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Tetracyclines are widely used in medical and dental practice. Since these drugs chelate calcium salts they are incorporated into bones and teeth during calcification. A review of the literature on the pharmacology of these drugs, their incorporation into calcified tissues and the management of tetracycline-stained teeth is given.
The bundling of principal fibers was investigated in tangential sections through the tooth-related portion in developing rat molars by light and electron microscopy. When root dentin calcification began, cross sections of principal fibers emerged as fibril aggregates in the narrow intercellular spaces in a densely packed population of periodontal ligament cells. Subsequently, these cells changed shape and location to widen the intercellular spaces. The fibril aggregates became thicker in these spaces. With root development, the collagen fibrils formed loosely aggregated bundles and the periodontal ligament cells extended cell processes between the bundles. The cell processes usually contained microfilaments suggestive of actin filaments, and as the cell processes extended and came in close apposition, they formed delimited compartments. These compartments appeared to be a sheath-like structure, and the loose fibril bundles developed into tight fibril bundles in the compartments. Finally the principal fibers consisted of many tight fibril bundles, which were partially or entirely surrounded by cell processes and cell bodies. The findings suggest that the sheath-like, cellular compartments cause the tight bundling of the principal fibers.
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With the demand for orthodontic treatment increasing, it is inevitable that the practitioner will see a significant number of patients with previously traumatized teeth who require orthodontic treatment. The possible risks and guidelines for the management of these teeth during active tooth movements are discussed. The use of orthodontic appliances in the management of incisors traumatized during active orthodontic treatment is also discussed.
A case is reported in which an intruded incisor was initially treated by an endodontic dressing with calcium hydroxide and then extruded using a removable orthodontic appliance. A follow-up examination seven years after completion of endodontic therapy and bleaching showed a favourable response. A review of the relevant literature indicates that intrusion occurs in five to twelve per cent of luxation cases. In this type of injury maximum damage occurs to the pulp and all supporting structures because the tooth is driven into the alveolar process. Complications which have been reported include: pulp necrosis, apical radiolucencies, partial or total pulp calcification, root resorption (surface, inflammatory or replacement), marginal periodontal bone breakdown, and arrested or disturbed root development. The prognosis for pulp survival after intrusion is much more favourable for teeth with incomplete root formation than for teeth with complete root formation. Treatment options available to bring an intruded tooth into alignment are: to await spontaneous re-eruption which may occur if root formation is incomplete, uncovering of the intruded crown, orthodontic extrusion which is allied with gentle luxation if the tooth does not move, and immediate surgical repositioning.
Trauma to primary teeth may result in direct damage to underlying developing permanent teeth because of the close relationship that exists between the apices of the primary teeth and their permanent successors. Injuries to developing teeth have been classified into ten different categories, using a classification that is largely based on developmental alterations to the permanent teeth. However, this classification does not include other types of trauma that may occur to developing teeth, such as crown fractures. Although apparently rare, such injuries can occur by direct contact of the impacting object with a developing tooth, as illustrated by the following case report.
Intercuspal distances and mesiodistal and buccolingual crown diameters of maxillary pre-molars were recorded from dental casts of 262 Australian Aboriginals. Although mesiodistal and buccolingual dimensions showed sexual dimorphism, no significant differences were noted between the sexes for intercuspal distances. Intercuspal dimensions showed greater variability and fluctuating asymmetry than did either of the traditional measures. No significant differences in heritability were noted among the three dimensions. Correlations between mesiodistal and buccolingual dimensions were higher than those between buccolingual and intercuspal measures. It appears that the sex differences, which are observed in overall crown dimensions, are established after the cusp tips are localized. Intercuspal distances appear to have a strong genetic component of variability, although they show high phenotypic variability and fluctuating asymmetry. Total tooth size may be subject to more intense selective pressures than the sites of initial calcification.
Tooth shape potential resides in those ectomesenchymal cells that colonise the presumptive jaws prior to the commencement of odontogenesis. Support for Butler's field theory as applied to the human dentition hinges on the observation that distal teeth within each morphogenic class are the most variable. This variability, it has been argued, reflects a decrease in the concentration of field substance with increased distance from the polar teeth. In contrast to the above, it is suggested here that tooth size variability should be related to the length of time spent in the soft tissue stage prior to calcification. It is argued that a long soft tissue stage will result in a variable phenotype and vice versa. Odontometric variability of distal teeth is thus unrelated to morphogenetic field concentrations and hence fails to support Butler's field theory.
The aim of these studies was to find out whether intact neonatal pulp tissue containing residual epithelial cells can induce the development of a tooth-like structure in situ. First maxillary neonatal hamster molar pulps containing adhering undifferentiated epithelial cells were transplanted submucosally in the oral cavity of recipient mothers for periods ranging from 2-8 weeks and the tissues were then processed for light microscopy. Developing tooth-like structures containing mineralised tubular dentine, predentine and a vascularised pulp-like chamber lined with functional odontoblast-like cells were observed in the specimens within 2 weeks of transplantation. Enamel and root formation were not observed. These data indicate that neonatal dental pulp tissues containing epithelial cell remnants have the capacity to develop into tooth-like structures and that this could be the explanation for the development of tooth-like structures sometimes observed in infants after extraction of a natal tooth.
OBJECTIVES: The aim of the present experiment was to study events involved in the healing of marginal, central and apical compartments of an extraction socket, from the formation of a blood clot, to bone tissue formation and remodeling of the newly formed hard tissue. MATERIAL AND METHODS: Nine mongrel dogs were used for the experiment. The fourth mandibular premolars were selected for study and were divided into one mesial and one distal portion. The distal root was removed and the socket with surrounding soft and mineralized tissue was denoted "experimental unit". The dogs were killed 1, 3, 7, 14, 30, 60, 90, 120 and 180 days after the root extractions. Biopsies including the experimental units were demineralized in EDTA, dehydrated in ethanol and embedded in paraffin. Serial sections 7 microm thick were cut in a mesio-distal plane. From each biopsy, three sections representing the central part of the socket were selected for histological examination. Morphometric measurements were performed to determine the volume occupied by different types of tissues in the marginal, central and apical compartments of the extraction socket at different intervals. RESULTS: During the first 3 days of healing, a blood clot was found to occupy most of the extraction site. After seven days this clot was in part replaced with a provisional matrix (PCT). On day 14, the tissue of the socket was comprised of PM and woven bone. On day 30, mineralized bone occupied 88% of the socket volume. This tissue had decreased to 15% on day 180. The portion occupied by bone marrow (BM) in the day 60 specimens was about 75%, but had increased to 85% on day 180. CONCLUSION: The healing of an extraction socket involved a series of events including the formation of a coagulum that was replaced by (i) a provisional connective tissue matrix, (ii) woven bone, and (iii) lamellar bone and BM. During the healing process a hard tissue bridge--cortical bone--formed, which "closed" the socket.
Membrane-type 1 matrix metalloproteinase (MT1-MMP) is expressed highly in mineralizing tissues including bones and teeth. Mice deficient in MT1-MMP (-/-) display severe defects in skeletal development including dwarfism, osteopenia, and craniofacial abnormalities. Death occurs in these mice by about 3 weeks of age. Since MT1-MMP is expressed by the ameloblasts of the enamel organ and by the odontoblasts of the dental papilla, we asked if the developing teeth were adversely affected in the knockout animals. Molars from MT1-MMP -/- mice and controls were examined by histological, X-ray, and SEM analysis at 4, 18-20, and 25 days of postnatal development. At 4 days of development the molars from the -/- mice appeared histologically normal. At 18-20 days of development, the first molars of the -/- mice had apparently normal tooth crowns with normal dentin and enamel; however, the roots were truncated and the teeth had not yet erupted. In contrast to the -/- mice, the first molars of the 18-20-day control animals had erupted. SEM analysis of a -/- first molar and incisor revealed a normal enamel prism pattern. However, X-ray analysis demonstrated that tooth eruption was delayed by approximately 5 days and that the tooth roots were abnormally short in the knockout animals. Since MT1-MMP-deficient mice have been demonstrated to display a generalized increase in bone resorption, these data suggest that inefficient growth of bone surrounding the tooth root complex causes a delay in tooth eruption.
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Two cases of trauma to immature teeth are described which differed significantly in their initial severity. However, both subsequently presented with continued apical root formation. In the two cases a histological examination after tooth removal confirmed continued apical development of the traumatised immature teeth distant to their respective coronal portions. These cases highlight the resilience of the root sheath of Hertwig to trauma.
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