extraction socket of tooth 30 was carried out with no intraoperative complications and uneventful postoperative course. However, the patient did not appear on the 14th postoperative day to initiate endodontic therapy of the transplanted tooth. She did not return for 3 months, at which time the clinical and periapical radiographic examinations revealed the presence of external inflammatory root resorption. Endodontic treatment was initiated immediately. Root canals were prepared and filled with a calcium hydroxide-based intracanal dressing (Calen paste), changed every 21 days during a 6-month period, and were thereafter obturated with Sealapex calcium hydroxide-based sealer and gutta-percha points. After 2 years of follow-up, the transplanted tooth was symptom free with no exacerbated sensibility to percussion, normal mobility, occlusion, and masticatory function. Probing revealed no periodontal pockets or other pathological signs. Radiographic examination showed the periradicular area with normal appearance, completely healed resorption areas, and presence of an intact lamina dura.

Adult↗