Efficacy of flapless intentional replantation with enamel matrix derivative in the treatment of hopeless teeth associated with endodontic-periodontal lesions: A 2-year prospective case series.

OBJECTIVE: In this prospective case series, the effects of flapless intentional replantation (IR) with root surface conditioning with enamel matrix derivative (EMD) was evaluated for the treatment of periodontally-endodontally involved hopeless teeth. METHOD AND MATERIALS: A total of 17 teeth (17 patients, aged 40 to 73) with ≥ 10 mm attachment loss and radiographic bone loss to the apex were included in the study. The affected teeth were atraumatically extracted using a flapless approach, then granulation tissues, calculus, and necrotic cementum on the root surfaces were removed. EMD was applied for 5 minutes to the root surfaces. The teeth were reinserted to the socket without any bone grafts and splinted. RESULTS: After 2 years, clinical healing was uneventful in 16 cases and the radiographs revealed no root resorption or ankylosis. IR with EMD treatment provided statistically significant reduction in probing depth (6.4 ± 2.6 mm), gain in clinical attachment level (5.9 ± 2.5 mm), and gain in radiographic bone level (48.2 ± 26.1%) compared to baseline values (P < .01). CONCLUSION: Within the limitations of the study, flapless IR with EMD treatment appeared to act as an alternative strategy to extraction of severely compromised teeth with endodontic-periodontal lesions beyond the root apex.

Effect of Causative Tooth Extraction on Clinical and Biological Parameters of Odontogenic Infection: A Prospective Clinical Trial.

PURPOSE: To prospectively compare changes of body temperature, white blood cell count, fibrinogen, and C-reactive protein between odontogenic infections in which the responsible tooth was removed and odontogenic infections in which the treatment included no extraction. MATERIALS AND METHODS: The sample was composed of patients admitted to the authors' maxillofacial unit for odontogenic infection from 2010 through 2013. One hundred seventy-nine patients were categorized into an extraction or a non-extraction group based on whether the causative tooth was non-restorable or restorable, respectively. Non-restorable teeth were extracted at admission of the patient. Otherwise, the treatment protocol, including incision of the involved space in conjunction with intravenous antibiotics, was the same for the 2 groups. The parameters were measured and recorded at admission and 2 days later. Data records were statistically analyzed by comparing the change of the parameters studied between the extraction and non-extraction groups. P values less than .05 were regarded as statistically significant. RESULTS: One hundred seventy-nine patients fulfilled the inclusion criteria and were enrolled in the study. The mean age of the patients was 39.1 years (minimum, 14 yr; maximum, 81 yr; standard deviation, 15.4 yr). One hundred nine patients (60.9%) were male, and 70 (39.1%) were female. Differences in the mean decrease of axillary temperature, white blood cell count, fibrinogven, and C-reactive protein between the 2 groups were 0.178, 2,300, 1.01, and 0.64, respectively. All these differences were statistically significant (P =.02, .001, .001, and .001, respectively). Also, the mean hospital stay in the extraction group was 1.05 days shorter than in the non-extraction group, with the difference being statistically significant (P = .006). CONCLUSIONS: In odontogenic maxillofacial infections, extraction of the causative tooth is associated with a faster clinical and biological resolution of the infection.

Soft-tissue re-growth following fibre retention osseous resective surgery or osseous resective surgery: a multilevel analysis.

BACKGROUND: The aim of this study was to assess soft-tissue re-growth following Fibre Retention Osseous Resective Surgery (FibReORS) or Osseous Resective Surgery (ORS) over a 12-month healing period. MATERIAL AND METHODS: Thirty patients with chronic periodontitis showing persistent periodontal pockets at posterior natural teeth after cause-related therapy were enroled. Periodontal pockets were associated with infrabony defect ≤3 mm; 15 patients were randomly assigned to FibReORS (test group) and 15 to ORS (control group). Measurements were performed by a blind and calibrated examiner. Soft-tissue rebound after flap suture was monitored by changes in gingival recession at 1-, 3-, 6-, and 12- month follow-up. Multilevel analysis considering patient, site, and time levels was performed. RESULTS: Greater osseous resection during surgery and higher post surgical gingival recession was observed in the ORS group. The mean amount of soft-tissue rebound following surgery was 2.5 mm for ORS-treated sites and 2.2 mm for FibReORS-treated sites. Approximately 90% of the coronal re-growth was detectable after 6 months for both procedures. The interaction between ORS and time of observation showed a higher soft-tissue rebound after 12 months (p = 0.0233) for ORS-treated sites. CONCLUSIONS: Both procedures showed a similar coronal soft-tissue re-growth with a significant higher recession reduction for ORS-treated sites. Significant clinical stability of the gingival margin is obtained 6 months after surgery for both procedures.

Bone grafts using autogenous tooth blocks: a case series.

OBJECTIVE: A case study was conducted to examine the clinical results and histologic healing of bone grafts performed using an autogenous tooth block (AutoBT block), which was developed recently and proprietary. STUDY DESIGN: Guided bone regeneration, extraction socket graft, sinus bone graft, and ridge augmentation were performed using autogenous tooth block graft material in 12 patients from March 2009 to June 2010. The clinical outcomes of each case were examined, and tissue specimens were collected from 1 case 2.5 months after the bone graft for histopathological analysis. RESULTS: All of the cases had successful bone graft results. One patient developed wound dehiscence after surgery, although favorable secondary healing was achieved. One implant resulted in osseointegration failure. A histopathologic examination was performed after 2.5 months and showed excellent bone healing due to osteoconduction. The AutoBT block was incorporated into the upper soft tissue, aponeurosis, and lower recipient bone. CONCLUSION: There were no notable complications associated with the bone transplant materials. The AutoBT block is clinically useful for a variety of bone grafts.

The anatomical evaluation of the dental arches using cone beam computed tomography--an investigation of the availability of bone for placement of mini-screws.

OBJECTIVE: To assess the amount of maxillary and mandibular inter-radicular bone mass and determine the most reliable mini-screw placement sites. MATERIALS AND METHODS: Retrospective Cone Beam Computed Tomography (CBCT) images of 40 Angle Class I subjects (20 females, 20 males, aged 16 to 32) were obtained. Measurements on the buccal (BI), medial (MI) and lingual (LI) sides of the inter-radicular spaces were taken at 0, 1, 2, 3, 4, 5 mm from the cemento-enamel junction (CEJ) in an apical direction. RESULTS: The male and female BI scores ranged from 2.99±0.73 mm to 6.18±1.03 mm and 2.69±0.84 mm to 6.21±1.22 mm respectively. The male and female MI scores ranged from 1.36±0.38 mm to 4.50±0.99 and 1.53±0.66 to 4.77±1.99 mm respectively. LI scores ranged from 2.37±0.70 to 6.47±1.0 mm and 2.45±0.56 mm and 6.66±1.33 mm respectively. In both maxillary and mandibular arch, the inter-radicular space increased in the apical direction except for the buccal and medial inter-radicular spaces between the maxillary first and second molars. CONCLUSION: The medial inter-radicular spaces are the decisive parameter for mini-screw placement. In the maxillary arch, regions between central and lateral incisors, lateral incisor and canine, first and second molars are not viable for mini-screw insertion. The residual inter-radicular regions are proper for implantation at 3 mm above the CEJ. In the mandible, the regions between incisors and canines are too narrow for mini-screw insertion and the reliable sites for mini-screws are regions between premolars, molars or first molar and second premolar at 2 mm below the CEJ.

[Bone tissue restoration after tooth removal by means of tissue-engineering construction based on multipotent stromal adipose cells].

The paper contains clinical examples of tissue-engineering construction based on multipotent stromal adipose cells application for tooth socket healing. The method do not only prevents the bone tissue resorption but allows recreating its volume.

Tooth separation: a risk-free procedure?

This article reports the case of a 12-year-old patient with tooth extrusion, pain, gingival bleeding, and localized periodontitis near the maxillary second premolar. Despite probing and radiographic examination, it was not possible to establish the etiology. Tooth extraction was indicated because of the severe tooth mobility and extrusion. Curettage of the tooth socket revealed a rubber separator. Preventive approaches are suggested to avoid iatrogenesis and legal problems.

Effectiveness of two flavored topical anesthetic agents in reducing injection pain in children: a comparative study.

UNLABELLED: Topical anesthesia is widely advocated in pediatric dentistry practice to reduce pain and anxiety produced by administration of local anesthesia. There are different combinations of topical anesthetic agents that are marketed worldwide. However, sparse literature reports exist regarding clinical efficacy of these agents. AIM: To compare the clinical effectiveness of two strawberry flavored topical anesthetics viz. Precaine (8% Lidocaine + 0.8% Dibucaine) and Precaine B (20% Benzocaine) in children before intra oral local anesthetic injections and for extraction of mobile primary teeth. STUDY DESIGN: This triple blind clinical study included sixty children divided equally under three techniques--palatal injections, inferior alveolar nerve block and extraction of mobile primary teeth. Both the products were used alternately using split mouth design in two visits and the child's pain response was assessed using VAS and SEM pain scale. The scores obtained were subjected to statistical analysis. RESULTS: Precaine has shown lower mean scores in all the techniques under both the pain scales, but were statistically insignificant. Gender wise comparison has also shown lower mean scores for Precaine for both males and females, however these were statistically insignificant. On visit wise comparison, Precaine B reported significant lower scores (p < 0.05) in visit 2 compared to visit 1 for inferior alveolar nerve block and extraction of mobile primary teeth under SEM pain scale. CONCLUSION: Precaine (8% Lidocaine + 0.8% Dibucaine) can be used as effectively as Precaine B (20% Benzocaine).

Simple diagnostic method to assess the available bone for immediate implant placement in an extracted socket.

The success rate of immediate tooth replacement has been well documented in the literature. To achieve long-term success of dental implants, evaluation of the dimensions of the resorbing alveolar process must be accurate because an implant should be surrounded by at least 1 mm of bone. To minimize facial gingival recession, an intact labial bony plate along with an osseous-gingival relationship of 3 mm on the facial aspect of the failing tooth has been suggested. This article mentions a technique wherein the amount of available labial and palatal bone of an extracted socket can be assessed by using the extracted tooth that is to be replaced with an endosseous implant and a ridge mapping procedure without reflecting the flap.

Selection of instruments for the successful extraction of molar teeth: a pilot study.

We report the result of a pilot study that was designed to test the effectiveness of a chart that gives advice about the choice of extraction instruments and the techniques necessary to remove molar teeth successfully. It was designed from experience gained from the extraction of several molar teeth under local anaesthesia, and includes 20 blocks that cover a combination of five clinical presentations of tooth decay with four clinical presentations of tooth mobility. Recent graduates who used the chart were able to extract more molar teeth successfully than those who did not, and its use can also reduce the amount of supervision time necessary without compromising the guidance required.

Treatment of intrabony periodontal defects with enamel matrix derivative in private practice: a long-term retrospective study.

The present study describes treatment of intrabony periodontal defects with enamel matrix derivative (EMD) in private practice. Ten patients with clinical diagnosis of chronic periodontitis were subjected to data analysis. A total of 18 teeth with various osseous defects received regenerative therapy with EMD, and were followed for a minimum of 2 years. Treatment of the intrabony defects with EMD led to a statistically significant improvement in the mean value of probing depth at 1-year when compared with at the baseline (p<0.01). Reduction in probing depth was achieved with minimal recession of the gingival margin, and was maintained over the 2-year observation period with no significant change. Mean values of attachment gain at 1 and 2 years were of clinical significance: 3.39+/-1.46 mm and 3.22+/-1.40 mm, respectively. Although one tooth was extracted because of subsequent loss of attachment and bone, most teeth treated have been successfully maintained for 2 to 7 years with no significant signs of disease progression. In conclusion, EMD treatment of intrabony osseous defects yielded clinically favorable responses. The gain in clinical attachment can be longitudinally maintained in a private practice setting. Further controlled studies are needed to elucidate the clinical significance of EMD treatment.

Use of pedicled buccal fat pad in root coverage of severe gingival recession defect.

BACKGROUND: Gingival recession in its localized or generalized form is an undesirable condition resulting in root exposure. Sites exhibiting Miller Class IV gingival recession are not suitable for treatment with surgical root coverage techniques, and their prognoses are very poor with current techniques. The aim of this case report is to establish a new technique for the root coverage of severe gingival recession defects (Miller Class IV) by providing a new source of enough tissue with good blood supply using the pedicled buccal fat pad (PBFP). METHODS: The PBFP was mobilized through an incision in the base of the buccal flap at the level of the upper second molar; the vascularized flap was secured to the buccal surface of the upper first molar tooth and premolar teeth and sutured with the wound margins. RESULTS: A clinically significant amount of keratinized gingiva that covered the root recession defect was obtained. Epithelialization of the buccal fat pad was completed after 6 weeks, with formation of healthy-looking keratinized mucosa in the anatomic site of the keratinized gingiva. CONCLUSIONS: The PBFP technique is simple and easy to handle. It may also be considered a novel application with promising results for the root coverage of severe gingival recession defects (Miller Class IV) that may provide a considerable amount of keratinized tissue used for root coverage of the upper posterior molar teeth.

Intraoral findings of Papillon-LeFevre syndrome.

Papillon-Lefevre syndrome (PLS) is a rare autosomal, recessive condition characterized by hyperkeratosis of palms and soles of the feet and elbows and by rapid formation of periodontitis and hypermobility, migration and exfoliation of the teeth of primary and permanent dentition. The purpose of this report was to describe the case of an 8-year-old boy who presented to the Department of Oral Diagnosis and Radiology of Faculty of Dentistry of Ondokuz Mayis University with a chief complaint of mobility and rapid loss of teeth. Hyperkeratosis of palms and soles were realized. His gingivae were hyperemic and edematous, and the teeth were mobile. Histopathological examination of the specimen taken from the thickened skin was reported to be consistent with PLS. All teeth with poor prognosis were extracted and extensive periodontal therapy was administered, and a special denture was constructed.

Bisphosphonate-related osteonecrosis of the jaws: a report of three cases demonstrating variability in outcomes and morbidity.

BACKGROUND: Bisphosphonates are used widely to manage skeletal disorders resulting from malignancies that destroy bone and from some metabolic bone diseases. A strong association between bisphosphonate treatment and the appearance of painful exposed nonvital bone in the mandible and maxilla after oral surgery has been reported in the last decade. Extensive reviews have appeared in the dental literature regarding bisphosphonate-related osteonecrosis of the jaws (BRONJ), including protocols for diagnosis, management and diagnostic imaging for early detection; feature definition; and determination of extent of the disease. CASE DESCRIPTION: The authors provide three case reports to show the contrast in treatment outcomes and morbidity in patients with BRONJ. The cases involved diagnostic imaging modalities commonly used in the practice of dentistry: panoramic radiography and cone-beam volumetric computed tomography. CLINICAL IMPLICATIONS: These case reports demonstrate the usefulness of dental diagnostic imaging in the detection and management of BRONJ, corroborate the increasing number of reports regarding high levels of morbidity associated with various BRONJ treatments, and underscore the danger of performing invasive dental procedures for patients receiving bisphosphonate therapy.

Implant-supported reconstruction in a patient with generalized aggressive periodontitis.

BACKGROUND: A 31-year-old female was diagnosed with generalized aggressive periodontitis based on clinical and radiographic findings. Dental implants were used to restore her dentition. The long-term success of osseointegrated implants in periodontally healthy patients has been documented well in the literature. However, only a few cases of full-mouth rehabilitation, using dental implants, have been reported in periodontally compromised patients, especially those who exhibited generalized aggressive periodontitis. METHODS: Following extraction of all teeth except #6 through #11 in the maxilla, oral rehabilitation was accomplished with the use of implant-supported restorations; detailed treatment planning and sequence are presented. RESULTS: Eight implants were loaded immediately in the mandible. Six implants were placed in the posterior maxilla with a conventional two-stage approach. The maxillary implants were loaded after a 4-month healing period. The patient was followed for 18 months postloading in the maxilla and 24 months postloading in the mandible. CONCLUSION: Successful oral rehabilitation was accomplished using osseointegrated implants in a patient with generalized aggressive periodontitis.

[Natal and neonatal teeth]. / Natale und neonatale Zähne.

Natal teeth have been defined as teeth which are present at birth, while neonatal teeth erupt during the first 30 days. Their occurrence is rare, the prevalence ranges from 1:2000 to 1:3000 with a higher frequency in the lip and palate clefts and syndroms. In about 85% natal or neonatal teeth are lower central incisors (60% in pairs), rare are upper teeth, molars and multiple teeth. In almost 90% they are part of the deciduous dentition. A lot of possible causes of early eruption are discussed, but only the relation to hereditary factors seems to be evident. An autosomal dominant trait is often described. The appearance of these teeth is dependent on the degree of maturity, but most of the time it is loose, small, discoloured and hypoplastic. Histologically, enamel hypoplasia with normal prism structure is apparent. No significant disturbances of the dentin structures are observed, only cervically dentin becomes atubular with spaces and enclosed cells. A large vascular pulp and failure of root formation are further investigations. Our microhardness measurements showed values from 24.3-32.4 KHN for enamel and 48.3-62.2 KHN for dentin, while normal deciduous teeth have an enamel hardness of 322.0 +/- 17.5 KHN. The thickness of enamel was never more than 280 microm compared to up to 1200 microm in normal teeth. This shows the retarded development of natal and neonatal teeth, because mineralization has not finished at the time of birth. In accordance with developmental age tooth structure and appearence are normal. In consideration of complications as Riga-Fede-disease, feeding problems, possibility of infection and hypermobility most of the time extraction is the treatment of choice, but in the interest of protecting the child this decision should be made carefully.

Bioabsorbable membrane and bioactive glass in the treatment of intrabony defects in patients with generalized aggressive periodontitis: results of a 5-year clinical and radiological study.

BACKGROUND: The aim of this clinical and radiological prospective 5-year study was to compare the long-term effectiveness of a bioabsorbable membrane and a bioactive glass in the treatment of intrabony defects in patients with generalized aggressive periodontitis. METHODS: Sixteen patients (11 women and five men) with generalized aggressive periodontitis were enrolled in the study. The investigations were confined to 1- to 3-walled intrabony defects with a depth >/=4 mm and with preoperative probing depths (PDs) >/=7 mm. Teeth with furcation involvement were excluded. Twenty-two of the defects were treated with the membrane (RXT group) and 20 with the bioactive glass (PG group). Allocation to the two groups was randomized. The clinical parameters plaque index (PI), gingival index (GI), PD, bleeding on probing (BOP), gingival recession (GR), clinical attachment level (CAL), and tooth mobility were recorded before surgery and at 6 months and every year for 5 years after surgery. Intraoral radiographs were taken using a standardized paralleling technique at baseline and every year for 5 years. Statistical analysis was based on Kolmogorov-Smirnov and Wilcoxon signed-rank tests, analysis of covariance, and Spearman's bivariate correlation analysis. RESULTS: After 5 years, a reduction in PD of 3.6 +/- 0.8 mm (P = 0.016) and a gain in CAL of 3.0 +/- 2.0 mm (P = 0.01) were registered in the RXT group. There was a slight increase in GR by 0.6 +/- 1.4 mm (P = 0.334). In the PG group, a reduction in PD of 3.5 +/- 1.4 mm (P = 0.01) and a gain in CAL of 3.3 +/- 2.1 mm (P = 0.01) were recorded, whereas GR increased by 0.2 +/- 1.7 mm (P = 0.525). The 1-, 2-, 3-, and 4-year results did not differ significantly from the 5-year results. Radiographically, the defects (the point on the proximal surface of the defective tooth at which the projected alveolar crest intersected the root surface [xCA] to the most coronally located point at the proximal surface of the tooth on the defect side up to which the periodontal ligament space still displayed a uniform width [xBD]) were found to be filled by 47.5% +/- 38.3% (P = 0.001) in the RXT group and by 65.0% +/- 50.5% (P = 0.001) in the PG group. Crestal resorption (the most apical point of the enamel at the proximal surface of the tooth on the defect side [xCEJ] to the xCA) was 19.0% +/- 30.2% (P = 0.374) in the RXT group and 12.3% +/- 38.6% (P = 0.647) in the PG group. The xCEJ to the xBD was significantly more in the PG group (28.4 +/- 24.6 versus 7.3 +/- 21.8, P = 0.048). A good standard of oral hygiene and inflammation-free periodontal tissue in the postoperative phase improved the treatment outcome. No dependence of attachment gain was found on the tooth type, number of walls involved in the defects (r = 0.075; P = 0.319), or intraoperative depth (r = 0.114; P = 0.307). CONCLUSIONS: Highly significant improvements in the parameters PD and CAL were recorded after 5 years with both regenerative materials. Radiographically, the defects (the xCED to the xBD) were found to be filled significantly more in the bioactive glass group. A good standard of oral hygiene and inflammation-free periodontal tissue in the postoperative phase improved the treatment outcome.