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PubMed1998

Effect of systemic tetracycline and amoxicillin on inflammatory root resorption of replanted dogs' teeth.

The use of systemic penicillin after an avulsion injury has been recommended as a way to decrease the occurrence of resorption complications. Our previous study has shown systemic tetracycline to possess anti-resorptive properties independent of potential anti-bacterial actions. The purpose of this study was to compare histologically the effectiveness of tetracycline and amoxicillin in limiting inflammatory root resorption (IR) secondary to pulpal infection, in replanted dogs' teeth. Thirty root canals in five dogs were infected with plaque. The roots were extracted, the lingual mid-roots were shaved with a fissure bur ensuring cemental damage and immediately replanted. Dogs were given either tetracycline hydrochloride or amoxicillin, administered orally, on the day of extraction and replantation and for the following 6 days. The control group was teeth in these animals treated in the same manner but where no antibiotics were given. After approximately 6 months, the dogs were sacrificed and the teeth prepared for histologic evaluation. The shaved root surface was identified in cross-sections and eight equidistant points along the cut root surface were evaluated for healing (H) or IR in eight sections per tooth. For the tetracycline group, H averaged 67.22% and IR 32.78%, which was not statistically different from the amoxicillin group with H averaging 56.88% and IR 43.12%. The tetracycline group was superior to the control group with H = 27.86% and IR = 72.14%. Since tetracycline has been shown to have anti-resorptive properties in addition to the antibacterial properties demonstrated here, it could be considered as an alternative to amoxicillin after avulsion injuries.

Amoxicillin↗
PubMed2005

Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device.

When teeth are replanted after being avulsed, the repair process sometimes results in ankylosis. In a growing child, the ankylosed tooth fails to move along with the remaining alveolar process during vertical growth, resulting in a tooth that gradually appears more and more impacted and requires several reconstructive procedures to correct. Ankylosed teeth can, however, serve as anchorage for orthodontic correction of a malocclusion and as a point of force application for a dentoalveolar segment during alveolar distraction osteogenesis. This case report describes the treatment of a 13-year-old girl whose maxillary left central incisor had been avulsed and replanted 5 years earlier. The tooth had become ankylosed, and it was used to provide "free anchorage" during distalization of the maxillary dentition. The underdeveloped alveolar process adjacent to the ankylosed tooth was reconstructed by dento-osseous segment distraction osteogenesis, by using the ankylosed tooth as the point of force application.

Adolescent↗
PubMed2000

[Phantom limb after amputation--overview and new knowledge].

Almost all patients who have an extremity amputated will experience a phantom limb. Amputations of other parts of the body can also cause phantom sensations. One fourth of all women who undergo mastectomy relates phantom breast sensations. Phantoms are common following rectum amputation and may be significant as indicators of rectal tumor relapse. Visual phantoms can appear in patients who undergo eye amputation. Phantom phenomena occur after tooth extraction, ureterocystectomy, penectomy, plexus avulsion or spinal cord injury. The causes underlying phantom sensations are unknown. Sensory deprivation in animals causes reorganization of the cortical and subcortical maps: the areas representing the deprived input shrink and the neighbouring areas expand. The mapping allocates areas to represent the most used peripheral inputs. Every level of the nervous system seems to exhibit plasticity. The primary site seems to be the cortex. The cellular basis of plasticity is unclear. Significant sensory and motor reorganization was found in humans suffering phantom pain. There was a strong relationship between the amount of cortical reorganization and the intensity of phantom pain. These findings may influence the rehabilitation of the amputee. It was shown that pain and cortical reorganization can be reduced or even prevented by the active use of prostheses.

Animals↗
PubMed1995

[Odontogenic sinusitis with cutaneous fistulization. A case report].

A 70-year-old male patient presenting with a cutaneous node of the genal region that was first diagnosed as basal cell carcinoma is described. Owing to the following observation, the authors were prompted to a diagnosis of cutaneous odontogenic sinusitis: a) examination of the lesion which emitted pus upon gentle squeezing; b) presence in the vestibular fornix of a large fibrous cord; c) the serious conditions of the mouth and the radiologic results of homolateral sinusitis. The importance of the sinusitis picture, and the necessity to completely remove all bacteria foci prior to surgery on the abdominal aorta the patient was scheduled to undergo, prompted the authors to avulse the cutaneous lesion with tooth extraction, after a "Caldwell-Luc" operation of the homolateral paranasal sinus. Full restitutio ad integrum was achieved.

Aged↗
PubMed1997

Comparison of various transport media on human periodontal ligament cell viability.

The purpose of this study was to determine the ability of various solutions to maintain human periodontal ligament cell (PDL) viability in vitro. PDL cells were obtained from extracted third molars and premolars of healthy individuals. These cells were placed into 24-well culture plates containing milk, Save-A-Tooth, Save-A-Tooth supplemented with platelet-derived growth factor-BB (PDGF), or Gatorade at a concentration of approximately 80,000/well. Cells left dry served as negative controls, and cells placed in Eagles' Minimal Essential Medium served as positive controls. At 1, 2, 4, 8, and 12 h, cell viability was evaluated using an MTS assay and an ELISA plate reader to determine optical density. ANOVA and Student-Newman-Keuls tests indicated that milk and Save-A-Tooth with PDGF are suitable as transport medium for avulsed teeth and that the addition of PDGF to Save-A-Tooth may enhance its ability to maintain PDL cell viability. They also suggests that Gatorade would be unsuitable as a transport medium.

Animals↗
PubMed2000

Determination of periodontal ligament cell viability in long shelf-life milk.

The purpose of this study was to determine the ability of long shelf-life milk to serve as a temporary storage medium for the maintenance of periodontal ligament (PDL) cell viability on avulsed teeth. PDL cells were plated onto 24-well culture plates and allowed to attach for 24 h. Minimal Essential Medium was replaced with regular pasteurized milk (refrigerated milk), long shelf-life milk (Parmalat), or Save-A-Tooth. Tap water served as the negative control, and Minimal Essential Medium served as the positive control. The tissue culture plates were incubated at 37 degrees C for 1, 2, 4, or 8 h. Cell viability was determined using a cell proliferation assay (CellTiter 96 AQ Assay) and absorbance read at 490 nm. ANOVA indicated that all media performed significantly better than tap water at all time periods. At 8 h, PDL cell viability in regular pasteurized milk and long shelf-life milk were significantly greater than in Save-A-Tooth (p < or = 0.001). There was no significant difference between regular pasteurized milk and long shelf-life milk at any time period. These results suggest that long shelf-life milk, which has the advantage of not requiring refrigeration, is as effective a storage medium for avulsed teeth as regular pasteurized milk and more effective than Save-A-Tooth.

Analysis of Variance↗
PubMed1999

[What does the non-dentistry-trained person know about avulsion?].

The prognosis of an avulsed permanent incisor depends on a swift and correct emergency treatment. The chance of a favourable prognosis increases if the tooth is replanted as quickly as possible, preferably by the persons first present at the scene of the accident. Usually this person is a layman, therefore the aim of this study is to investigate the knowledge in this respect. To 48 schools and 15 swimming pools in Amsterdam, Arnhem and Nijmegen (the Netherlands), questionnaires were sent. Thirty-six schools and 15 swimming pools responded. Twenty-eight percent of the respondents had previous experience with an avulsion. Ten percent of the respondents would replant the incisor and 90% would store the incisor. Sixty-three percent would treat the tooth correctly. Respondents with previous experience had no more knowledge of the most effective treatment than persons without previous experience. Swimming instructors and physical health instructors knew significantly more about avulsion than teachers in primary schools. Since only 10% of the respondents would replant the incisor and 37% would handle this accident incorrectly, more information seems to be necessary.

Caregivers↗
PubMed1984

Gingival contour and clinical crown length: their effect on the esthetic appearance of maxillary anterior teeth.

Fractured, congenitally missing, or avulsed maxillary incisors can often jeopardize the esthetic appearance of the remaining maxillary anterior teeth after orthodontic treatment. In many cases the unesthetic appearance is related to the irregular clinical crown lengths of either the fractured teeth or those that have been substituted for the missing teeth. The results of five cases with either fractured or traumatically avulsed central incisors are reported. Selective tooth intrusion and restorative techniques were used during the finishing stages of orthodontic treatment to improve the final esthetic result. The advantages and disadvantages of the intrusion technique are discussed.

Adolescent↗
PubMed2000

Treatment of traumatic dental injuries in a cohort of 16-year-olds in northern Sweden.

The prevalence and yearly incidence of traumatic tooth injury between 1 and 16 years of age have been studied in a cohort of 16-year-olds, born in 1975, and residing in the County of Västerbotten. The study material comprised 3007 dental records from the Public Dental Health Service. Of these, 1040 contained information on dental injuries. Out of 1000 injured primary teeth, 32% were lost, either avulsed at the time of the accident or extracted due to complications. A majority (92%) of the extractions was performed at the first or second follow-up. A total of 690 tooth injury episodes had occurred in the permanent dentition, involving 981 teeth. In 10% of the teeth more than one diagnosis was recorded for the same tooth. 416 restorations were performed due to crown fractures, the majority at the emergency visit. 44% of the patients had to come back one or more times to revise the composite restoration. Complicated fractures or serious luxation injuries constituted only 5% of the total number of injuries in the permanent dentition. 77 (8%) of the traumatised teeth were treated endodontically. Two percent of the teeth with uncomplicated crown fractures required endodontic treatment due to pulp necrosis, while 28% of teeth with a combination of crown fractures and luxation injury were endodontically treated. Out of 6 avulsed incisors, 4 survived after endodontic treatment. A total of 7 incisors were lost as a consequence of the injuries. A specialist treated 4% of the patients.

Adolescent↗
PubMed2005

Effect of luxation type on pulpal blood flow measurements: a long-term follow-up of luxated permanent maxillary incisors.

Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood-flow (PBF). Dental injury has been associated with significant PBF reduction. The purpose of this study was to assess whether (i) the type of luxation trauma may affect PBF measurements and (ii) whether luxation type-related measurements may show short- and long-term changes of PBF values. In 41 trauma patients, 69 maxillary incisor treated by repositioning and splinting, and the respective contralateral homologous tooth were investigated by LDF to assess local PBF values. Perfusion units were recorded in four sessions, on the day of splint removal, and 12, 24 and 36 weeks after splint removal. Statistical analysis consisted of univariate analysis of variance for repeated measurements. For the LDF measurements, the main effect of the variable 'session' was not significant (P = 0.119). However, there was a significant 'session'/'luxation type' interaction (P = 0.000). Analysis of simple session-within-luxation type effects revealed intrusive luxations to be associated with a significant decrease in PBF values (P = 0.000), while subluxations (P = 0.568), lateral luxations (P = 0.980), extrusive luxations (P = 0.910), and avulsions (P = 0.996) showed no significant difference between session-related values. The PBF measurements did not change over time for the contralateral incisors (P = 0.996). The LDF may become useful in the detection of pulpal ischaemic episodes in luxated maxillary incisors after repositioning and splinting. Further studies are warranted to assess the validity of the diagnosis of post-traumatic 'ischaemic episodes' by comparing it with histological tooth pulp changes, and by determining how well it may predict course and response to treatments in clinical trials.

Adolescent↗
PubMed1998

Magnetic resonance imaging features of two cases of acquired Brown's syndrome.

The action of the superior oblique muscle depends on both the contractile function of the muscle belly as well as the force transmission function of the tendon trochlea complex. Brown's syndrome is a restriction to elevation in adduction presumed due to an anomaly of the superior oblique tendon trochlea complex. This report presents two patients with an unusual restriction to elevation in adduction in the affected eye, and a clinical picture consistent with a Brown's syndrome. A non-invasive analysis of the functional anatomy of the superior oblique was performed using a high-resolution MRI with surface coils. Imaging in the first case revealed a cyst in the area of the right superior oblique tendon just posterior to the trochlea in primary position. The second patient had undergone reattachment of an avulsed trochlea after a dog bite (canine tooth syndrome). Imaging in the second case revealed scarring and connective tissue disruption around the tendon impeding muscle function. These findings provide distinct mechanical explanations for Brown's syndrome.

Journal Article↗
PubMed2000

[The nonhealing of the buccal mucosa after tooth extraction. Apropos a case of histiocytosis X].

We report a case of eosinophilic granuloma falsely diagnosed as a radicular cyst in a 28-year-old patient. Between August 1996 and June 1997, successful extraction [correction of avulsion] of teeth 36 and 37 was followed by non-healing of the mucosa in the corresponding sockets. Three bone biopsies were needed to establish the diagnosis of histiocytosis X. In case of non-healing of the intraoral mucosa after tooth extraction [correction of avulsion], the first step is to rule out a malignant tumor. A clinical and radiographic work-up as well as biopsy are needed. Less common conditions such as tuberculosis or histiocytosis X requiring specific treatment can be diagnosed by pathology.

Adult↗
PubMedDate not supplied

The tooth as a foreign body in soft tissue after head and neck trauma.

Thorough evaluation of dentition is important in the management of craniofacial trauma. Avulsed or fractured teeth in the pulmonary and gastrointestinal tracts can lead to serious complications that are well described. However, the penetration of avulsed teeth into soft tissues of the head and neck is unusual and may not be recognized. Two cases in which a tooth became a foreign body in these soft tissues are illustrative. One patient had bronchoscopy for possible aspiration of an avulsed maxillary canine; it was later found embedded in the premaxillary tissues. The other patient had a right mandibular molar propelled into the posterior triangle of the left side of the neck. Physicians must be aware of dental injury resulting from facial trauma and account for all teeth as part of their evaluation, keeping an open mind as to where a missing tooth might be located.

Accidents, Traffic↗
PubMed2005

[Dental avulsions and blood coagulation disorders].

INTRODUCTION: We performed a retrospective study of tooth removal for patients with coagulation disorders. MATERIAL AND METHOD: The study included 67 patients divided into 3 groups according to their coagulation disorder. The first group included 31 patients with a congenital disorder, the second 19 patients receiving anticoagulant therapy, and the third 16 patients with an acquired disorder. The same surgical procedure was used for all patients: alveoli regulation, socket preparation with resorbable oxycellulose dressing, and sutures with separate stitches. Biological glue and celluloid splints were not used. Depending on the severity of the coagulation disorder, factor VIII or concentrated von Willebrand factor or Desmopressine was administered for patients in the first group. If possible, low-molecular-weight heparin replaced oral anticoagulation for patients in the second group. Platelet concentrates were administered for 2 of the patients in the third group. RESULTS: Postoperative bleeding was noted in 4 patients in the first group, 2 in the second and 2 in the third. DISCUSSION: We have abandoned the use of biological glue and celluloid splints. The rate of bleeding in the first and second group was similar to that reported in the literature. We were unable to find any comparable report for the third group.

Anticoagulants↗
PubMed2006

Histological evaluation of a replanted tooth retained for 49 years.

A maxillary incisor that had been replanted immediately after avulsion 49 years previously was evaluated histologically after extraction. The histological evaluation revealed resorption of the apical root surface, depositions in cement with different phases and mineral density, and histological changes in the periodontal ligament.

Aged↗
PubMedDate not supplied

Pulp reactions to restoration of experimentally induced crown fractures.

OBJECTIVES: Reattachment of the avulsed enamel-dentine coronal fragment to the remaining tooth structure has become an accepted clinical alternative to a resin composite build-up for the restoration of crown fractured teeth. Since little knowledge exists as to the pulpal response to this procedure, this study was designed to observe the condition of the pulp following experimentally induced crown fracture and restoration in monkeys. METHODS: Experiments were conducted in eight young green Vervet monkeys (Cercopithecus aethiops). In all, 64 fractured incisors were investigated. Light microscopic examination of pulp tissue specimens was carried out after 3 months of observation. RESULTS: The evaluation was restricted to specimens having a fracture plane within 2 mm of the pulp and no pulpal exposure. In general, pulp tissue was well preserved irrespective of the restorative procedure. Even if the restoration or the bonded tooth fragment had been lost during the follow-up period, the pulp generally remained in good condition. Inflammatory infiltrates where seen in only a few specimens and then as clusters of mononuclear leukocytes. Hard tissue repair was frequently observed and displayed various configurations from isolated hard tissue deposits to areas of extensive hard tissue repair in the coronal portion of the pulp. Pronounced hard tissue repair and occurrence of inflammatory cell infiltrates correlated with the presence of stainable bacteria on the fractured dentine surface. CONCLUSIONS: In the absence of direct exposure, reparative dentine is a frequent feature of the pulp's response to crown fracture and restoration with composite or reattachment of the crown fragment with dentine bonding. These restorative procedures appear to ensure continued function of the underlying pulp.

Animals↗
PubMed2001

Splinting of traumatized teeth with a new device: TTS (Titanium Trauma Splint).

Displacement injuries of permanent teeth are an increasing emergency in the dental office. Children and adolescents are particularly prone to dental trauma due to participation in risky activities. Repositioning or replantation with subsequent stabilization by a dental splint is the standard of care for most displaced or avulsed permanent teeth. Non-rigid fixation allowing physiologic tooth mobility has been shown to be desirable for periodontal healing. A flexible splint of short duration appears to reduce the risk of dentoalveolar ankylosis or external replacement resorption. Different splinting techniques are currently recommended for stabilization of repositioned or replanted teeth, including a wire-composite splint, an orthodontic bracket splint or a resin splint. Each splinting option has its specific advantages and shortcomings. This paper describes a new splinting technique which offers improved comfort and handling to the patient and dentist alike.

Adult↗