The consequences of orthodontic extrusion on previously intruded permanent incisors-A retrospective study.

AIM: The aim of this study is to compare the adverse effects that occur after orthodontic extrusion of teeth that have been traumatically intruded with those of similar teeth that have not experienced any trauma. BACKGROUND: The outcome of incisors intrusion can be affected by the patient's age, extent of injury, root development, and malocclusion. Orthodontic extrusion is a potential solution, but it may also cause complications. MATERIALS AND METHODS: A retrospective study of the effects of extrusion of traumatically intruded teeth was carried out. The study group included 21 teeth in 14 patients. The control group included 32 teeth in 10 patients that underwent orthodontic extrusion with no history of trauma. Patients' age, gender, and stage of root development were recorded. The severity of the intrusion was classified as mild (<3 mm), moderate (3-6 mm), and severe (≥7 mm). A comparison of signs of pulp necrosis and root resorptions between the groups was made. RESULTS: The central incisor is the tooth that is most injured in 80.9% of cases. A majority of these incidents involve severe intrusion, which was found in 42.9% of cases. 90% of the traumatized teeth had already lost their vitality prior to orthodontic treatment. Various forms of root resorption were observed in the study group. In the control group, 31.2% of teeth showed signs of external root resorption, but no endodontic intervention was carried out during the follow-up period, as these teeth remained vital. CONCLUSIONS: Following intrusion, there is a high risk for root resorption and pulp necrosis. Orthodontic repositioning should be carried out with caution and mild force to prevent complications. Long-term follow-ups are required to ensure the best possible outcome.

An Assessment of the Effects of Orthodontic Treatment after Apexification of Traumatized Immature Permanent Teeth: A Retrospective Study.

INTRODUCTION: Root resorption may occur in traumatized necrotic teeth that have undergone apexification after orthodontic treatment. This study examined the effects of orthodontic treatment on the outcome of apexification. METHODS: This retrospective study included 36 children presenting with anterior permanent traumatized teeth with immature roots who were treated by apexification and root canal treatment. The orthodontic group consisted of 17 children with 24 teeth that were subjected to orthodontic treatment after apexification. The control group consisted of 19 children with 21 teeth that underwent only apexification without orthodontic treatment. Almost half of the teeth in both groups underwent apexification with calcium hydroxide, whereas the other half were treated with mineral trioxide aggregate. The effects of sex, stage of root development, and apexification material on the outcomes of apexification were analyzed and compared between the 2 groups. RESULTS: Apexification was successful in 88% of cases after at least 5 years of follow-up. Neither apexification technique nor sex had a significant effect on treatment outcome. The stage of root development had a positive effect on outcome, although it was not statistically significant. Some root resorption (average = 0.3 mm) was observed after orthodontic treatment, whereas teeth that underwent apexification without orthodontic treatment exhibited some root elongation (average = 0.1 mm). This difference was highly significant. CONCLUSIONS: Minor root resorption was observed in the orthodontic group compared with a minor increase in root length in the control group. Orthodontic movement of immature traumatized teeth after apexification appears to be safe.

Accelerated healing of endodontically treated teeth with a periapical lesion as a result of orthodontic extrusion: evaluation and rationale.

Resolution of a periapical periodontal lesion as determined by radiographic examination may take a year or longer. Orthodontic movement is known to have a positive effect on the bone topography and morphology. The literature presents no information about the effect of orthodontic movement on the rate of periapical endodontic healing following a root canal treatment. The aim of this report was to present the use of orthodontic root extrusion in cases with a periapical lesion, where other options are ruled out. Three case reports involving endodontically treated teeth with a periapical lesion are presented. In each case, the performed orthodontic extrusion resulted with healing of the periapical environment towards a predictable crown fabrication or replacing a hopeless tooth more safely with an implant-supported crown. In all cases presented, signs of radiographic healing were demonstrated in a relatively shorter time than is considered acceptable, following the extrusive orthodontic movement, with no clinical sensitivity to percussion or periodontal pockets. In conclusion, orthodontic extrusion of endodontically treated teeth with periapical lesions presented positive radiographic healing signs along with no clinical symptoms of pain and mobility and a positive effect on marginal bone level and soft tissues, at a faster rate than was expected. This report may assist in supporting a clinical decision to apply vertical extrusive forces on compromised endodontically treated teeth presenting with a periapical lesion. Healing signs may be observed within a shorter time period, which may allow better prediction for the prosthetic phase.

Detection of Tooth Color Before and After Bleaching Using an Electronic Device.

The purpose of this article is to present a new computerized technique for evaluating tooth color before and after internal bleaching. Internal bleaching is a common and relatively safe procedure, from which results can be easily evaluated by both the dentist and the patient. Clinically, evaluation of the tooth color before, during and after internal bleaching is usually completed by using a color scale and comparing the shade to that of the tooth. However, since in some cases the bleaching results are not obvious, this method has limited value for complicated cases and especially for dental research. The case presented here demonstrates the digital color evaluation process of a tooth going through all phases of internal bleaching. The detected color is presented as the color scale numbers and can easily be saved for follow-up. Those results are presented on the device screen for the all-labial surface and also separately for the incisal, middle and cervical areas. This digital method for color detection can easily be used at every dental clinic as a validated dental record for the bleaching process. This method can also be used for dental research that evaluates the efficacy of bleaching techniques. The esthetic results can be verified easily and precisely.

A Multidisciplinary Approach for Managing Severely Malaligned Lower Molars.

An impacted mandibular molar is a common clinical situation that may damage adjacent teeth and impair periodontal health. Improper treatment brings the risk of damaging adjacent vital tissues. The risk can be reduced by early diagnosis and extraction of the impacted tooth by an experienced clinician. However, in clinical cases of two impacted molars, it may be beneficial for the patient to save at least one molar. This can be achieved by orthodontic alignment of one of the molars, while extracting the other. The decision should be based upon prognosis and risks for each procedure and for both teeth. The case presented here demonstrates a recommended clinical decision-making process before treatment, followed by monitored multidisciplinary treatment with adaptations made as the treatment progresses.

Antimicrobial photodynamic therapy (aPDT) induction of biofilm matrix architectural and bioadhesive modifications.

BACKGROUND: Dental implants are commonly used today for the treatment of partially and fully edentulous patients. Despite the high success rate they are not resistant to complications and failure due to a variety of problems including peri-implantitis or peri-mucositis due to bacterial biofilm formation on the implant surface. The use of non-surgical and surgical treatment procedure to promote healing in cases with peri-implantitis have limited efficacy. Here we studied the ability of photodynamic therapy to destroy a known bacterial pathogen and the extracellular matrix architecture of biofilm attached to titanium plates and germanium prisms. METHODS: Titanium plates or germanium prisms were incubated for 24h with Fusobacterium nucleatum a fusiform, gram-negative bacterium was used to enable biofilm formation. Photodynamic therapy was carried out by incubating the biofilm samples on each substrata with porfimer sodium. Treatment was carried out using a diode laser at 630nm, 150mW/cm(2) for light doses ranging from 25-100J/cm(2). Evaluation of killing efficacy was done by counting colony forming units compared to controls. Multiple attenuated internal reflection-infrared spectroscopy (MAIR-IR) and SEM were used to analyze the samples pre and post PDT for validation. RESULTS: F. nucleatum was significantly reduced in a dose dependent manner by treatment with PDT. Changes in biofilm components and strength of bioadhesion were examined with MAIR-IR following jet impingement using calibrated water jets. SEM demonstrates significant morphological alterations in the bacteria, consistent with damage associated with exposure to reactive oxygen species. CONCLUSION: The results are indicative that aPDT is a method that can be used to eradicate micro-organisms associated with biofilm in peri-implantitis on relevant substrata. Data shows that the slime layer of the biofilm is removed and that further methods need to be employed to completely remove weakened or destroyed biofilm matrix components. Reactive oxygen species (ROS) mediated oxidative damage results in morphologic changes as a consequence of changes in cell membrane integrity.

Fractured Endodontic Instrument: A Clinical Dilemma Retrieve, Bypass or Entomb?

A common clinical complication of root canal treatment is fracture of an endodontic file. The risk of treatment failure because of incomplete cleaning and shaping encourages the dentist to retrieve the fractured part. Several techniques have been offered to remove the fractured file, yet those techniques sacrifice sound dentin, which may lead to increased risk for perforations and root fractures. The aim of this article is to describe a clinical approach to accessing fractured files, depending on their location in the canal and stage of cleaning and shaping. This prudent approach may decrease complications from unnecessary dentin removal, while respecting the biological aspects of cleaning the canals.

Extranodal large B cell lymphoma of the anterior maxilla. Case report and review of literature.

In the oral cavity, lymphoproliferative disorders can manifest in various ways, often as an extranodal externalization. In the case presented here, it was a B cell lymphoma originating in the periapical bone of the anterior maxilla. X-ray revealed a periapical radiolucency associated with an intact tooth with no decay, fillings or history of trauma. The tooth tested non-vital. After root canal treatment, an apicoectomy was performed with a biopsy. The most common diagnosis would be of dental etiology. The pathology report revealed a non-Hodgkin's B cell lymphoma. Most often, this disease appears as localized dental or oral pathology. Non-specific signs and symptoms present in association with lymphoproliferative disorders include lymphadenopathy, trismus, pain, swelling, sinusitis, fever, sepsis, prosthetic instability and paresthesia. Early detection results in decreased morbidity and a better prognosis for the patient.

Role of regulator of G protein signaling proteins in bone.

Regulators of G protein signaling (RGS) proteins are a family with more than 30 proteins that all contain an RGS domain. In the past decade, increasing evidence has indicated that RGS proteins play crucial roles in the regulation of G protein coupling receptors (GPCR), G proteins, and calcium signaling during cell proliferation, migration, and differentiation in a variety of tissues. In bone, those proteins modulate bone development and remodeling by influencing various signaling pathways such as GPCR-G protein signaling, Wnt, calcium oscillations and PTH. This review summarizes the recent advances in the understanding of the regulation of RGS gene expression, as well as the functions and mechanisms of RGS proteins, especially in regulating GPCR-G protein signaling, Wnt signaling, calcium oscillations signaling and PTH signaling during bone development and remodeling. This review also highlights the regulation of different RGS proteins in osteoblasts, chondrocytes and osteoclasts. The knowledge from the recent advances of RGS study summarized in the review would provide the insights into new therapies for bone diseases.

Fractured endodontic instrument: a clinical dilemma. Retrieve, bypass or entomb?

A common clinical complication of root canal treatment is fracture of an endodontic file. The risk of treatment failure because of incomplete cleaning and shaping encourages the dentist to retrieve the fractured part. Several techniques have been offered to remove the fractured file, yet those techniques sacrifice sound dentin, which may lead to increased risk for perforations and root fractures. The aim of this article is to describe a clinical approach to accessing fractured files, depending on their location in the canal and stage of cleaning and shaping. This prudent approach may decrease complications from unnecessary dentin removal, while respecting the biological aspects of cleaning the canals.

Applying extrusive orthodontic force without compromising the obturated canal space.

BACKGROUND: Complicated tooth fractures can be the unfortunate result of orofacial trauma and can offer a therapeutic challenge for the dentist. A conservative solution for gaining supragingival sound tooth structure often includes orthodontic forced eruption. Usually, this procedure is carried out by applying extrusive force after placing a provisional acrylic Richmond crown on the tooth. However, this long-lasting dental treatment may jeopardize the coronal seal of the root canal space, leading to microleakage and endodontic failure. CASE DESCRIPTION: Orthodontic forced eruption demands application of force to an attachment connected to the remaining short clinical crown. In this article, the authors describe a case in which they used a new technique for orthodontic forced eruption of a traumatized tooth, using an extracanal attachment to apply extrusion force, and discuss its possible advantages and limitations. CONCLUSIONS: An extracanal attachment approach for orthodontic forced eruption without compromising the obturated canal space can be a solution for posttraumatic crown fracture. Practical Implications. The described procedure for forced eruption by using an extracanal pin attachment is efficient and convenient and does not require the clinician to apply force directly to the provisional crown. Therefore, during the application of force, there is less risk of loosening the provisional crown, and the canal space is kept intact with either the final restoration or dressing material.

The significance of epithelial rests of Malassez in the periodontal ligament.

INTRODUCTION: The purpose of this review was to describe the function of epithelial rests of Malassez (ERMs) in a variety of physiologic and pathologic conditions. METHODS: The authors performed a PubMed search on the term "epithelial rests" alone or in combination with "Malassez." Relevant articles were categorized into primary subtopics and related to current and historic literature. RESULTS: The review was divided into 7 subtopics. Those sections discuss possible roles for ERM in a variety of physiologic and pathologic processes. CONCLUSIONS: ERMs have a fundamental role in root development, protect against root resorption, and are involved in reparative and regenerative functions of the pulp and periodontal tissues including apexogenesis and periodontal healing. They also appear to be involved in pathologic processes such as the development of oral cysts and tumors.

Understanding resolvin signaling pathways to improve oral health.

The discovery of resolvins has been a major breakthrough for understanding the processes involved in resolution of inflammation. Resolvins belong to a family of novel lipid mediators that possess dual anti-inflammatory and pro-resolution actions. Specifically, they protect healthy tissue during immune-inflammatory responses to infection or injury, thereby aiding inflammation resolution and promoting tissue healing. One of the major concerns in modern medicine is the management and treatment of oral diseases, as they are related to systemic outcomes impacting the quality of life of many patients. This review summarizes known signaling pathways utilized by resolvins to regulate inflammatory responses associated with the oral cavity.

Is endodontic re-treatment mandatory for every relatively old temporary restoration? A narrative review.

OBJECTIVES AND BACKGROUND: In this review, the authors examine whether there is any decisive evidence to support the revision of root fillings that have been exposed to the oral environment for more than three months, undertaken solely because of suspicions of microleakage. Researchers in numerous endodontic studies have addressed the evaluation of coronal microleakage by using different tracers and techniques. The need to achieve a tight, permanent coronal seal as soon as possible after the completion of endodontic treatment is obvious. However, the clinical importance of microleakage studies recently has been questioned because of their wide range and even contradictory results, and findings from only a few clinical investigations have demonstrated a clear relationship between the endodontic success rate and failure rate owed to coronal microleakage in cases involving high-quality endodontic therapy. METHODS: The authors analyzed commonly cited articles regarding the clinical relevance of microleakage studies and the success rate of teeth with compromised restorations. CONCLUSIONS: In a review of the literature, the authors found no clear evidence to support immediate replacement of well-obturated endodontic treatment that has lasted more than three months solely because of suspicions of microleakage. It may be prudent in such cases to make a new coronal restoration immediately and to observe the tooth for at least three months before placing the permanent crown.

Enamel development in primary molars from children with familial dysautonomia.

OBJECTIVES: Familial dysautonomia (FD) is an autosomal recessive disorder, classified as a hereditary sensory and autonomic neuropathy type III, associated with growth defects affecting postnatal development. This study analysed prenatal and postnatal enamel development and postnatal calcification in upper second primary molars from FD children in comparison with healthy controls. The postnatal enamel of FD was also examined histologically for manifestation of growth insults. DESIGN: The analyses were carried out on two ground sections, connecting buccal and palatinal cusp tips of mesial and distal cusps. The measurements included apical location of neonatal line, width and percentage of prenatal enamel. Chemical analyses were performed using an energy dispersive X-ray spectrometer. RESULTS: The prenatal proliferative phase and prenatal apposition rate of enamel were faster on the distal cusps in FD. The postnatal enamel thickness was similar in both groups. The phosphate content of FD teeth was significantly higher and the Ca/P ratio was significantly lower. Postnatal traumatic lines were observed in all FD children and in only one healthy child. CONCLUSIONS: FD upper primary second molars showed thicker prenatal enamel formation in comparison to healthy and other syndromes and better mineralisation. All FD primary molars showed large number of postnatal traumatic lines, implicating severe traumatic episodes during the first year of life.

Absorption of nickel, chromium, and iron by the root surface of primary molars covered with stainless steel crowns.

Objective. The purpose of this study was to analyze the absorption of metal ions released from stainless steel crowns by root surface of primary molars. Study Design. Laboratory research: The study included 34 primary molars, exfoliated or extracted during routine dental treatment. 17 molars were covered with stainless-steel crowns for more than two years and compared to 17 intact primary molars. Chemical content of the mesial or distal root surface, 1 mm apically to the crown or the cemento-enamel junction (CEJ), was analyzed. An energy dispersive X-ray spectrometer (EDS) was used for chemical analysis. Results. Higher amounts of nickel, chromium, and iron (5-6 times) were found in the cementum of molars covered with stainless-steel crowns compared to intact molars. The differences between groups were highly significant (P < .001). Significance. Stainless-steel crowns release nickel, chromium, and iron in oral environment, and the ions are absorbed by the primary molars roots. The additional burden of allergenic metals should be reduced if possible.

Is a C-shaped configuration possible in teeth other than mandibular molars?

This case report presents a maxillary third molar with a C-shaped canal system. This is the first known description of a maxillary third molar with C-shaped anatomy. This unique pulp chamber morphology was observed under the operating microscope. Root canal treatment consisted of cleaning and shaping combined with ultrasonic irrigation with sodium hypochlorite. A calcium hydroxide dressing was applied between appointments. Obturation of the root canal system was performed with warm vertical condensation. The complexity of this canal morphology requires the prudent clinician to perform strict measures to achieve satisfying results.

Acid resistance of the enamel in primary second molars from children with down syndrome and cerebral palsy.

OBJECTIVES: This study was carried out to evaluate the extent of differences in mineralization of inner and outer enamel of the lower primary second molars of children with Down syndrome (DS) and Cerebral Palsy (CP) as revealed by acid treatment of exfoliated teeth. The results were compared to those obtained from a control group of healthy children. METHODS: The sample included 4 mandibular second molars from each group. On each tooth, a thin section was cut, bisecting the mesial cusps. The analysis was carried out on the mesio-buccal cusps. Atomic force microscopy (AMF) was used to analyze the morphological structure of the dental enamel after 10 sec of 0.1 mol% citric acid treatment. The measurements were performed on 3 points in the enamel close to the outer surface and 3 points in the enamel close to the dentin. The differences between groups were analyzed using Mann Whitney tests. RESULTS: In controls and CP teeth the outer enamel was more resistant to etching than the inner enamel. In DS teeth both outer and inner enamel showed similar results for all parameters. Between group comparisons showed that roughness values were significantly higher (P<0.01) in DS teeth than in either controls or CP teeth. No significant differences were found between CP and control teeth. CONCLUSIONS: The higher values obtained for DS enamel reflect increased solubility of the enamel to acid relative to controls and CP teeth together with irregularity of the organic matrix. The practical importance of the results is that DS primary molars needs reduced etching time when prepared for pit and fissure sealants or composite/compomer restorations.

Rapidly progressive internal root resorption: a case report.

The etiology of internal root resorption is not fully understandable, trauma and chronic pulpitis are considered the main risk factors. Usually the process is asymptomatic and diagnosed upon routine radiographic examination. This case report presents a rapid progression of internal resorption related directly to traumatic injury. A 16-year-old female arrived at the emergency room after a mild extrusion of the mandibular incisors. The initial treatment included repositioning and splinting of the teeth. Radiographs performed at repositioning and splinting demonstrated normal configuration of the incisor's roots. Ten months later progressive internal resorption of the left mandibular first incisor was diagnosed. While treating this tooth similar process was detected in the right mandibular second incisor and in the mandibular left second incisor. The lower right first incisor reacted inconsistently to vitality test. As a result of the severe and rapidly progressive nature of the process, root canal treatments were performed in all lower incisors. The follow-up radiographs demonstrate arrest of the internal resorption process.

Multiple sinus tracts as a result of root fracture: a case report.

Sinus tracts are a consequence of chronic apical disease or vertical root fractures. They are usually diagnosed upon routine clinical examination or in response to patient complaints of swelling and occasional pus secretion. An unusual case report of a maxillary canine with multiple orifices of sinus tracts is presented. Vertical root fracture was confirmed after removal of the root canal filling under an operating microscope. Clinicians should suspect vertical root fracture when multiple sinus tracts originating from the same tooth are observed.