The effect of different bonded retainer wires on tooth mobility immediately after orthodontic treatment.

OBJECTIVES: This study aimed to compare the immediate influence of four commonly used retainer wires on tooth mobility following orthodontic treatment with fixed appliances. MATERIALS AND METHODS: Eighty patients after orthodontic treatment were assigned to four study groups (n = 20 in each group). Groups were provided with directly bonded fixed retainers-0.0150″ (group A), 0.0175″ (group B), 0.016 × 0.022″ (group C), and 0.0215″ (group D). Tooth mobility was measured using the Periotest device at two times-after removal of fixed appliance (T1) and after bonding of the retainer (T2). Values of tooth mobility, 'Periotest values', were analysed between groups and compared with the physiologic tooth mobility in a control group of untreated patients (n = 65). Kruskal-Wallis H, Mann-Whitney U, Dunn's test, Fisher's exact test, and binary logistic regression tests were used to analyze the data. RESULTS: Tooth mobility after orthodontic treatment was significantly increased. While canines remained within normal range of tooth mobility, values for incisors increased on average to the first degree of tooth mobility (slight mobility). Logistic regression analysis identified age as a significant predictor for increased tooth mobility (P = 0.032) with odds ratio 1.065 (95% CI 1.005-1.128), with mobility increasing with age. After bonding of the retainer in all four groups, the tooth mobility was reduced to values which were not significantly different form normal physiological values found in the control group (P > 0.05). There were no differences in the amount of change or in tooth mobility values at T2 between the different types of bonded retainers. LIMITATIONS: Age of subjects in the control group was significantly higher than that in the study groups. An alternation method was used instead of randomization to distribute the four different types of retainers. CONCLUSIONS: All of the retainer wires were able to successfully reduce the increased tooth mobility caused by orthodontic treatment to normal levels. The values of tooth mobility after placement of retainers were within the range of physiologic tooth mobility.

Dental implications in Hajdu-Cheney syndrome: A novel case report and review of the literature.

OBJECTIVE: To identify the molecular genetic etiology of an individual with a dysmorphic face, unusual teeth mobility, and root resorption. SUBJECTS AND METHODS: DNA samples were collected from a trio of family members, and whole-exome sequencing was performed. RESULTS: Mutational analysis revealed a de novo mutation (c.6787C>T) in the last exon of the NOTCH2 gene. This mutation would introduce a premature stop codon [p.(Gln2263*)] and generate a truncated protein without C-terminus, escaping from the nonsense-mediated decay system. Sanger sequencing confirmed that this mutation was generated spontaneously. CONCLUSIONS: In this study, we identified a novel nonsense mutation in the last exon of the NOTCH2 gene causing Hajdu-Cheney syndrome. We described the genotype and phenotype correlation and the related dental complications. These results will advance the understanding of the NOTCH2 signaling in periodontitis and root resorption.

Predictors of long-term outcomes in patients undergoing periodontal maintenance.

AIM: This retrospective study aimed to characterize the baseline status of patients following periodontal maintenance, analysing the association between the long-term outcome of these patients, smoking, bruxism, and the main clinical and radiographic variables. MATERIAL AND METHODS: A sample of 174 patients with moderate to severe periodontitis was refined into homogeneous subsamples according to smoking and bruxism and the rate of tooth loss due to periodontal disease (TLPD): 0, 1-2, and >2 teeth. The association and the distribution (χ² test) of the variables within the subsamples were analysed. RESULTS: Smoking and bruxism were significantly associated with higher TLPD rates. Vertical and circumferential bone defects (p < .0001), and abfractions (p < .0001) were associated with bruxism and particularly with bruxism and TLPD >2. Furcation defects (p = .0002), fewer radio-opaque subgingival calculus (χ² p < .0001), a lower mean Gingival index (χ² p = .027), and increased mean recessions >1.5 mm (χ² p = .0026) were associated with smoking and higher TLPD rates. The mean baseline mobility, abfractions, and recessions characterized two basic types of TLPD. CONCLUSIONS: Smoking, bruxism, and routine clinical and radiological parameters can be used to characterize the baseline status of patients with worse outcomes.

Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture.

AIM: To analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify possible risk factors. MATERIAL AND METHOD: A total of 91 patients with 223 traumatized teeth. STATISTICS: The risks of PCO, PN, RRR, IRR, ARR, MBL, and TL were analyzed separately for teeth with immature and mature root development using Kaplan-Meier and Aalen-Johansen methods. Possible risk factors for PN (age, fracture in relation to apex, displacement, gingival injury, degree of repositioning, type of splint, duration of splinting, treatment delay, and antibiotics) were analyzed for mature teeth using Cox regression. The level of significance was 5%. RESULTS: Immature: No severe complications (PN, IRR, ARR, MBL, or TL) were diagnosed during follow up. Mature: Estimated risk after a 10-year follow up: PN: 56% (95% confidence interval (CI): 48.1-63.9), IRR: 2.5% (95% CI: 0-5.1), ARR: 2.1% (95% CI: 0.1-4.1), MBL: 2.4% (95% CI: 0.3-4.4), and TL: 7.8% (95% CI: 0-15.7). The following factors significantly increased the risk of PN in teeth with mature root development: fracture in relation to apex (hazard ratio (HR): 2.6 (95% CI: 0.2 - 5.7), P = 0.01), displacement in the horizontal part of the fracture >2 mm (HR: 1.8; 95% CI: 1.1-3.2, P = 0.03), incomplete repositioning (HR: 2.1 (95% CI: 1.3-3.5), P = 0.003), and age >30 years (HR: 2.3 (95% CI: 1.1-4.6), P = 0.02). The type of splint (rigid or flexible), the duration of splinting (more or less than 4 weeks), and the administration of antibiotics did not affect the risk of PN. CONCLUSION: Teeth involved in alveolar process fractures appear, apart from PN, to have a good prognosis. A conservative treatment approach is recommended.

Periodontal Regenerative Therapy in Patient with Chronic Periodontitis and Type 2 Diabetes Mellitus: A Case Report.

We report a case of generalized chronic periodontitis and type 2 diabetes mellitus requiring periodontal treatment including regenerative therapy. The patient was a 66-year-old man who presented with the chief complaint of gingival inflammation and mobile teeth in the molar region. He had been being treated for type 2 diabetes mellitus since 1999. His glycated hemoglobin (HbA1c) level was 7.8%. An initial examination revealed sites with a probing depth of ≥7 mm in the molar region, and radiography revealed angular bone defects in this area. Based on a clinical diagnosis of generalized chronic periodontitis, the patient underwent initial periodontal therapy. An improvement was observed in periodontal conditions on reevaluation, and his HbA1c level showed a reduction to 6.9%. Periodontal regenerative therapy with enamel matrix derivative was then performed on #16, 26, and 27. Following another reevaluation, a removable partial denture was fabricated for #47 and the patient placed on supportive periodontal therapy (SPT). To date, periodontal conditions have remained stable and the patient's HbA1c level has increased to 7.5% during SPT. The results show the importance of collaboration between dentist and physician in managing periodontal and diabetic conditions in such patients.

[Diagnostics of tooth supporting structures]. / Diagnostika sostoyaniya oporno-uderzhivayushchego apparata zubov.

The aim of the study was to assess alveolar bone resorption in patients with periodontal disease and individuals with normal periodontal status and coordinate resorbtion rates with tooth mobility. Tooth mobility was measured in 19 patients with periodontal disease and 17 healthy individuals by two-parametrical periodontometry in two different positions: in equilibrium and after pre-loading. The level of bone resorption was determined by periodontal probe. Previously unknown correlation between tooth mobility and alveolar bone resorption was found out meaning that bone atrophy can be determined by tooth mobility.

[The relationship of molecular genetic markers with clinical signs and risk factors of periodontitis]. / Vzaimosvyaz' molekulyarno-geneticheskikh markerov s klinicheskimi priznakami i faktorami riska razvitiya parodontita.

The study revealed positive correlation between bleeding on probing and teeth loss risk with periodontal hypercolonization by Porphyromonas gingivalis, Prevotella intermedia and Treponema denticola. Pathological tooth mobility was associated with hypercolonization by P. intermedia and Tannerella forsythensis. Expression of IL8, TNF-α, MMP8 and MMP9 genes was also assessed in patient groups divided according to the depth of periodontal pockets and-the severity of chronic periodontitis revealing IL8 as positive diagnostic marker.

Retrospective study of 100 autotransplanted teeth with complete root formation and subsequent orthodontic treatment.

INTRODUCTION: Autotransplantation has become a major therapeutic option for replacing missing teeth in adult orthodontic patients. However, little systematic information is available about the long-term stability of autotransplanted teeth with complete root formation after the application of an orthodontic force. The objective of this study was to investigate the outcomes of autotransplanted teeth with complete root formation that underwent orthodontic treatment. METHODS: One hundred teeth, autotransplanted in 89 patients, were examined over a mean observation period of 5.8 years. Orthodontic force was applied with nickel-titanium wires 4 to 8 weeks after autotransplantation. Root resorption, ankylosis, mobility, pocket depth, and inflammation at the recipient site were investigated clinically and with radiographs. RESULTS: The survival rate of the autotransplanted teeth was 93.0%. Abnormal findings were found in 29 teeth, including 7 lost teeth, for a success rate of 71.0%. Donor tooth type and occlusal condition of the donor tooth before transplantation were associated with abnormal findings. CONCLUSIONS: The early application of orthodontic force may increase the success rate of autotransplanted teeth, and the type and presurgical occlusal condition of donor teeth affect the success rate.

Periodontitis associated with plasminogen deficiency: a case report.

BACKGROUND: Plasminogen deficiency is a rare autosomal recessive disease, which is associated with aggressive periodontitis and gingival enlargement. Previously described treatments of plasminogen deficiency associated periodontitis have shown limited success. This is the first case report indicating a successful therapy approach consisting of a non-surgical supra- and subgingival debridement in combination with an adjunctive systemic antibiotic therapy and a strict supportive periodontal regimen over an observation period of 4 years. CASE PRESENTATION: The intraoral examination of a 17-year-old Turkish female with severe plasminogen deficiency revealed generalized increased pocket probing depths ranging from 6 to 9 mm, bleeding on probing over 30%, generalized tooth mobility, and gingival hyperplasia. Alveolar bone loss ranged from 30% to 50%. Clinical attachment loss corresponded to pocket probing depths. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia, Prevotella nigrescens and Eikenella corrodens have been detected by realtime polymerase chain reaction. Periodontal treatment consisted of full mouth disinfection and adjunctive systemic administration of amoxicillin (500 mg tid) and metronidazole (400 mg tid). A strict supportive periodontal therapy regimen every three month in terms of supra- and subgingival debridement was rendered. The reported therapy has significantly improved periodontal health and arrested disease progression. Intraoral examination at the end of the observation period 3.5 years after non-surgical periodontal therapy showed generalized decreased pocket probing depths ranging from 1 to 6 mm, bleeding on probing lower 30%, and tooth mobility class I and II. Furthermore, microbiological analysis shows the absence of Porphyromonas gingivalis, Prevotella intermedia and Treponema denticola after therapy. CONCLUSION: Adjunctive antibiotic treatment may alter the oral microbiome and thus, the inflammatory response of periodontal disease associated to plasminogen deficiency and diminishes the risk of pseudomembrane formation and progressive attachment loss. This case report indicates that patients with plasminogen deficiency may benefit from non-surgical periodontal treatment in combination with an adjunctive antibiotic therapy and a strict supportive periodontal therapy regimen.

Substantial bone loss in the mandibular central incisors area as a complication of tongue piercing: a case report.

BACKGROUND: Along with the increasing popularity of oral piercings, the number of reported complications and side effects increases, too. CASE REPORT: The aim of this report is to present a case of substantial bone loss in the area of the mandibular central incisors caused by lingual piercing and persistent bad habits. Dentist should be aware of potential complications associated with oral piercings and warn patients about them.

Dental considerations in hereditary epidermolysis bullosa.

Epidermolysis bullosa is an inherited mucocutaneous disorder characterized by blister formation due to a defect in collagen metabolism. Each of the three major subtypes of epidermolysis bullosa has distinct clinical and oral manifestations. A case report of the most classic form of epidermolysis bullosa, recessive dystrophic epidermolysis bullosa, is presented here, along with a review of the literature on the clinical features and management of the condition. An attempt has been made to highlight the anesthetic and oral surgical considerations when treating a patient with epidermolysis bullosa.

Tooth separation potential problems.

A displaced orthodontic elastic separator was proposed as being the source of a gingival abscess that progresses to severe bone loss and exfoliation in a healthy adolescent patient with sound periodontal status prior to commencement of orthodontic treatment. After one year of undergoing orthodontic treatment, the patient presented with dull pain and mobility in the left upper permanent molar for which there was no apparent etiology. On clinical examination the patient had gingival inflammation, associated with a deep pocket and severe mobility (Grade III) in relation to the same teeth. Radiographic examination ofan Orthopantomogram (OPG) and IntraOral Periapical Radiograph (IOPAR) revealed a chronic periodontal abscess with severe necrosis of the periodontal ligament and severe alveolar bone loss. On curettage it was found that there was orthodontic elastic separator which was displaced sub gingivally. Active orthodontic forces were temporarily removed and splinting was done. 6 month follow up showed no mobility and significant improvement of alveolar bone height.

Segmental root development of immature necrotic permanent teeth following regenerative endodontic procedures: a case series.

Regenerative endodontic procedures (REPs) are frequently utilized to treat immature permanent teeth with necrotic or inflamed pulps. In most instances, these treatments successfully result in the resolution of apical periodontitis and continued root maturation. However, after reviewing over 180 REP cases treated in the Endodontics Department of Stomatology Hospital at Zhejiang University School of Medicine over the past seven years, we identified an unusual root development pattern in ten cases, characterized by root tips detached from the root body. We conducted a comprehensive analysis of the patients' demographic information, dental histories, and therapeutic efficacy, and identified five potential etiological factors for this rare phenomenon, including external force, prolonged extensive periapical inflammation, iatrogenic factors, traumatic history of primary teeth, and excessive tooth mobility. In our study, we observed that therapeutic failure was more likely in patients with initially separated root tips, while those with initially normal teeth demonstrated significantly better prognoses. We hypothesize that the initial root condition may exert a considerable influence on treatment outcomes.

Complications and survival rates of teeth after dental trauma over a 5-year period.

OBJECTIVES: The purpose of this study was to evaluate whether the current guidelines of the International Association of Dental Traumatology (IADT) for emergency care of traumatised teeth result in lower complication rates. MATERIALS AND METHODS: Therapeutic strategies of 361 dental injuries in 291 patients treated at a university dental hospital over a 5-year period were investigated by evaluating the patients' records. Adherence to the guidelines of the IADT (Flores et al. Dent Traumatol 17:1-4, 2001; 49-52, 2001; 97-102, 2001; 145-148, 2001; and 193-196, 2001; Flores et al. Dent Traumatol 23:66-71, 2007; 130-136, 2007; and 196-202, 2007) was evaluated. Complications were also recorded according to the patients' records and analysed relative to the treatment and injury pattern. During follow-up visits, the teeth were inspected regarding pulp vitality and overall function of the injured tooth. The Kaplan-Meier survival analysis of pulps and teeth was performed for different injury categories. RESULTS: The majority of injuries (322/361; 89.2 %) were treated according to the guidelines. When IADT guidelines were followed, complication rates were significantly lower than for cases treated without adherence to the guidelines. The most frequent complication was the loss of restoration, followed by pulp necrosis, abnormal mobility, and tooth loss. The overall survival analysis showed that in the permanent dentition, the loss of pulp vitality and tooth occurs within the first 6 months but may also occur later. CONCLUSIONS: The results of this study indicate that traumatised teeth that were treated according to the recommendations had a lower complication rate. In addition, the majority of pulp necrosis and tooth losses in the permanent dentition occurred within the first 6 months after trauma. These results indicate that early follow-up visits are essential to promptly treat complications. CLINICAL RELEVANCE: Adherence to the IADT guidelines for treatment of dental trauma may lead to more favourable outcomes when compared to cases treated without compliance to the guidelines.

Five-year multicenter study of magnetic attachments used for natural overdenture abutments.

The purpose of this study was to examine a longitudinal clinical performance of magnetic attachments used for natural overdenture abutments. The study included 131 patients who had used removable prostheses (complete overdentures 31%, partial dentures 69%) more than 5 years (40-90 years old) with 211 magnetic attachments on natural abutments (Magfit 400 or 600; Aichi Steel co., Aichi, Japan) treated in 15 clinics using a standardized protocol. Analyses were performed on the degree of patient satisfaction regarding retention, complications of magnets (corrosion, detachment from denture base), abutments (pain during mastication, periodontal pocket formation, inflammation, mobility), and dentures (fracture etc.). Ninety-seven percent of patients were satisfied with the retention and stability of their dentures. No corrosion of magnet was observed, and 19 magnets were detached. Most frequent complication of abutments was periodontal pocket formation (52%), followed by the inflammation (29%), increase in mobility (27%) and pain (4%). Magnetic attachment on natural tooth abutments provided a viable and long-term treatment option.

Influence of adhesive point dimension and splint type on splint rigidity--evaluation by the dynamic Periotest method.

AIM: To evaluate the influence of adhesive point dimension and splint type on the rigidity of wire-composite splints in vitro. MATERIALS AND METHODS: A custom-made artificial model was used. The two central incisors served as injured teeth (degrees of loosening III and II) and the two lateral incisors as non-injured teeth (physiological mobility). Horizontal and vertical tooth mobilities were investigated before and after splinting with the Periotest(®) method; the percent change was taken as the relative splint effect. Teeth were splinted with three types of wire-composite splints: Dentaflex (0.45 mm), Strengtheners (0.8 × 1.8 mm), and Dentaflex completely covered with composite. Four adhesive point dimensions (2, 3, 4, and 5 mm) were evaluated. Normal distribution was tested with the Kolmogorov-Smirnov test. Differences were evaluated with the anova and post hoc tests for pair-wise comparisons. Significance level was set at 0.05. RESULTS: The adhesive point dimension did not influence splint rigidity, in general ( P  = 0.288). Significant effects were found in non-injured teeth with the Dentaflex ( P  < 0.001) and in injured teeth with the Strengtheners ( P  < 0.001). The Strengtheners splint rigidity increased significantly with increasing adhesive point dimensions. The three splints showed significantly different effects at 5-mm adhesive point dimension ( P  < 0.001). CONCLUSION: Splint rigidity for injured teeth was influenced by adhesive point dimension only when splinting with Strengtheners. We recommend adapting splint rigidity by selecting different wires and reducing the adhesive point dimension to a minimum. Dentaflex can be used for flexible splinting, Strengtheners, and composite covered Dentaflex for rigid splinting.

Importance of root development in autotransplantations: a retrospective study of 137 teeth with a follow-up period varying from 1 week to 14 years.

The aim of the present study was to perform a retrospective study of autotransplanted teeth with a variable but individually maximized follow-up period in order to provide information on the long-term clinical outcome. The sample was obtained from patients who were treated at the University Hospitals KU-Leuven, Belgium, during the period 1996-2010. Of the total of 109 subjects (137 teeth), 98 patients were invited for recall, of whom 68 patients (87 teeth) responded positively. Eleven out of the 109 patients were excluded due to loss of the transplanted tooth. Although 41 patients had no re-examination visit, clinical and radiological data from all 109 subjects were included in the sample. The follow-up period varied from 1 week of 14.8 years, with a mean of 4.9 years. Transplanted teeth receiving orthodontic treatment had a lower risk of ankylosis and were less likely to fail. The risk of root resorption was lower for teeth with stages one-half to three-quarters of root length at the time of transplantation. Molars were more susceptible to ankylosis. Almost all teeth showed partial or full obliteration of the pulp. Absence of further root development was higher in donor teeth with root length stage less than one-half. Trans-alveolar transplantation was less successful. Autotransplantation can be a valid alternative method in young adolescents for replacing missing teeth because of agenesis or trauma. The optimal time to transplant is when the root has reached two-thirds to three-quarters of the final root length.

Arrest of root formation in relation to permanent mandibular incisors: a rare case report.

AIM: To report a rare case of arrested root formation of permanent incisors in a young boy with mixed dentition and its management. BACKGROUND: Traumatic injury to a primary tooth may damage the underlying permanent tooth germ and affect its development. The extent of the malformation depends upon the developmental stage of the permanent tooth and the intensity of trauma. Discoloration and hypoplasia of the crown, dilaceration, root angulation and disturbances in eruption are commonly seen developmental disturbances following trauma. However, partial or complete arrest of root formation is a rare developmental sequela of trauma to primary teeth. Attempt should be made to retain these natural teeth during the mixed dentition period. CASE DESCRIPTION: A case is presented of a young boy with rare occurrence of arrested root formation of permanent mandibular incisors, following trauma to the primary predecessors. Clinically these teeth exhibited mobility and radiographic examination showed absence of root formation in relation to the incisors. The treatment plan was to retain the natural permanent teeth for a maximum period and to stabilize them until a more permanent replacement could be carried out. As the patient had mixed dentition, immediate stabilization was done using fiber reinforced splint until further definitive treatment is carried out. Early diagnosis of developmental disturbances in permanent teeth resulting from trauma at a young age is necessary. Regular follow-up appointments, through clinical and radiographic examination and timely intervention may minimize or even avoid harm to the developing tooth.

[Biomechanical basis splinting of loose teeth while preserving their mobility at physiological].

The aim of this study was biomechanical rationale for splinting mobile teeth with periodontitis according to the height and slope of teeth crowns, their degree of mobility, and type of occlusion. The research studied the effect of axial vertical and horizontal loads on the functioning of the proposed method of splinting. Set clear indications and contraindications for the use of the method of splinting. Biomechanically proven unreasonableness includes teeth with III degree of mobility in the splinted construction. Clinical variant of splinting is only possible at the height of the anatomical crowns of the teeth of at least 7 mm, otherwise the preferred laboratory methods for the manufacture of tires.

Comparison of the impact of two types of removable partial dentures on the periodontal health of the remaining teeth: A prospective clinical study.

OBJECTIVE: To evaluate and compare the impact of two removable partial dentures (acrylic removable partial denture [ARPD] and metallic removable partial denture [MRPD]) on periodontal tissues of the remaining teeth in the first 12 months of denture use. MATERIALS AND METHODS: This prospective clinical study included 40 patients, of which 20 received ARPDs, 20 received MRPDs, nine in the maxilla, and 11 in the mandible each. The patients were 45-65 years old; 24 were females, and 16 were males. Patients' demographic details, clinical indicators of periodontal complications, and biochemical measurement of Hs-C-reactive protein (CRP) and alkaline phosphatase (ALP) were considered. One-way analysis of covariance and Friedman were used to measure the differences in clinical periodontal parameters between the two types of dentures. RESULTS: The significant findings were: Plaque index (PLAQ) scores for abutment teeth were higher in MRPD wearers (mean = 12.15) than ARPD wearers (mean = 10.45), whereas ARPD users had significantly higher mean bleeding on probing (BOP) values (mean = 1.5) than MRPD users (mean = 0.00); mobility of abutment teeth showed no significant differences; timeline comparisons showed a significant increase in the percentage of nonabutment teeth mobility in ARPD users (p = .028) compared with MRPD users over the same follow-up period (p = .102). CONCLUSIONS: For a short-term period of 1 year, periodontal and mobility parameters have no significant impact on the abutment and nonabutment teeth of ARPD and MRPD users. Moreover, biochemical markers (CRP and ALP) for periodontal inflammation exhibited no significant difference in both types of dentures.