An evaluation of 910 premolars transplanted in the anterior region-A retrospective analysis of survival, success, and complications.

AIM: The aim this retrospective analysis was to evaluate the survival, success and possible complications of transplanted premolars to the anterior region subdivided in development stage and patient's age. MATERIALS AND METHODS: The material comprised patients that underwent a tooth transplantation between April 2004 and December 2021. A total of 910 premolars were transplanted in 707 patients. Tooth mobility, oral hygiene, and periodontal parameters were clinically evaluated. Standardized radiographs were used to evaluate pulpal and periodontal healing and root formation. The cumulative survival rate was calculated using the Kaplan-Meier method. RESULTS: The data were subdivided in three groups based on the stage of root development and patient's age. The average age at surgery was 16 years. The main indication for transplantation was trauma, followed by agenesis and other indications. Two premolars were lost during the whole observation period. The overall survival and success in the immature premolars group after an observation period of 10 years was 99.8%. The 10-year survival and success rate when fully developed premolars were transplanted in the anterior region in adolescents were 100% and 96.3%, respectively. In adults, the 10-year survival and success rate were 87.5%. CONCLUSION: Transplantation of premolars with developing and fully developed roots to the anterior region in children, adolescents, and adults is a predictable treatment modality.

An evaluation of 1654 premolars transplanted in the posterior region-A retrospective analysis of survival, success and complications.

AIM: The aim of this retrospective analysis was to evaluate the survival, success and possible complications of transplanted premolars in the posterior region subdivided by developmental stage and patient age. MATERIALS AND METHODS: This study included patients who underwent tooth transplantation between April 2004 and December 2021. A total of 1654 premolars were transplanted into 1243 patients. Tooth mobility, oral hygiene and periodontal parameters were clinically evaluated. Intraoral radiographs were used to evaluate pulpal and periodontal healing, and root formation. The cumulative survival rate was calculated using the Kaplan-Meier method. RESULTS: Data were subdivided into three groups based on the stage of root development and patient age. The mean age at surgery was 14.5 years. The main indication for transplantation was agenesis, followed by trauma and other indications, such as impacted or malformed teeth. A total of 11 premolars were lost during the study period. The overall survival and success rates in the immature premolar group after an observation period of 10 years were 99.7% and 99.4%, respectively. High survival and success rates (95.7% and 95.5%, respectively) were also observed when fully developed premolars were transplanted into the posterior region of adolescents. In adults, the success rate after 10-year follow-up is 83.3%. CONCLUSIONS: Transplantation of premolars with developing and fully developed roots is a predictable treatment modality.

A clinical approach strategy for the diagnosis, treatment and evaluation of external cervical resorption.

AIM: To propose a clinical approach strategy on the diagnosis, treatment and evaluation of external cervical tooth resorption (ECR) cases. To investigate and discuss the outcome of this approach. METHODOLOGY: A clinical approach strategy on ECR was developed based on a retrospective observation study of 542 teeth. Forty-seven teeth were excluded due to lack of clinical/radiographical information, and 182 were immediately extracted. This approach had three steps: diagnosis, treatment planning and evaluation. During diagnosis, the medical, dental history and clinical/radiographical characteristics were evaluated. Depending on the resorption extent, ECR cases were categorized into four classes according to Heithersay's classification. During treatment planning, a treatment decision flowchart was prepared based on four main decisive criteria: probing feasibility, pain, location and extent of resorption (class), and existence of bone-like tissue. Three treatment options were applied: (a) extraction, (b) monitoring or (c) conservative treatment by external, internal or combination of internal-external treatments. During evaluation, assessment of ECR progression, tooth survival and other factors like aesthetics and periodontal attachment were performed. Descriptive statistical analysis of the outcome for up to 10 years (for the overall clinical approach and for each individual treatment decision), was carried out with OriginLabs OriginPro 9 and Microsoft Excel 365. RESULTS: A three-step strategy was developed on how to deal with ECR cases. Indicative examples of each treatment decision were presented and discussed. The overall survival rate of this strategy was 84.6% (3 years), 70.3% (5 years), 42.7% (8 years) and 28.6% (10 years). Higher survival rate was observed for external treatment decision than for internal. The success of each treatment decision depended on the extent of the resorption (class). The success of a treatment decision should be based on the long-term outcome, as a different evolution can be observed with time. CONCLUSIONS: A clinical approach strategy was introduced on ECR pathosis. This strategy was not solely based on ECR class, as other important decisive criteria were considered. This step-wise approach, has a 70.3% survival rate with a mean of 5 years. This work will hopefully provide an incentive for a broader collaboration, to potentially establish a universally accepted ECR treatment strategy.

Descriptive Analysis of Factors Associated with External Cervical Resorption.

INTRODUCTION: The aim of this study was to perform a descriptive analysis of the occurrence of external cervical resorption (ECR) in relation to the patients' characteristics (sex, age, and tooth type) and the potentially involved predisposing factors. METHODS: This study includes data on 284 patients (337 teeth with evidence of ECR) referred to the University Hospital Leuven (Leuven, Belgium) and Endo Rotterdam (Rotterdam, the Netherlands) for diagnosis and treatment from 2010 to 2015. The medical history, existing radiographs, and dental records were available for evaluation. Each patient was then interviewed followed by a thorough clinical and radiographic examination. Intraoral pictures using a dental operating microscope and digital camera were taken during clinical examination. The radiographic examination consisted of digital periapical radiography and/or cone-beam computed tomographic imaging. A review of existing literature provided a potential predisposing factor checklist for ECR. The clinical data were correlated with the dental and medical history of each patient in an attempt to identify some potential predisposing factor(s) that could contribute to ECR. The frequency of the occurrence of ECR was correlated with tooth type, sex and age of the patient, and each 1 of the recorded potential predisposing factor(s). RESULTS: From the examined teeth (337) with ECR, 175 (54%) were found in male patients and 162 (46%) were found in female patients. In 59% of the cases, more than 1 potential predisposing factor was identified. Most ECR cases were observed on maxillary central incisors (29%) followed by maxillary canines (14%), mandibular molars (14%), and maxillary premolars (11%). In addition, most ECR cases were observed on maxillary teeth (72%). The most frequently appearing factor was orthodontics (45.7%). Other frequently observed factors were trauma (28.5%), parafunctional habits (23.2%), poor oral health (22.9%), malocclusion (17.5%), and extraction of a neighboring tooth (14%). CONCLUSIONS: The data indicate that ECR is not related to patient sex. ECR occurs most often in the maxillary central incisor. In the majority of the cases, more than 1 potential predisposing factor was identified, indicating that ECR may be mainly multifactorial. The most frequently appearing factors were orthodontics, iatrogenic or accidental trauma, and poor oral health. This information may be helpful in diagnosing ECR at an early stage when screening patients presenting with these predisposing factors.

Probing pressure, a highly undervalued unit of measure in periodontal probing: a systematic review on its effect on probing pocket depth.

AIM: To investigate the influence of probing pressure on the probing pocket depth (PPD) in diseased and healthy periodontal tissue conditions through a systematic review. In addition, to facilitate comparison of the study outcomes, an attempt was made to provide a correction factor that compensates for the different probing pressures used. MATERIAL AND METHODS: The MEDLINE-PubMed and Cochrane Central Register of controlled trails (Central) were searched up to June 2008 to indentify appropriate studies. RESULTS: The search yielded 3032 titles and abstracts. In total, five papers fulfilled the eligibility criteria. These studies provided data with probing pressures ranging from 51 to 995 N/cm(2). For the evaluation of the results a distribution was made between diseased and healthy/treated sites. The incremental change in PPD in healthy/treated sites decreased as the pressure increased above 398 N/cm(2). In diseased sites, this phenomenon was already present at pressures above 100 N/cm(2). At healthy/treated sites, a mean increase of PPD of 0.002 mm per increase of 1 N/cm(2) in probing pressure could be calculated whereas at diseased sites this value amounted to 0.004 mm. CONCLUSION: The results show that with increasing probing pressure, the PPD increases. The dimensions of the increase are dependent on the periodontal tissue conditions.

Detection of the cemento-enamel junction with three different probes: an "in vitro" model.

AIM: The purpose of the present study was to test the accuracy and precision with which the cemento-enamel junction (CEJ) can be assessed using three commercially available periodontal probes with different tip endings in both deciduous and permanent teeth. MATERIAL AND METHODS: An "in vitro" model was developed, consisting of 70 extracted permanent and 30 deciduous human teeth mounted in plaster with an artificial gingiva made of silicone rubber. The probes tested were the Merritt-B probe, the ball-ended CPITN probe and the Vivacare TPS beveled-ball probe. With each probe, duplicate CEJ assessments were carried out at six sites per tooth by four examiners. Upon completion, the distance between the CEJ and the artificial gingival margin was determined using a stereomicroscope. RESULTS: The mean difference between the microscopic assessment and the mean clinical probe measurements in permanent teeth was -0.05 mm with the Merritt-B, 0.11 mm for the CPITN and 0.19 mm with the TPS probe. In deciduous teeth, the differences were -0.02, 0.35 and 0.63 mm, respectively. In both permanent and deciduous teeth, only the Merritt-B did not differ from the microscopic assessment. CONCLUSIONS: Results showed that the use of the Meritt-B probe offered the most accurate location of the CEJ in both permanent and deciduous teeth.

Penetration depths with an ultrasonic mini insert compared with a conventional curette in patients with periodontitis and in periodontal maintenance.

AIM: The aim of the study was to test whether a slim Ultrasonic Tip reaches a more apical position when penetrating a periodontal pocket compared with the working blade of a conventional Gracey Curette in both untreated periodontitis and periodontal maintenance patients. MATERIAL AND METHODS: Twenty untreated and 15 periodontal maintenance patients were selected based on the presence of at least one site a pocket of > or =5 mm in each quadrant. Recordings were made at the four approximal sites of four experimental teeth in each patient. First, the probing pocket depth was measured with the Jonker Probe. Second in randomized order, the penetration depth was assessed with an EMS PS Ultrasonic Tip and a Gracey Curette. RESULTS: In the periodontitis group, the Ultrasonic Tip penetrated significantly deeper than the Jonker Probe and the Gracey Curette. In the maintenance group, no differences were observed. Comparing the penetration of the instruments between groups, as related to the Jonker Probe measurements, only in the periodontitis group did the Ultrasonic Tip reach a significantly more apical level. CONCLUSION: The results of the present study show that in untreated periodontitis patients, the Ultrasonic Tip penetrated the pocket deeper than the pressure-controlled probe and the Gracey Curette.