Tratamiento Laser-Lok® en implantes dentales. A propósito de un caso clínico / Laser-Lok® treatment on implants dental. About a clinical case

Uno de los retos más importantes, hoy en día, en implantología oral es evitar la pèrdida ósea alrededor de los implantes oseointegrados y funcionales con el paso del tiempo. Una de las superficies que se ha desarrollado en los últimos años es la resultante de la microtexturación mediante láser. Diversos estudios han demostrado la adhesión del tejido conectivo a las superficies tratadas con láser en la zona cervical de los implantes oseointegrados, consiguiendo de este modo un sellado biológico a este nivel. Revisamos lo publicado sobre este tema y presentamos un caso clínico de inserción de un implante unitario con tratamiento láser en su zona cervical desde su colocación hasta la restauración final, donde se observa la buena integración de los tejidos y el èxito del caso a largo plazo. (AU)

There are certainly situations where the standard implants can not be placed or suppose a risk for the crestal bone maintenance. The narrow implants have been used for a wide variety of indications, stablishing scientifically-based treatment protocols with excellent long-term results.In the present study we present a narrative review of narrow implants highlighting their indications and limitations, and a case report where narrow implants have been sh it is evident that narrow implants are an alternative when rehabilitate edentulous spaces with low available bone in the horizontal direction or reduced mesio-distal spaces in aesthetic areas. (AU)

Novel approach in managing post-extraction alveolar bone dimensions.

This case report presents a novel approach towards the preservation of alveolar ridge dimensions following the extraction of an upper left lateral incisor. The extracted teeth of a 56-year old patient was ground with a diamond bur running under the normal saline spray. Sedimented fine tooth-powder was collected and mixed with 2.0 ml of patient's intravenous blood. The powdered paste pushed inside the tooth socket by means of plugger until the socket was filled, leaving a space of 3mm only. The socket was sutured with a non-resorbable silk material. After one week, the adjacent tooth were endodontically prepared and a fixed partial denture was placed on the prepared abutments. The results suggest therapeutic approach with no immune response, which can be implemented at chairside. A significant preservation of alveolar ridge can be maintained using this novel approach.

Tooth autotransplantation as a pillar for 3D regeneration of the alveolar process after severe traumatic injury: A case report.

In dental traumatology, the loss of teeth and the supporting alveolar bone in children compromise the proper development of maxillofacial structures and also limit the solutions that can be offered. In this case report, multidisciplinary management is described of a child with a significant loss of alveolar bone and associated teeth due to a traffic accident at 8 years of age. The management involved staged teeth autotransplantation into surgically prepared sites with bone expanders, orthodontic treatment and dental implants. The 3D regeneration of the alveolar process was successfully stimulated by teeth autotransplantation. At the 4-year follow-up visit, evaluation of the autotransplanted teeth and the implants indicated a successful outcome for the patient.

[Autotransplantation of a maxillary incisor and orthodontic care: a case study]. / Autotransplantation d'une incisive maxillaire et prise en charge orthodontique : à propos d'un cas.

INTRODUCTION: Severely impacted teeth with atypical root anatomy do not respond well to orthodontic traction after surgical exposure. Consequently, they are often removed, but replacing them with dental prostheses can prove difficult in patients who are still growing. Thus, autotransplantation seems to be the only way to preserve a natural tooth and the alveolar bone. MATERIALS AND METHODS: An upper central incisor impacted in the region of the nasal cavities with an open apex was diagnosed in an 8.5-year-old female patient. The tooth displayed a curved root pressed against the maxillary cortical bone preventing orthodontic traction treatment. Through this clinical case involving autotransplantation of a maxillary incisor report and a review of the literature, this article explores the indications and exposes the different stages of this orthodontic-surgical protocol. RESULTS: In this case, autotransplantation enabled restoration of maxillary arch continuity. After two years of orthodontic treatment, the bone reconstruction of the extraction site was very satisfactory. DISCUSSION: The benefits of this technique and the precautions to be taken are discussed as well as the various protocols. The increasing success rate of this surgical procedure makes it possible to consider it as a protocol for the future.

Guided Autotransplantation of Teeth: A Novel Method Using Virtually Planned 3-dimensional Templates.

INTRODUCTION: The aim of this study was to introduce an innovative method for autotransplantation of teeth using 3-dimensional (3D) surgical templates for guided osteotomy preparation and donor tooth placement. METHODS: This report describes autotransplantation of immature premolars as treatment of an 11-year-old boy having suffered severe trauma with avulsion of permanent maxillary incisors. This approach uses modified methods from guided implant surgery by superimposition of Digital Imaging and Communications in Medicine files and 3D data sets of the jaws in order to predesign 3D printed templates with the aid of a fully digital workflow. RESULTS: The intervention in this complex case could successfully be accomplished by performing preplanned virtual transplantations with guided osteotomies to prevent bone loss and ensure accurate donor teeth placement in new recipient sites. Functional and esthetic restoration could be achieved by modifying methods used in guided implant surgery and prosthodontic rehabilitation. The 1-year follow-up showed vital natural teeth with physiological clinical and radiologic parameters. CONCLUSIONS: This innovative approach uses the latest diagnostic methods and techniques of guided implant surgery, enabling the planning and production of 3D printed surgical templates. These accurate virtually predesigned surgical templates could facilitate autotransplantation in the future by full implementation of recommended guidelines, ensuring an atraumatic surgical protocol.

The effect of Emdogain gel on periodontal regeneration in autogenous transplanted dog's teeth.

AIM: The aim of this study was to assess the enamel matrix derivative (EMD) as biomaterial used in autogenous tooth transplantation. MATERIAL AND METHODS: The study consisted of 3 beagle dogs, 5 months old, in which six incisors and six premolars were transplanted to mechanically prepared recipient alveolar sockets. One group of teeth was transplanted to a recipient bed, with EMD in the root surface. The second groups of teeth were transplanted using saline solution in the root surface. Every week, clinical examinations were done. Nine weeks later, the animals were killed and the specimens decalcified and prepared for histological and imunohistochemical analysis. Periodontal healing was evaluated by undertaking histomorphometric investigation and analyzed using the Mann- Whitney test (P = 0.05). RESULTS: In both groups, all the transplanted teeth survived. Between the experimental groups, there was statistically significant difference in the complete healing (P = 0.004). There was statistically significant difference between the treatment group in the occurrence of inflammatory root resorption (P = 0.015) and the occurrence of replacement root resorption (P = 0.041). CONCLUSIONS: Emdogain gel used on the surface of transplanted teeth improves the occurrence of complete healing and reduces root resorption.

The critical apical diameter to obtain regeneration of the pulp tissue after tooth transplantation, replantation, or regenerative endodontic treatment.

INTRODUCTION: Regeneration of pulp-like tissue in the pulp chamber after tooth transplantation, replantation, or in regenerative endodontic treatment is only possible if the apical foramen is open. According to the literature, the success of regeneration decreases considerably if the foramen is smaller than 1 mm when measured on radiographs. The aim of this study was to study histologically the relation between the width of the apical foramen and regeneration of tissue in the pulp chamber after autotransplantation. METHODS: Fifteen single-rooted mature teeth of 3 adult beagle dogs were used. All experimental teeth were extracted and underwent apicoectomy. The teeth were photographed from the apical side, and the width of the foramen was calculated. The foramen width ranged from 0.24-1.09 mm. All teeth were replanted in infraocclusion. The observation period was 90 days after transplantation. RESULTS: The 10 teeth with the smallest apical diameter, ranging between 0.24 and 0.53 mm, showed vital tissue in at least one third of the pulp chamber. The 6 most successful teeth showing vital tissue in the entire pulp chamber had an apical diameter between 0.32 and 0.65 mm, and 80% of the experimental teeth with a diameter varying between 1.09 and 0.31 mm showed vital tissue in at least one third of the pulp chamber 90 days after transplantation. CONCLUSIONS: The size of the apical foramen seems not to be the all decisive factor for successful revascularization and ingrowth of new tissue after transplantation. The minimum width of the apical foramen has not been determined, but a size smaller than 1 mm does not prevent revascularization and ingrowth of vital tissue. In this animal study an apical foramen of 0.32 mm did not prevent ingrowth of new tissue in two-thirds of the pulp chamber 90 days after transplantation.

Long-term preservation of Bone Morphogenetic Activity in stored demineralized murine incisors.

Demineralized bone or dentine implanted intramuscularly induce endochondral bone formation. This phenomenon, termed "bone induction" is triggered by non-collagenous signal molecules, named "Bone Morphogenetic Proteins" (BMPs), released from bone or dentine. Demineralization of bone/dentine prior their implantation facilitates the release of BMPs from the extracellular matrix allowing to reach a BMP threshold level needed to initiate the process of differentiation of mesenchymal cells towards an osteogenic/chondrogenic lineage. Unprocessed, mineralized tissues usually fail to induce cartilage/bone. Isolated BMPs are commercially available, and in clinical practice are an alternative for demineralized tissues, however, in many cases demineralized bone has advantages over soluble BMPs, as it combines both bone inducing principles and mechanical properties, a feature important for bridging bone fracture and filling bone defects. Demineralized bones are an inexpensive source of bone forming agents for bone-fracture healing or filling bone defects. In this report we demonstrated that storage of lyophilized demineralized murine incisors for 30 months does not deteriorate its osteoinductive potency and colonizing induced bone by bone marrow. Lyophylized incisors, stored for 0-30 months at refrigator were implanted intramuscularly and recovered, together with surrounding tissues at various time intervals ranging 10-450 days. Bone closely associated with implant was observed in about 87% of cases, regardless the storage duration. It is concluded that storage of demineralized and lyophilized incisor matrices for at least 30 months does not change their osteoinductive potency.

[Effect of orthodontic force on expression of Asporin after tooth auto-transplantation: an experimental study in Beagle dogs].

OBJECTIVE: To evaluate the effect of orthodontic light force on the expression of Asporin, bone morphogenetic proteins-2 (BMP-2) and alkaline phosphatase (ALP) after auto-transplantation. METHODS: Thirty-two maxillary and mandibular incisors in four 13 month-old male Beagle dogs were auto-transplanted to the other side of the same jaw. The teeth were all endodontically treated and divided into four groups, control (group 1) and three experimental groups (groups 2, 3 and 4).In control group, the teeth were unloaded. In the other three experimental groups, continuous force was applied in the 1st week (group 2), 2nd week (group 3) and 4th week (group 4) after auto-transplantation, respectively. The dogs were sacrificed in the 8th week. The mRNA expressions of Asporin,BMP-2 and ALP were examined by real time PCR. The expression of periodontal ligament associated protein-1 (PLAP-1) was examined by Western blotting. The data were statistically analyzed using SPSS 17.0 and one-way analysis of variance (ANOVA). RESULTS: In group 3, the expression of Asporin mRNA (2.047 ± 0.281) was higher than that in the other three groups, while the expression of BMP-2 (1.358 ± 0.095) was lower than that in group 2 and control group (P < 0.05). The expression of PLAP-1 (1.054 ± 0.113) in group 3 was higher than other groups, while significant difference was found between any two groups. CONCLUSIONS: Orthodontic force could stimulate the expression of Asporin and PLAP-1. The orthodontic force applied in the 2nd week after the tooth auto-transplantation, the expression of Asporin and PLAP-1 reached the highest level.

The adipocyte component of bone marrow in heterotopic bone induced by demineralized incisor grafts.

The relative proportion of adipocytes to hematopoietic elements in the marrow of heterotopically induced bone evaluated 4-42 weeks post implantation of demineralized murine incisors was estimated by histological analysis of hematoxylin-eosin stained tissue sections. Using computerized image analysis of microphotographs,the proportion of nuclear cells vs. adipocytes was ascertained. The percentage of adipocytes in marrow increases over time. Such an effect, the replacement of myelopoietic marrow by adipogenic (yellow) marrow and the resorption of induced bone, is observed in human osteoporosis. A decline in the non-adipogenic cell compartments of bone marrow accompanying induced bone begins in the fourth week of induction, gradually progresses until the 26th week, and does not change after that. The luminosity, a parameter used in image analysis and proportional to the number of nuclear cells, was 124 ± 3 in hematopoietic femoral bone marrow, and that of bone marrow of the induced bone was of a similar value (117 ± 8) in the fourth week. An evident decline in luminosity of bone marrow filling the foci of heterotopic bone was observed in samples taken at nine weeks (82 ± 20). This process progressed until the 26th week, reaching a luminosity of 70 ± 21. At the 42nd week, the luminosity remained at the same level (71 ± 27). This indicates that the replacement of hematopoietic bone marrow of heterotopically induced bone by unilocular adipocytes begins relatively early (the fourth week) and is persistent.

[Effect of orthodontic force on periodontal healing after autotransplantation: an experimental study].

OBJECTIVE: To investigate the effect of the continuous light force to the donor teeth on the periodontal healing after transplantation. METHODS: Thirty-two maxillary and mandibular incisors in four 10-month-old male Beagle dogs were autotransplanted. The pulps were removed in all teeth. The teeth were divided into four groups, one control and three experimental groups. In control group (group 1), the teeth were unloaded. In the other three experimental groups, continuous force (0.49 N) was applied in the 1st (group 2), 2nd (group 3) and 4th (group 4) week, respectively. The dogs were sacrificed in the 8th week. The tissue blocks were demineralized and sectioned perpendicular to the long axis of the teeth. The histological analysis was made. RESULTS: Histomophometric analysis revealed a significantly lower occurrence of replacement root resorption in the group 3 (2.1%) than in the control group (12.5%, P < 0.05). The significant lower incidence of replacement root resorption, and a higher surface and inflammatory root resorption were found in group 2 (6.3% and 68.8%) than in the control group (12.5% and 41.7%, P < 0.05). No significant difference was found between group 4 and control group (P > 0.05). CONCLUSIONS: The orthodontic force promoted the regeneration of the periodontal ligament and prevented dentoalveolar ankylosis, whereas excessive initial force might cause root and bone resorption.

Think before you extract--a case of tooth autotransplantation.

Renewed interest in autotransplantation has resulted in additional options in the treatment for rehabilitation of missing anterior teeth. Premolar teeth have been commonly used after extensive modifications while a supernumerary tooth from the anterior region when present would be a more suitable option. This case presents such a scenario, with a successful outcome ensuring adequate restoration of function, economical viability and aesthetic satisfaction for both the patient and clinician.

Effects of time of initial exposure to MSV sarcoma on bone induction by dentine matrix implants and on orthotopic femora.

HCl-demineralized murine lower incisors were implanted intramuscularly into syngeneic BALB/c mice to induce heterotopic osteogenesis. Implants were exposed at the early, preosteogenic stage (4), or at the later, osteogenic stage (12) to the Moloney sarcoma virus (MSV), which within 3-4 days results in a sarcoma. The yield of bone induction was determined by weight of dry bone mass following NaOH hydrolysis of soft tissues. To verify the effect of this sarcoma on orthotopic local femoral bone, the dry mass of the tumor-exposed femora was measured and compared with the weight of MSV-unexposed contralateral controls. MSV-sarcoma or cells involved with their spontaneous rejection have a stimulatory effect on the periosteal membrane of the tumor-adjacent femoral bones, increasing their dry mass on average by 18%. No stimulatory effect on heterotopic bone induction was observed when the MSV sarcoma grew during the early, preosteogenic stage (4 onward), but when the tooth matrix had been exposed to such tumor at the already bone-forming stage, (12 onward), the yield of bone induction was enhanced. Thus, it is postulated that lesions induced by MSV during the early, preosteogenic stage inhibit recruitment of osteoprogenitor cells or degrade Bone Morphogenetic Proteins (BMPs) released by matrix resorbing inflammatory cells, whereas when acting on already existing bone they have a stimulatory effect.

Quantitative scintigraphic analysis of pulp revascularization in autotransplanted teeth in dogs.

OBJECTIVE: The purpose of this study was to evaluate the pulpal changes associated with autogenous single-rooted immature tooth transplantation in dogs, using either one, or two-stage surgical techniques. METHODS: Teeth from 3 beagle dogs, 5 months old, were extracted and transplanted to mechanically prepared recipient sockets. Group (A), where the teeth were transplanted using a one-stage method to recipient beds prepared immediately before transplantation. Group (B), where the teeth were transplanted using a two-stage method in which the recipient beds were prepared and left to heal for 7 days before transplantation. Clinical examinations were done every week during 9 weeks. After 9 weeks, the animals were injected with 99(m)Technetium hydroxylmethylene diphosphonate (99(m)Tc-HMDP) and 3h after injection, a whole body scintigraphic acquisition was performed. After scintigraphic acquisition the animals were euthanized and the teeth extracted and its radioactivity counted in a well counter calibrated to 99(m)Tc. With the data obtained, the percentage of activity injected was calculated for each tooth. The data for each group of teeth were evaluated and analyzed using the Mann-Whitney test (p=0.05). RESULTS: All the transplanted teeth in both groups survived. No statistically significant difference was found in the absorption of the 99(m)Tc-HMDP, between the treatment groups (p=0.464) and between them and the control group (Group A vs. control p=0.713 and Group B vs. control p=0.157). CONCLUSIONS: This study demonstrated that there was no difference between the two surgical techniques in terms of the pulp revascularization in transplanted teeth.

Histological evaluation of periodontal regeneration in autogenous tooth transplantation in the dog: a comparison between one and two-stage surgical techniques, a pilot study.

OBJECTIVE: To compare the periodontal regeneration, associated with autogenous tooth transplantation in dogs, using either one- or two-stage surgical techniques. METHODS: The study group consisted of three Beagles, older than 5 months, in which six incisors and six premolars were transplanted to mechanically prepared recipient sockets. One group was transplanted using a one-stage method to recipient beds prepared immediately before transplantation. The second group of teeth were transplanted using a two-stage method in which the recipient beds were prepared and left to heal for 7 days before transplantation. Clinical examinations were done every week and the animals were euthanized 9 weeks later. Subsequently, decalcified sections were prepared for routine and immunohistochemical histological evaluation. Periodontal healing was evaluated by undertaking histomorphometric analysis and analyzed using the Mann-Whitney test (P = 0.05). RESULTS: All the transplanted teeth in both groups survived. No statistically significant difference was found in the complete healing between the treatment groups (P = 0.053). There was no difference between the occurrence of inflammatory root resorption (P = 0.135) and replacement root resorption (P = 0.081). CONCLUSIONS: This study demonstrated that there was no difference between the two surgical techniques in terms of preventing root resorption in transplanted teeth.

A case of ring chromosome 18 syndrome treated with a combined orthodontic-prosthodontic approach.

OBJECTIVE: The aim of this study was to report the case of a Japanese subject with ring chromosome 18 syndrome. A cephalometric analysis was performed, and the treatment procedure is described. DESIGN: Lateral and posteroanterior cephalograms were compared with Japanese norms. Dental anomalies were evaluated by a model analysis. The outcome of orthodontic-prosthodontic treatment was evaluated by comparing cephalograms during the course of treatment. RESULTS: The cephalometric analysis showed a reduction in the cranial base length and cranial width, midfacial depth, and height and width. Comparison of lateral cephalograms at age 16 years 6 months and 22 years 4 months showed late growth of the mandible. The model analysis showed that all of the teeth, except for the mandibular canine, were small. CONCLUSIONS: Characteristic craniofacial and dental anomalies were clarified. Successful oral rehabilitation was achieved by combined orthodontic-prosthodontic treatment.

Complicated crown fractures - management and treatment options.

AIM: Complicated crown fractures involve enamel, dentine and the pulp. The incidence of complicated crown fractures ranges from 2% to 13% of all dental injuries and the most commonly involved tooth is the maxillary central incisor. Various treatment modalities are available depending upon the clinical, physiological and radiographic status of the involved tooth. The aim of this article was to discuss techniques for the management of complicated crown fractures. SUMMARY: Management of complicated crown fractures depends upon several factors with the result that various clinical modalities have been suggested. Seven case reports of complicated crown fractures are presented and risks/benefits of the treatment plans are discussed. KEY LEARNING POINTS: Proper diagnosis, treatment planning and follow-up care are important factors in the prognosis of complicated crown fractures. Thorough understanding of the available treatment modalities and their specific indications is critical. The risks and benefits of each treatment option should be carefully evaluated during the treatment planning process.

Autotransplantation of an intruded lateral incisor replacing an avulsed central incisor--a case report.

UNLABELLED: Oral injuries cause aesthetic, psychological, social, and therapeutic problems and also affect a large number of people, causing irreparable dental loss not only at the accident time but also during post-treatment. Missing permanent teeth by trauma in children is a particular challenge, especially in the anterior region of the maxilla. In the past few decades, tooth transplantation has been successfully researched for the treatment of anterior tooth loss in young individuals. OBJECTIVE: The present case describes transplantation of an excessive intrusive maxillary left lateral incisor into the socket of avulsed maxillary left central incisor STUDY DESIGN: The lateral incisor tooth was extracted and placed into the socket of avulsed tooth. Splinting was maintained for 2 weeks. After the root canal treatment, the crown of the lateral incisor tooth was reshaped with composite resin in central tooth form and performed an interim prosthesis both preventing movement of the canine tooth into the space of the transplanted lateral incisor tooth and providing aesthetic. CONCLUSION: The treatment provided is considered to be an interim solution for space maintenance, with time the child patient may reach an age that allows alternative, more definitive treatment as implant.

Autotransplantation of a supernumerary incisor as a replacement for fused tooth: 24-month follow-up.

This case report describes the technique and 24-month follow-up of autotransplantation of a well-shaped, healthy supernumerary maxillary central incisor as a replacement for a fused maxillary incisor. Because the alignment of the teeth neighboring the fused incisor was not suitable as an abutment for post-transplantation splinting, a custom palatal splint that took anchorage from permanent first molars was fabricated. Following extraction of both teeth, the supernumerary incisor was immediately autotransplanted into the extraction site of the fused incisor. The autotransplanted tooth was secured to the custom splint with acid-etch composite, and the splint was removed 2 weeks later. Closure of the apex was observed at 18 months. Both the esthetics and function were restored to an ideal level in the absence of postoperative complications, as evidenced by 24-month clinical and radiographic findings.