Autotransplantation of teeth to the anterior maxilla: A systematic review of survival and success, aesthetic presentation and patient-reported outcome.

BACKGROUND/AIM: Autotransplantation of teeth to the anterior maxilla may be indicated after trauma or in patients with congenitally missing teeth. The aim of this systematic review was to report the current evidence concerning survival and success rate, aesthetic outcome, and patient-reported outcome of autotransplanted teeth to the anterior maxilla. MATERIALS AND METHODS: A MEDLINE search followed by an additional hand search was performed to identify relevant literature. All levels of evidence except case reports were considered. Any publication reporting on 10 or more autotransplanted teeth to the anterior maxilla, and written in English were eligible for this systematic review. RESULTS: The systematic search identified 95 abstracts. Thirty-seven full-text articles were evaluated of which 17 could finally be included. Data on survival and success rate of the transplants could be extracted from 11 studies. Survival rates ranged between 93% and 100% (weighted mean: 96.7%, median: 100%) after 9 months to 22 years of observation (median: 8.75 years). No consensus regarding definition of success criteria of the transplants could be found in the literature. Two and four studies contained data on aesthetic and patient-reported outcomes, respectively. In general, they reported favourable aesthetic results and high patient satisfaction. CONCLUSION: The current available evidence suggests a high survival rate after autotransplantation of teeth to the anterior maxilla. However, the level of evidence is low. Limited data on aesthetic and patient-reported outcomes warrant additional research in this field.

Prognosis of teeth in the line of jaw fractures.

BACKGROUND/AIM: The decision as to whether teeth in the line of jaw fractures should be extracted or retained remains a controversial issue. The aim of this study was to assess the prognosis of teeth directly in the line of, and adjacent to, jaw fracture sites. MATERIALS AND METHODS: The study consisted of 50 patients with facial fractures in the dentate region, the diagnosis of which was made on the basis of clinical and radiographic examinations. A total of 124 teeth were present in 69 fracture sites (50 patients), of which 89 teeth were evaluated both, clinically (tooth mobility, pocket depth, pulp sensibility) and with periapical radiographs (degree of fracture displacement, marginal bone loss, root resorption). RESULTS: The results revealed that 61.9% of teeth in directly in the line of fractures showed no response to electric pulp testing compared with 48.9% teeth adjacent to fractures. The maximum frequency of non-responsive teeth was observed in Type I fractures followed by Type II fractures. Response to pulp tests was highly significant at postoperative 3- and 6-month periods (Wilcoxon's test). There was continuous reduction in the measurement for mean pocket depth at both test and control sites of teeth. The measurement of marginal bone levels of teeth in the line of fractures revealed a significant reduction (P < 0.01) from preoperative to postoperative 7-day period only. In teeth adjacent to fracture sites, the mean marginal bone levels of control site and test sites were not significant at any time interval. There was no difference in postoperative complications pertaining to whether the tooth at the fracture site was extracted or retained. CONCLUSIONS: Teeth in line of jaw fractures should not be removed on a prophylactic basis and should be followed up clinically and radiographically to determine any treatment needs.

Complete-mouth rehabilitation using a 3D printing technique and the CAD/CAM double scanning method: A clinical report.

According to evolving computer-aided design/computer-aided manufacturing (CAD/CAM) technology, ceramic materials such as zirconia can be used to create fixed dental prostheses for partial removable dental prostheses. Since 3D printing technology was introduced a few years ago, dental applications of this technique have gradually increased. This clinical report presents a complete-mouth rehabilitation using 3D printing and the CAD/CAM double-scanning method.

Regeneration or replacement? A case report and review of literature.

Endodontic treatment of immature necrotic teeth is a real challenge. Recently, a biologically based treatment strategy, referred to as regeneration, has been introduced. Tissue regeneration requires the presence of stems cells, a scaffold, and growth factors. Endodontic regeneration may improve the prognosis of immature necrotic teeth by re-establishing the functional pulpal tissue and further development of the root. However, the tissue formed in the pulpal space may not be original pulp tissue, and in some cases, it may result in uncontrolled calcification of the pulp. This study reports a case of successful endodontic regeneration and compares this process with the normal development of the contralateral tooth. Finally, it discusses the nature of the tissue formed during endodontic regeneration.

Successful autotransplantation of a mature mesiodens to replace a traumatized maxillary central incisor.

AIM: This case describes the successful transplantation of a mature mesiodens tooth to replace a traumatized maxillary central incisor. SUMMARY: A 17-year-old male attended 1 week after a traumatic injury to his left maxillary central incisor (tooth 21). Radiographs revealed a horizontal root fracture and a poor prognosis. The tooth was atraumatically removed and replaced with a mesiodens lying in the same region. After stabilization, root canal treatment was performed and aesthetics were restored with a tooth coloured restoration. A 2-year follow-up revealed the tooth had good aesthetics and function. KEY LEARNING POINTS: A supernumerary nonfunctional tooth such as a mesiodens can be successfully used to replace a missing permanent tooth by autotransplantation. Autotransplantation has a high success rate if case selection is good, appropriate surgery is carried out and excellent hygiene is maintained. Autotransplantation should be considered as one of the most biologic techniques for replacing a missing tooth with minimal cost. Autotransplantation can be carried out even after complete root formation in the donor tooth.

Replacement of severely traumatized teeth with immediate implants and immediate loading: literature review and case reports.

One of the options for management of severely traumatized dentitions is to provide immediate implant placement with immediate loading. Three representative cases out of 15 patients with 23 traumatized teeth treated to date in our clinic are presented. None had labial bone fractures. The teeth were replaced with NobelReplace Groovy implants (Nobel Biocare, Gothenburg, Sweden) in the fresh sockets immediately after extraction. They were placed toward the palatal areas in the sockets and 3 mm below the gingival margins. If there were gaps between implants and sockets wider than 1 mm, particulate deproteinized bovine bone was grafted in the gaps. Immediately after placement, the implants were loaded with provisional prostheses. The final restorations were installed 3-4 months later. The patients were reevaluated clinically and radiographically 1-3 years after the final restorations had been placed. In all 15 patients, excellent functional and esthetic results were achieved. No implants showed radiolucency, peri-implant suppuration, or mobility. The patients were satisfied with the results. Immediate implant placement with immediate loading is an option that provides good treatment outcomes and allows good functional and esthetic results, as well as addressing the social/psychological aspects of dental trauma.

Rehabilitation of a patient with gunshot injury through the iliac graft and implant-retained restorations with a 3-year follow-up: a brief clinical study.

Trauma is one of the most common causes of teeth loss. Assault with a gunshot and bullet shot is life threatening, and for patients who survive the injury, it results in hard and soft tissue loss in the tissues and organs crossed by the bullet. The tissue loss results in the loss of structure and function. Rehabilitation of these patients to function and aesthetics requires surgical and prosthodontic procedures over time. This report is of a 24-year-old male patient who had a bullet injury resulting in hard and soft tissue deficiency. The ridge deficiency was augmented with iliac bone graft, and 3 months later, implants were placed. Five months later, hybrid prosthesis was delivered. At 3-year follow-up visit, the hybrid prosthesis was replaced with porcelain fused to a metal bridge. The bone levels on all the implants were stable.

Takotsubo cardiomyopathy precipitated by maxillofacial surgery and general anesthesia: a case report and review of literature.

PURPOSE: Takotsubo cardiomyopathy (TCM) is a syndrome characterized by a transient episode of heart failure. The specific etiology of this condition is widely speculated. The purpose of this case report and literature review was to investigate the incidence of TCM with regard to general anesthesia, especially those cases involving operative procedures within the realm of oral and maxillofacial surgery. It is intended that the present case serve as a guide for fellow surgeons to identify and manage this syndrome. MATERIALS AND METHODS: The present case was explained and a review of the literature was performed. PubMed was used to search for articles involving surgical procedures under general anesthesia, including oral and maxillofacial surgery. RESULTS: It was determined that TCM rarely occurs in conjunction with surgical procedures under general anesthesia, especially those of the head and neck region. CONCLUSIONS: TCM is an uncommon medical condition with significant morbidity and mortality when managed incorrectly. The occurrence of this syndrome in relation to oral and maxillofacial procedures is also rare, although it is imperative that surgeons be able to recognize and treat this condition appropriately.

Use of cone-beam tomography and digital subtraction radiography for diagnosis and evaluation of traumatized teeth treated with endodontic surgery and MTA. A case report.

The aim of this paper was to report the diagnosis and evaluation of periradicular bone repair by using computed tomography and digital subtraction radiography in an endodontic surgery case treated with mineral trioxide aggregate (MTA). The patient had local swelling and fistula 7 years after trauma in the upper jaw. Periapical lesion on tooth #12 and root resorption of tooth #11 were detected radiographically. Endodontic therapy and placement of intracanal medication were carried out. After 3 months, with no improvement in the clinical signs and symptoms, computed tomography was performed, showing extensive apical bone resorption on tooth #12 and dental resorption promoting communication of the root canal with the periodontium of tooth #11. The patient was referred to endodontic surgery. After surgery and postoperative periods of 15, 30, 60, 90, and 120 days, standardized radiographs were taken, digitized, and subjected to digital subtraction of the images using Adobe Photoshop CS software. Four years later, a cone-beam computed tomography was performed, showing bone repair and absence of root resorption at tooth #11. In this clinical case, digital subtraction radiography was effective for early detection of new bone formation and evolution of repair.

Histomorphometric analysis of inflammatory response and necrosis in re-implanted central incisor of rats treated with low-level laser therapy.

Low-level laser therapy is a tool employed in the management of post-operative inflammation process and in the enhancement of reparative process. The aim of the study was to perform histological evaluation of dental and periodontal ligament of rats central upper-left incisor teeth re-implanted and irradiated with low-level laser (InGaAl, 685 nm, 50 J/cm(2)) 15, 30, and 60 days after re-implantation. Seventy-two male rats had the central upper left incisor removed and kept for 15 min on dry gauze before replantation. Laser was irradiated over the root surface and empty alveolus prior replantation and over surrounding mucosa after the re-implantation. After histological procedures, all slices were analyzed regarding external resorption area and histological aspects. We observed an increase of root resorption (p < 0.05) in the control group compared to the laser group at 15, 30, and 60 days. These results showed that the laser groups developed less root resorption areas than the control group in all experimental periods. Additionally, histological analysis revealed less inflammatory cells and necrotic areas in laser groups.

Aesthetic restoration of upper lip after removal of post-trauma foreign body (orthodontic bracket).

AIM: Approach to dental trauma should always be based on a careful examination of the traumatised area, including both hard and soft tissues, to ascertain the presence of a foreign body and to assess the best treatment and follow-up. In this work a case of an orthodontic bracket migrated to the upper lip and retained there for 10 years, following a trauma is discussed. CASE REPORT: The patient complained symptomatic swelling of the upper lip; palpation and x-rays showed the presence of a foreign body, identified as an orthodontic bracket. Medical history revealed that patient had a dental trauma 10 years prior. The foreign body was localised and removed. At the two week follow-up visit after surgical incision of the lip, signs and symptoms (i.e. the swollen lip) were resolved. This case emphasises the importance of accurate management of the traumatic event, through proper diagnosis and therapy of both hard and soft tissues, even if the examination if the patient is performed years after the dental trauma.

Reasons for extraction in a group of Libyan patients.

AIMS AND OBJECTIVES: To investigate the pattern and causes of tooth loss in patients among eastern part of Libya. MATERIALS AND METHODS: This study carried out at Faculty of Dentistry, Garyounis University, Benghazi, Libya. The out patients undergoing extractions at the Oral Surgery Department were randomly selected for this study between Jan 2007 and March 2008 where a total of 9,570 extractions were performed on 8,514 patients. The incidence and reasons for tooth extraction, their distribution according to age and sex were studied. RESULTS: Males had more teeth extracted than females. Forty patients had one or more systemic illnesses, 34 were on regular medication. The study revealed two major causes of tooth loss: dental caries (55.90%) and periodontal diseases (34.42%). Other important causes were trauma (3.76%), impaction (1.83%), prosthodontic reasons (2.19%), and orthodontic reasons (1.30%) and others which included extraction where the tooth was associated with a tumour, cyst or supernumerary tooth (1.61%). Dental caries was the main causes of tooth loss during the 2nd, 3rd and 4th decades. While periodontal diseases were the prevalent aetiological factor during the 4th, 5th, 6th and 7th decades of life. The posterior teeth most frequently extracted due to dental caries were lower first molars (43.92%). Whereas anterior teeth were more frequently extracted due to periodontal diseases (28%) with the remaining posterior teeth also being extracted (7%).

[Apical root end resection (Apicoectomy) as treatment option in cases of dental trauma in young patient].

Apical root end resection is becoming popular procedure as a treatment option in cases of ortho-grade endodontic failure. In this case report it has been shown that root end resection (Apicoectomy) had succeed to preserve a tooth after dental trauma with root fractured in the apical third. Any other conservative endodontic treatment failed. One-year follow-up revealed complete healing of the area. Apical root end resection might serve as a viable treatment option in cases of dental trauma in young patient in carefully selected patients.

A prospective study of 3 treatment methods for isolated fractures of the mandibular angle.

PURPOSE: The purpose of this investigation was to evaluate treatment outcomes prospectively when isolated fractures of the mandibular angle are treated by 1) nonrigid fixation that includes 5 to 6 weeks of maxillomandibular fixation, 2) nonrigid but functionally stable fixation using a single miniplate, and 3) rigid fixation using 2 miniplates. PATIENTS AND METHODS: All patients treated for isolated fractures of the mandibular angle at Parkland Hospital over a 12-year period were treated by 1 of the 3 methods sequentially assigned. Demographic, fracture characteristic, and treatment and outcome data were prospectively collected and statistically analyzed to determine whether the 3 treatments produced different outcomes. RESULTS: One hundred eighty-five patients had sufficient follow-up for inclusion in this study. There were no significant differences in demographic data for the 3 groups. There were significant differences in treatment outcomes for several variables, including the amount of time it took to perform the surgery and postoperative wound problems. CONCLUSION: The use of single miniplate was the easiest to perform and was associated with the lowest number of complications.

Calcitonin, sodium alendronate and high intensity laser in the treatment of traumatized teeth: a preliminary study.

The aim of this study was to evaluate the influence of erbium:yttrium-aluminum-garnet (Er:YAG) laser compared with traditional treatment on dentin permeability to calcitonin and sodium alendronate. Forty bovine roots were sectioned and divided into eight groups. Groups 1 and 2 (G1/G2) were immersed in saline solution; G1T/G2T were immersed in ethylene diamine tetra-acetic acid plus sodium lauryl ether sulfate (EDTA-T) and sodium hypochlorite (NaOCl); G1I/G2I were irradiated with Er:YAG laser (2.94 microm, 6 Hz, 40.4 J/cm(2)); G1TI/G2TI were immersed in EDTA-T, NaOCl and subjected to Er:YAG irradiation. After 4 h the radioactivity of the saline solution was measured. Statistical analysis revealed a significant difference (P < 0.05) when the groups treated with EDTA-T and NaOCl followed by Er:YAG laser irradiation were compared with the groups treated with EDTA-T only and with the groups that received no treatment. Er:YAG laser associated with traditional procedures significantly increased the diffusion of calcitonin and sodium alendronate through dentin. All groups showed calcitonin and sodium alendronate diffusion.

One-stage surgical approach to rehabilitate severely injured anterior teeth in a young woman.

Trauma of the maxillofacial district may cause severe injuries to patients, such as tooth loss or tooth fractures, which can irreversibly compromise aesthetics and function.The aim of this clinical report was to illustrate the possibility of achieving positive aesthetic and functional outcomes in a young patient through a 1-stage surgical approach. In a single stage, the patient underwent extraction of a compromised tooth, insertion of 5 implants, bone and connective grafts, and management of a fresh scar. A satisfied and appeased result from the patient's and clinician's points of view was obtained by means of some clinical tricks, avoiding the patient's stress because of a multiple-stage surgery.

Tooth loss among Nigerians treated in teaching hospitals: a national pilot study.

AIM: The aim of this study was to identify the causes and patterns of tooth loss among Nigerian adults. BACKGROUND: Tooth loss continues to be a major problem in clinical dentistry and has received significant attention in everyday dental practice. In Nigeria there is a discernible lack of current data that would explain the reasons and patterns of tooth loss from its different geopolitical zones. METHODS AND MATERIALS: The reasons for tooth extractions during a period of 12 months were obtained from the hospital records of teaching and specialist hospitals in Nigeria's six geopolitical zones and the Federal Capital Territory (FCT). Data were analyzed using Statistical Package for the Social Sciences for Windows (SPSS) version 9.0. RESULTS: A total of 4,204 teeth were extracted from 3,431 patients. Of these teeth 52.4 percent were lost due to dental caries while 30.2 percent were removed because of periodontal disease, 5.0 percent were missing as a result of trauma, and 3.9 percent were impacted and required extraction. The remaining 8.5 percent were extracted for a variety of reasons such as orthodontic treatment, overeruption, neoplasms, supernumerary teeth, attrition, a cystic lesion, and hypoplasia. Dental caries was the most common diagnosis given for tooth loss in the South-South (79 percent), South-East (68 percent), North-East (47 percent), North-West (69 percent), and North-Central (35 percent) zones followed by periodontal disease. In contrast, periodontal disease was the most common cause of tooth loss in the South-West zone (65 percent) and in the FCT (55 percent), followed by dental caries at 22 percent and 33 percent, respectively. CONCLUSION: Although teeth were extracted based on a variety of diagnoses, dental caries was identified as the common reason cited for tooth loss in Nigeria and to a lesser extent periodontal disease. Also different reasons were given for tooth loss among the various geographical zones. CLINICAL SIGNIFICANCE: Tooth loss among Nigerians was attributed largely to dental caries and secondarily to periodontal disease. Both conditions can be prevented if diagnosed early enough and treatment is instituted in a timely manner.

Nasal Septal Abscess Caused by Protrusion of a Dental Implant Into the Nasopalatine Duct: A Case Report.

OBJECTIVE: A nasal septal abscess after placement of a dental implant is seldom seen and is usually caused by an infection around the implant. A septal haematoma following dental implantation leading to septal abscess formation has never been reported. METHODS AND RESULTS: We present a case of a patient who developed a septal abscess after dental implantation without accompanying signs of infection around the implant. On the computed tomography scan we found the implant protruding the nasopalatine duct which led to bilateral septal hemorrhage, resulting in abscess formation. The patient underwent reconstructive nasal septum surgery, using an autologous auricular cartilage graft. This resulted in a good nasal function and cosmetic outcome. CONCLUSIONS: Medical health care professionals should be aware of a septal abscess in case of an acute blocked nose even without prior nasal or facial trauma or nasal surgery. Reconstruction of the septal nasal cartilage using autologous conchal cartilage is a good solution to preserve nasal function as well as tip support.

Implant periapical lesion. A case series report.

One complication in implant dentistry is the implant periapical lesion-IPL--which is a lesion around the apex of a stable implant diagnosed radiographically as a radioluscency in the bone at the apical part of an implant.The IPL can perform with or without clinical symptoms such as tenderness, swelling, suppuration and fistulation. This report describes 4 cases of IPL which were treated surgically with sectioning and removal of the affected portion of a stable implant and thorough debridement of the granulomatous tissue around it. This treatment was, up to 4 years after treatment, successful in all 4 cases. It can also from this report be concluded that IPL is a rather rare condition and that it can occur at any stage of implant treatment, in these cases from 4 months up to 11 years after implant installation. Finally there is a discussion about the aetiology of IPL and a comparison to findings in other reports on IPL and it is concluded that it is difficult to claim that there is a single cause to IPL. Rather it is evident that the condition might be a sequel of the summation of many possible causes.This summation exceeds the local biological threshold for the individual patient.