[Histomorphometric evaluation of ridge preservation after molar tooth extraction].

OBJECTIVE: To evaluate bone formation in human extraction sockets with absorbed surrounding walls augmented with Bio-Oss and Bio-Gide after a 6-month healing period by histologic and histomorphometric analyses. METHODS: Six fresh molar tooth extraction sockets in 6 patients who required periodontally compromised moral tooth extraction were included in this study. The six fresh extraction sockets were grafted with Bio-Oss particle covered with Bio-Gide. The 2.8 mm×6.0 mm cylindric bone specimens were taken from the graft sites with aid of stent 6 months after the surgery. Histologic and histomorphometric analyses were performed. RESULTS: The histological results showed Bio-Oss particles were easily distinguished from the newly formed bone, small amounts of new bone were formed among the Bio-Oss particles, large amounts of connective tissue were found. Intimate contact between the newly formed bone and the small part of Bio-Oss particles was present. All the biopsy cylinders measurement demonstrated a high inter-individual variability in the percentage of the bone, connective tissues and Bio-Oss particles. The new bone occupied 11.54% (0-28.40%) of the total area; the connective tissues were 53.42% (34.08%-74.59%) and the Bio-Oss particles were 35.04% (13.92%-50.87%). The percentage of the particles, which were in contact with bone tissues, amounted to 20.13% (0-48.50%). CONCLUSION: Sites grafted with Bio-Oss particles covered with Bio-Gide were comprised of connective tissues and small amounts of newly formed bone surrounding the graft particles.

Classification and Epidemiology of Traumatic Dentoalveolar Injuries in Dogs and Cats: 959 Injuries in 660 Patient Visits (2004-2012).

The objective of this study was to determine the epidemiology of traumatic dentoalveolar injuries (TDI) in dogs and cats and to evaluate the applicability of a human classification system for TDI in dogs and cats. All patients diagnosed with a TDI were identified from the University of Wisconsin-Madison School of Veterinary Medicine Dentistry and Oral Surgery Service case log and the hospital patient processing software. The study population consisted of 621 dogs and cats, in a total of 660 patient visits from 2004 to 2012, admitted for oral treatment and subsequently diagnosed with at least one TDI Medical records including diagnostic imaging studies were reviewed to group the injury according to a classification system used in humans for TDI. Patient signalment, tooth injured, and number of injuries per patient were recorded and tabulated. The overall prevalence of TDI was 26.2%. The mean +/- SD number of TDI per patient was 1.45 +/- 0.85. All 14 classes of TDI recognized by the classification system utilized in humans were identified, and all (100%) TDI identified in this study were classifiable using this system. Enamel-dentin-pulp fracture was the most common TDI (49.6%). The most commonly injured teeth were the mandibular or maxillary canine teeth (35.5%). The most common age for dogs and cats with TDI were 3-6 years (33.0%) and 7-10 years (31.3%). With a frequency of 1 in 4 animals, TDI are common and represent a significant pet health concern. Most TDI are considered severe and require timely, and sometimes immediate, treatment. The adoption and utilization of a complete classification system, such as the one used in this study, is recommended in order to improve future epidemiological study of TDI in animals.

Root amputation: a new look into an old procedure.

A treatment option for managing furcation invasions is root amputation. Long-term survival of resected molars requires a complete harmony of sequential endodontic, periodontic, restorative and maintenance procedures. The main objective of this article is to provide a concise historical perspective of this procedure and to review available literature regarding its efficacy and limitations. It also illustrates a current modification of the procedure using guided bone regeneration (GBR) and socket preservation to eliminate some of the potential disadvantages of the traditional root amputation procedure.

Minimally invasive intervention of acute trauma in the primary dentition: Successful five-year follow-up.

The main objectives of diagnosis and treatment of traumatic injuries affecting children in the primary dentition are pain management and prevention of damage to the developing tooth germ. Inappropriate approaches to treating dental trauma can cause more damage than the trauma itself; for this reason, minimal intervention presents a low risk of sequelae development in the permanent successor teeth. This case describes a five-year follow-up of acute trauma in the primary dentition. Conservative management with minimal intervention of the traumatized teeth was adopted. The traumatized teeth were followed until eruption of their permanent successors. The permanent teeth erupted in the correct order. The conservative management was a success and resulted in normal eruption of the permanent teeth with no sequelae.

A successful outcome using a minimal invasive approach to manage a severe trauma to the primary maxillary incisor in a toddler.

Intrusive and lateral luxation are common traumatic injuries in children. The aim of this work is to report the successful conservative management of severe intrusion and lateral luxations of the primary maxillary central incisors in a 27-month-old patient.

Ridge preservation of compromised extraction sockets applying a soft cortical membrane: A canine proof-of-principle evaluation.

OBJECTIVES: To explore whether placement of a soft cortical membrane can restore and regenerate the original alveolar ridge contour in deficient sockets. MATERIALS AND METHODS: One Beagle dog was used in this proof-of-principle evaluation. In a first intervention, a standardized buccal dehiscence defect was artificially created at the distal roots of the 3rd and 4th mandibular premolars. Four weeks later, following endodontic treatment of the mesial roots, teeth were hemisected and the distal roots were extracted without raising a flap. A cortical membrane (Lamina®, Osteobiol) was placed outside of the bony envelope of the extraction socket to rebuild the buccal bone contour. Afterwards, sockets were filled with a collagen-modified porcine bone graft material (Gen-Os®, Osteobiol) to the level of the surrounding bone height. The socket orifice was closed with a porcine dermal matrix (Derma®). After four months, block specimens containing the socket-sites and remaining roots were retrieved, histologically processed and analyzed. RESULTS: Surgery and post-operative healing were uneventful. Histologically, bone formation under the membrane was found, i.e. bony protrusions and ossicles by osteoblasts could be identified. Concomitantly, the membrane showed clear signs of degradation. Bone substitute was well integrated in newly formed bone and resorption of particles was found. CONCLUSION: Three major observations were made in the present proof-of-principle study: (i) regeneration of a compromised socket seems possible when applying the presented approach, (ii) the soft cortical membrane was sufficiently stable to allow for the establishment of the contour and to inhibit soft tissue invasion and (iii) the applied xenogenic graft material was undergoing remodelling processes while allowing adequate bone regeneration.

Nasal septal abscess caused by anaerobic bacteria of oral flora.

Although nasal septal abscess (NSA) was formerly common, it has become rare since the development of antibiotics. NSA, if left untreated, can lead to intracranial complications such as meningitis and eventually result in saddle-nose deformity. NSA often occurs after injury, and indigenous skin bacteria such as Staphylococcus aureus are frequently detected. We treated a patient who had injured the upper alveolus in a fall on the stairs and developed NSA two weeks later. Anaerobic bacteria, including Veillonella parvula and Peptostreptococcus sp., were detected. Symptoms were relieved by needle and incisional drainage. Our patient represents a very rare case of NSA in terms of the cause of onset and the detected bacteria. Early drainage can result in good outcomes.

Diagnosis and management of common maxillofacial injuries in the emergency department. Part 5: Dentoalveolar injuries.

Injuries to teeth can be very distressing for patients. Prompt treatment is essential. Injuries of the tooth bearing portion of the mandible are common and can even result after a relatively low impact trauma. The alveolus (tooth bearing portion of bone) and/or the tooth may be damaged. Segmental fractures involve multiple teeth and the supporting alveolar bone.

Socket preservation as a precursor of future implant placement: review of the literature and case reports.

Dimensional changes after tooth extraction often result in bone resorption that complicates restorations with implant or traditional prostheses. Preservation of alveolar dimensions after tooth extraction is crucial to achieve optimal esthetic and functional prosthodontic results. In addition, with the increasingly frequent use of dental implants to replace nonrestorable teeth, preservation of the existing alveolus is essential to maintain adequate bone volume for placement and stabilization of the implants. Atraumatic extraction and socket preservation techniques have been introduced to minimize bone resorption after tooth extraction. This article reviews the literature, presents clinical cases on the healing of the alveolus and its dimensional changes after tooth extraction, and discusses socket preservation techniques that have been introduced to minimize these dimensional changes.

Influence of trans-operative complications on socket healing following dental extractions.

AIM: Extraction healing complications have been attributed to several factors. The influence of trans-operative complications on an extraction site wound healing was the focus of this investigation. METHODS AND MATERIALS: This prospective study was conducted at the Oral Surgery Clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital (LUTH) in Nigeria . Subjects selected were those referred for one or two adjacent extractions and who satisfied the inclusion criteria for the study. The relevant pre-operative information recorded for each patient were age and sex of patient, indications for extraction, time taken to extract the tooth, tooth/teeth removed, and any trans-operative complications. Extractions were performed with dental forceps, elevators, or both under local anaesthesia. Patients were blindly evaluated on the third and seventh post-operative day for socket healing assessment without reference to pre-operative information on the patients. RESULTS: Seventy-three (24.25%) of 301 teeth considered for socket healing assessment had various trans-operative complications due to accidental crown, root, or alveolar bone fractures. Of the 73 extractions with trans-operative complications during extraction, 18 developed a socket healing complication, while 17 of the 228 extractions without trans-operative complications developed socket healing complications (p = .000). The mean (SD) time taken to extract teeth developing healing complications was also found to be significantly longer than those without healing complications (p < .01). CONCLUSIONS: The study demonstrated the combination of tooth/bone fragments in the socket and increased time of extraction due to trans-operative complications and accidents predispose to the development of extraction site wound healing disturbance.

Diagnosis of alveolar and root fractures: an in vitro study comparing CBCT imaging with periapical radiographs.

OBJECTIVE: To compare periapical radiograph (PR) and cone-beam computed tomography (CBCT) in the diagnosis of alveolar and root fractures. MATERIAL AND METHODS: Sixty incisor teeth (20 higid and 40 with root fracture) from dogs were inserted in 60 anterior alveolar sockets (40 higid and 20 with alveolar fracture) of 15 macerated canine maxillae. Each fractured socket had a root fractured tooth inserted in it. Afterwards, each maxilla was submitted to PR in two different vertical angulation incidences, and to CBCT imaging with a small field of view (FOV) and high-definition protocol. Images were randomized and posteriorly analyzed by two oral and maxillofacial radiologists two times, with a two-week interval between observations. RESULTS: Sensitivity and specificity values were good for root fractures for PR and CBCT. For alveolar fractures, sensitivity ranged from 0.10 to 0.90 for PR and from 0.50 to 0.65 for CBCT. Specificity for alveolar fractures showed lower results than for root fractures for PR and CBCT. Areas under the ROC curve showed good results for both PR and CBCT for root fractures. However, results were fair for both PR and CBCT for alveolar fractures. When submitted to repeated measures ANOVA tests, there was a statistically significant difference between PR and CBCT for root fractures. Root fracture intraobserver agreement ranged from 0.90 to 0.93, and alveolar fracture intraobserver agreement ranged from 0.30 to 0.57. Interobserver agreement results were substantial for root fractures and poor/fair for alveolar fractures (0.11 for PR and 0.30 for CBCT). CONCLUSION: Periapical radiograph with two different vertical angulations may be considered an accurate method to detect root fractures. However, PR showed poorer results than CBCT for the diagnosis of alveolar fractures. When no fractures are diagnosed in PR and the patient describes pain symptoms, the subsequent exam of choice is CBCT.

Bone fractures: assessment and management.

Severe dental traumatic injuries often involve the supporting bone and soft tissues. This article outlines the current concepts in the management of dentoalveolar fractures for the general dental practitioner with case reports to illustrate management principles and techniques.

Preparation and biocompatibility evaluation of bioactive glass-forsterite nanocomposite powder for oral bone defects treatment applications.

Bone defects which emerge around dental implants are often seen when implants are placed in areas with insufficient alveolar bone, in extraction sockets, or around failing implants. Bone regeneration in above-mentioned defects using of bone grafts or bone substitutes may cure the long-term prognoses of dental implants. Biocompatibility, bioactivity and osteogenic properties are key factors affecting the applications of a bone substitute. This study was aimed at preparation, characterization, biocompatibility and bioactivity evaluation of the bioactive glass-forsterite nanocomposite powder as a desired candidate for oral bone defect treatments. Nanocomposite powders containing 58S bioactive glass and different amounts of forsterite nanopowder were synthesized in situ by sol-gel technique. Characterization of the prepared nanocomposite powders and their cytotoxicity assessment was performed via MTT test. Bioactivity assessment was done by immersing the prepared powder in the simulated body fluid (SBF). Results showed that nanocomposite powders containing forsterite with crystallite size of 20-50nm were successfully fabricated by calcination at 600°C. The prepared bioactive glass-forsterite nanocomposite powders revealed high in vitro biocompatibility; besides, the nanocomposite containing 20wt.% forsterite showed a substantial increase in the cell viability compared with control groups. During immersion in SBF, the formation of apatite layer confirmed the bioactivity of bioactive glass-forsterite nanocomposite powders. According to the results, the fabricated nanocomposite powders can be introduced as a promising candidate for oral bone imperfection treatments and hard tissue mend.

The effects of local trauma to the enamel-related periodontal tissues in the eruption of the rat incisor.

The periodontal tissues related to enamel (PTE) of the rat incisor comprise a connective tissue derived from the dental follicle and the enamel organ with its successive stages of development. Localized damage to these tissues in rat lower incisors was done surgically in three ways: with an endodontic file introduced into the labial periodontal space through either (i) its basal or (ii) its incisal extremities, or (iii) by the partial removal of the mandibular lower border, at the level of the molar teeth, together with the introduction of an endodontic file into the incisal part of that space. The lesions in the molar region of the PTE produced first a variable period of retarded eruption, and, depending upon their extent or degree were followed by a cessation of the eruptive movement and, in the majority of the operated teeth, a recovery of the normal eruption rate before the end of the experiment (17 weeks after surgery). Access to the PTE through the basal portion of the socket was erratic, but when the tissues were damaged produced similar effects. Effects on eruption of lesions produced through the alveolar crest were minimal or even absent. Localized injury to the periodontal ligament of either lower or upper incisors did not produce similar effects on tooth eruption. The dental follicle and the enamel organ of teeth of limited growth when their crown is completed are similar to the PTE in the molar region of continuously growing rodent incisors. In teeth of limited growth these tissues play an essential part in the intraosseous stage of eruption. The results here suggest that the PTE may also have a role in the supraosseous stage of eruption, which is continuous in teeth such as rat incisors due to the presence of a continuously functioning odontogenic organ.

Intrusion injuries of primary incisors. Part I: Review and management.

Intrusion injuries commonly occur in the primary dentition. They can be described as luxation injuries resulting from an axially directed impact, which drives the tooth deeper into the alveolar socket. The impact results in compression of and damage to the periodontal ligament as well as injury to the pulp of the intruded incisor. In addition to rendering treatment to the intruded primary tooth, the dentist must also be aware of the possibility of an injury to the developing permanent teeth germs located in close proximity to the roots of the injured primary teeth. This review will discuss the characteristics, implications, and management of intrusion injuries of primary incisors.

Extraction sites--foundations for restorative excellence.

Preservation of the socket site architecture promotes better esthetics, easier prosthetic treatment, and restoration of the alveolar bone for implant or bridge replacement options. The purported simplicity of the simple extraction can be misleading if the bone housing or soft tissues have been ravaged by disease. This article provides guidelines for case selection, patient consultations, selection of appropriate materials, and a step-by-step methodology for completing successful extraction site therapy.

Odontología deportiva y prevención de trauma dentoalveolar / Sports dentistry and prevention of dentoalveolar traumas

La odontología deportiva es la rama de la medicina deportiva que se ocupa de la prevención y el tratamiento de las lesiones bucodentales y las enfermedades orales asociadas al deporte y el ejercicio. Por lo que se hace necesario la intervención de profesionales de la salud bucodental para hacer evaluaciones del deportista y el deporte que practica para ver los riesgos que puede tener de desarrollar y sufrir lesiones bucodentales como traumas dentoalveolares y lesiones no cariosas. Y de este modo realizar las recomendaciones a cada paciente que practica deporte, de los elementos que deben usar como equipamiento bucodental para evitar o reducir el daño dentoalveolar (AU)

Sports dentistry is the branch of sports medicine that deals with the prevention and treatment of oral injuries and oral diseases associated with sports and exercise. Therefore it is necessary the intervention of oral health professionals to make evaluations of the athlete and the sport he practices to see the risks that may have to develop and suffer oral injuries such as dentoalveolar trauma and non-carious lesions. And in this way make the recommendations to each patient who practices sports, of the elements that should be used as oral equipment to avoid or reduce dentoalveolar damage (AU)

Uso de Hepar sulphur en el tratamiento de la alveolitis húmeda / Use of Hepar sulfur in the treatment of wet alveolitis

Fue realizado un estudio pre experimental de intervención con 50 pacientes que consultaron un servicio de urgencia entre noviembre de 2016 y julio de 2017 con diagnóstico de alveolitis húmeda con el objetivo de evaluar la efectividad del tratamiento homeopático en esta patología. Todos os pacientes fueron tratados con Hepar sulphur 30cH hasta completar 10 días. Los pacientes fueron citados a nueva consulta a las 24, 48, 72 horas, 5, 7 y 10 días del inicio del tratamiento para su evolución. La desaparición total del dolor a las 72 horas de comenzado el tratamiento homeopático ocurrió en casi la totalidad de los pacientes (98%) y la mayoría (98%) estuvieron satisfechos con el tratamiento recibido. Se puede considerar que el tratamiento de la alveolitis húmeda con Hepar sulphur 30cH fue efectivo. (AU)

We performed a pre experimental intervention study with 50 patients who visited an emergency department for alveolitis from November 2016 through July 2017 to assess the effectiveness of homeopathic treatment. All the participants received Hepar sulphur 30cH for 10 days and were assessed 1,2, 3, 5, 7 and 10 days. In almost all the participants (98%) pain fully disappeared after 72 hours of homeopathic treatment, and most (8%) reported to be satisfied with the treatment received. We conclude that treatment of alveolitis with Hepar sulphur 30cH was effective. (AU)