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PubMed1994

[Esthetic and prosthetic procedures in single-tooth replacement].

Loss of anterior maxillary teeth always results in bone resorption and loss of interdental papillae, and the resorption makes a single tooth replacement by a dental implant very difficult. When infections have been present and the patient's history shows previous surgery at the apex of the root, bone destruction is substantial, which results in an increased resorption defect, thereby further increasing the aesthetic and prosthetic problems. This paper describes the steps necessary for implant surgery and the prosthetics; a brief summary is provided. The quality and quantity of bone, along with the space available between the adjacent teeth, are the basic factors in treatment planning and determine the type of implant to be used. Some resorption and bone defects are usually present after a tooth extraction, and bone regeneration procedures can be performed either before or simultaneously with the implant placement, with numerous flap designs available. Soft tissue augmentation can be achieved by taking a connective tissue graft from the palatal side. Antirotational devices (eg, hex lock abutments) are necessary for all implants in single tooth replacement. Screw-retained abutments can be used in posterior areas and in angled positions in facial areas as well. With proper single tooth implant position, cementation of laboratory fabricated crowns can be considered.

Alveolar Bone Loss↗
PubMed1999

Aberrant eruption and its relationship to crowding: the need for early detection and management.

A modular, fixed-functional method has been described using a new generation of appliances that are smaller, more comfortable and more patient friendly, while gaining the advantages of a combined fixed-functional and postural therapy. The case has been made for the middle mixed dentition as the optimal starting time. Crowding, overbite and molar rotation are managed simply with a combined use of flexible lip bumpers, bite plane and sequential primary tooth extraction. In conclusion, Phase I Postural Therapy will be shown to have the following advantages: more biologically and patient friendly more conducive to non-extraction more efficient and cost effective simple fabrication and reduced chair time reduced Phase II fixed appliance time, and completion at a younger age.

Child↗
PubMed2006

A new method for vector control during alveolar distraction osteogenesis: a case report.

We report a case of dentoalveolar rehabilitation employing the technique of alveolar distraction osteogenesis in a 25-year-old male patient with a right posterior mandibular defect that was a result of previous tooth extractions and consequent severe loss of alveolar bone. A new method for vector control during alveolar distraction osteogenesis was used. This method consisted of placing an orthodontic wire on an immediately loaded implant (in the right third molar position) and securing it by means of resin composite to the implant and the adjacent tooth. Implant positioning and soft tissue management were performed successfully. The described treatment strategy appears to have good potential for providing an ideal final position of the regenerated bone in cases where major tissue defects exist in the posterior mandible.

Adult↗
PubMed2001

Prolonged immobilization-induced stress delays alveolar bone healing. A histometric study in rats.

The purpose of the present study was to investigate the effect of prolonged immobilization-induced stress on reparative bone formation, using the rat alveolar healing as an experimental protocol. Stress was attained by immobilization for 2 hours a day, beginning three days before extraction of the upper right incisors and continuing until sacrifice. The stress condition was assayed on the basis of plasma corticosterone concentration (measured by double-antibody radioimmunoassay), which increased by 2.5 to 4 times in rats submitted to immobilization. The volume density of neoformed bone filling the alveolar socket was quantified by a histometric differential point-counting method 7 to 21 days following tooth extraction. Stress caused a significant delay in reparative bone increment, somewhat related to impairment of coagulum remission and/or organization.

Animals↗
PubMed1997

Complication from an extraction of a primary tooth.

A complication that occurred during the extraction of mandibular right second primary molar is presented. The clinical and radiographic examinations were done; however, the germ of the second premolar came out with the primary tooth. In the same session, replantation was done and monitored very often for two years. The tooth erupted normally into occlusion without any abnormality in dental arch.

Bicuspid↗
PubMed2006

Cyclooxygenase-2 induction after oral surgery does not entirely account for analgesia after selective blockade of cyclooxygenase 2 in the preoperative period.

BACKGROUND: The administration of selective cyclooxygenase-2 inhibitors before surgery is regarded as an innovative option to manage postoperative pain. This study was designed to (1) examine the efficacy of preoperative cyclooxygenase-2 blockade on postoperative oral pain and (2) compare pain intensity with prostaglandin E2 (PGE2) production and cyclooxygenase isoform (cyclooxygenase-1, cyclooxygenase-2) messenger RNA (mRNA) expression at the surgical site during the postoperative period. METHODS: Sixty patients with impacted lower third molars were randomly allocated to three single-dose treatment groups--placebo, 50 mg rofecoxib, or 550 mg naproxen--1 h before extraction. Pain intensity was evaluated with categorical and visual analog scales every 30 min from 90 to 240 min after surgery. At these times, PGE2 production in the alveolar socket was also evaluated. Cyclooxygenase-1 and cyclooxygenase-2 mRNA expression was examined by reverse-transcription polymerase chain reaction in gingival specimens collected during tooth removal and 240 min after surgery. RESULTS: Pain intensity and PGE2 production in the placebo group increased throughout the observation period. Naproxen prevented pain and decreased PGE2 release at all time points. Rofecoxib reduced PGE2 production versus placebo from 150 min onward, while inducing analgesia through the whole observation period. mRNA assay in gingival specimens collected at tooth extraction revealed cyclooxygenase-1 expression, whereas cyclooxygenase 2 was undetectable. At the end of observation, cyclooxygenase-1 mRNA expression was unchanged, whereas cyclooxygenase-2 mRNA was significantly induced. CONCLUSIONS: This study indicates that preoperative administration of a selective cyclooxygenase-2 inhibitor ensures effective control of postoperative pain. It is suggested that the selective blockade of inducible cyclooxygenase 2 at the surgical site does not entirely account for the analgesic action occurring in the postoperative period.

Actins↗
PubMed2004

Human histologic analysis of mineralized bone allograft (Puros) placement before implant surgery.

Because clinicians are placing more dental implants, it is becoming more important to maintain bone volume after tooth extraction. This article discusses the various bone-augmentation materials available to the clinician and illustrates a case report of particulate mineralized bone allograft (Puros) placement after extraction. Exposure of the grafted site after 5 months revealed a hard bony structure. Human histologic analysis at the light microscopic level revealed nonvital spicules of mature calcified bone having a highly organized matrix surrounded by viable noncalcified immature bone matrix, or osteoid. It was concluded that mineralized human allograft demonstrated the formation or remodeling of bone histologically and was clinically useful to maintain bone volume for implant placement after extraction. To the authors' knowledge, this is the first publication to demonstrate human histology of particulate mineralized bone allograft (Puros) after placement into an extraction site.

Alveolar Ridge Augmentation↗
PubMed2005

For debate: problems with the DMF index pertinent to dental caries data analysis.

The Decayed, Missing, Filled (DMF) index has been used for over 50 years and is well established as the key measure of caries experience in dental epidemiology. Despite its long history of use, there is debate about the most appropriate number of surfaces to include for a missing tooth. Assigning the maximum possible value for the 'M' component of DMFS (Surfaces) leads to overestimation of an individual's caries experience, and in any associated comparisons of in-caries experience, whereas assigning the minimum possible value for the 'M' component has the opposite effect. Alternative methods of assigning the number of caries-affected surfaces for an extracted tooth are considered. The net caries increment and adjusted caries increment (common methods of correction of the crude increment measure for reversals) are discussed, along with incidence density, a measure of caries extent. Problems exist with the adjusted caries increment, particularly among cohorts with low mean baseline caries experience. Development of an alternative method of estimating the relationship of 'true' and 'examiner' reversals is advocated, as well as greater utilization of incidence density in dental epidemiology.

Adolescent↗
PubMed1989

Dental aspects of hypophosphatasia: a case report, family study, and literature review.

The classic oral features of hypophosphatasia, namely, premature tooth loss and large pulp spaces, were found in a young adult woman with bone and joint pains. A study of 22 family members revealed several with dental abnormalities such as abnormal enamel, dentin, or cementum formation, decreased mandibular bone density, and abnormally large pulp spaces. Only the propositus' sister fulfilled the biochemical criteria for hypophosphatasia. Biochemical examination of an extracted tooth from this sister showed phosphate and alkaline phosphatase values that were 7 to 10 times lower than normal and reduced concentrations of the essential cofactors Zn++ and Co++. The spectrum of dental abnormalities is reviewed. This family study reveals that enamel hypoplasia, increased pulp spaces, and premature tooth loss are present not only in the deciduous but also in the permanent dentition. These findings should draw the dentist's attention to this condition.

Adult↗
PubMedDate not supplied

The long road to success.

The conservation of teeth can involve the many facets of restorative dentistry in an attempt to retain both functional and aesthetic demands. This case report chronicles the management of a patient presenting with several traumatized teeth, which progressed through orthograde endodontics, periodontal crown-lengthening procedures, crown placement, surgical endodontics with attempted guided tissue regeneration, to eventual tooth extraction and replacement with osseointegrated implants.

Accidents, Traffic↗
PubMed1983

Long-term evaluation of autotransplanted maxillary canines with completed root formation.

Autotransplantation of 33 maxillary canines was followed up in 29 patients with an average age of 27.5 years. The mean follow-up period was 6.0 years. Endodontic treatment was performed in 23 teeth. Signs of root resorption were found in an increasing number of canines during the follow-up period. At the last examination eight canines showed no signs of resorption. External and internal resorption of inflammatory type were the most frequent forms of resorption and were also found to be the most hazardous factors for the prognosis of the transplanted tooth. Extraction of the transplant was necessary in four cases because of root resorption or poor bone regeneration.

Adolescent↗
PubMed2006

Management of interdental papillae loss with forced eruption, immediate implantation, and root-form pontic.

BACKGROUND: A 25-year-old Asian woman complained of an unesthetic black triangle between her upper right front teeth. Defective interdental papillae may result from external root resorption, which makes esthetic restoration more difficult. A combined use of forced eruption, immediate implant placement, and a root-form pontic made a successful esthetic and functional restoration. METHODS: The treatment sequences of this patient included short-term forced eruption, subsequent immediate implant placement after tooth extraction, and a provisional root-form pontic restoration. A final prosthesis was completed 6 months later, followed by clinical maintenance. RESULTS: Papillae were augmented by forced eruption. After immediate implantation and root-form pontic placement had been performed, the peri-implant soft and hard tissues were manipulated and maintained in a stable state. CONCLUSIONS: We successfully reconstructed the interdental papillae and replaced the deficient tooth with an immediate implantation. During 2 years of follow-up, the implant and peri-implant structures remained stable and healthy.

Adult↗
PubMedDate not supplied

Orofacial neurogenic pain and maxillofacial ischemic osteonecrosis. A review.

Cavitary alveolar osteopathy was described as an oral disorder of infectious origin characterized by the presence of osteopathic alveolar cavity lesions of significant size though radiologically undetectable and secondary to dental extractions for chronic infectious processes of the alveolar bone of the jaws. Such cavitary alveolar osteopathy has been implicated as a common cause in the origin of idiopathic trigeminal neuralgia and atypical facial pain. The concept of cavitary alveolar osteopathy caused by ischemic necrosis of alveolar bone was introduced in 1992. Recent coagulation studies have reported ischemic alterations in alveolar bone marrow as a cause of cavitation; following tooth extraction, maxillary osteonecrosis could result from thrombosis with or without hyperfibrinolysis, which in turn would lead to obstruction of the vascular spaces -- thereby compromising regional blood flow.

Facial Pain↗
PubMed1980

Healing following implantation of periodontitis affected roots into bone tissue.

The aim of the present experiment was to study whether new connective tissue attachment can occur to root surfaces which have been exposed to the oral environment and subsequently implanted into bone tissue. Twelve teeth in three beagle dogs were subjected to progressive periodontal breakdown to half the root length by placing cotton floss ligatures around the neck of the teeth. Following crown resection and root hemisection, the teeth were root filled and the roots thoroughly scaled and planed. Each root was extracted and implanted into bone cavities prepared in edentolous areas of the jaws in such a way that epithelial migration into the wound and bacterial infection were prevented during healing. Root implantation and sacrifice of the animals were scheduled to allow for observation periods of 1, 2 and 3 months. The results demonstrated that new connective tissue attachment did not occur to root surfaces which had been exposed to the oral environment, but healing was characterized by repair phenomena, i.e. mainly root resorption and ankylosis. In those areas of the roots where periodontal ligament tissue was preserved following tooth extraction, a functionally oriented attachment apparatus was reformed. The results indicate that in addition to apical migration of junctional epithelium and regrowth of subgingival plaque, the type of cells which repopulate the wound area may jeopardize new connective tissue attachment.

Animals↗
PubMed2006

Severe crowding and a dilacerated maxillary central incisor in an adolescent.

This study reports the treatment of an adolescent patient with dilacerated maxillary incisor. She complained of severe crowding with a high-positioned left upper canine. Her left central incisor had been impacted and moved to proper position at the age of eight years, resulting in a severe root dilaceration. To avoid any progression of root dilacerations and resorption in the maxillary incisor, maxillary lateral expansion and molar distalization plus multibracket appliance were selected as the best nonextraction treatment plan. The maxillary expansion and molar distalization should provide adequate space for the correction of the severe crowding, and treatment with a multibracket appliance was initiated. After a 17-month treatment with a multibracket appliance, an acceptable occlusion was achieved with a Class I molar relationship. An acceptable occlusion was maintained without recurrence of the crowding and impairment of the dilacerated root in the maxillary incisor during three years of retention. It is emphasized that careful planning is required to avoid any progression of the root dilaceration and resorption through orthodontic treatment. A shortening of the period of applying orthodontic force on the dilacerated incisor and avoidance of tooth extraction will minimize the risk factors.

Adolescent↗