Unusual cause of tooth mobility.

We describe a case of a 71-year-old otherwise healthy man who presented to the dental clinic with the chief complaint of mobility involving his upper left molar teeth. The patient was a febrile, and clinical oral examination revealed localised grade II mobility and absence of gingival swelling, erythema or sinus tract. Orthopantogram revealed a poorly defined radiolucency involving the upper left second and third molar teeth. Surgical exploration of the involved area was performed and revealed the presence of a 'jelly like' brown tissue that fragments easily. Pathological examination confirmed the diagnosis of diffuse large B cell lymphoma.

Increased tooth mobility after fixed orthodontic appliance treatment can be selectively utilized for case refinement via positioner therapy - a pilot study.

BACKGROUND: Increased tooth mobility persists after fixed orthodontic appliance removal, which is therapeutically utilized for post-treatment finishing with positioners. As such a fine adjustment is only required for selected teeth, the aim of this pilot study was to investigate tooth mobility in vivo on corrected and uncorrected subgroups under positioner therapy. METHODS: Mobility was measured on upper teeth of 10 patients (mean age 16.8) by applying loadings for 0.1, 1.0 and 10.0 s with a novel device directly after multibracket appliance debonding as much as 2d, 1, 2 and 6 weeks later. Positioners were inserted at day 2. Specimens were divided into Group C (teeth corrected via positioner), Group N (uncorrected teeth adjacent to teeth from group C), and Group U (uncorrected teeth in an anchorage block). Untreated individuals served as controls (n = 10, mean age 22.4). Statistics were performed via Kolmogorov-Smirnov test and Welch's unequal variances t-test for comparisons between groups. P < 0.05 was considered statistically significant. RESULTS: After 1 week, tooth mobility in Group U almost resembled controls (13.0-15.7 N), and reached physiological values after 6 weeks (17.4 N vs. 17.3 N in controls). Group C (9.0-13.4 N) and Group N (9.2-14.7 N) maintained increased mobility after 6 weeks. Tooth mobility was generally higher by reason of long loading durations (10.0 s). CONCLUSIONS: Positioner therapy can selectively utilized increased tooth mobility upon orthodontic fixed appliance treatment for case refinements. Here, uncorrected teeth in anchorage blocks are not entailed by unwanted side effects and recover after 6 weeks post treatment. Corrected teeth and their neighbors exhibit enhanced mobility even after 6 weeks, which represents a necessity for the proper correction of tooth position, and concurrently arouses the requirement for an adequate retention protocol.

Periotestometry and tissue hydration. How are these indicators related?

The mobility of teeth in terms of periotestometry and hydration of periodontal tissues in terms of bioimpedance spectrometry were studied in healthy volunteers without dental and concomitant somatic diseases. It was found that teeth of these subjects have both low and pathological mobility. It was also revealed as increased hydration (edema), indicating the presence of inflammation, and reduced hydration, indicating atrophic processes in periodontal tissues. A comparison of the data of periotestometry and bioimpedance spectrometry showed that the indicators of mobility of the teeth and hydration of the periodontal tissues reflect different characteristics of the functional state of dentoalveolar system, and can be used as complementary in the diagnostic studies.

Displacement of teeth without and with bonded fixed orthodontic retainers: 3D analysis using triangular target frames and optoelectronic motion tracking device.

PURPOSE: The objective of this study was to evaluate the anterior tooth movement without and with bonded fixed orthodontic retainers under incremental loading conditions. MATERIALS AND METHODS: Six extracted mandibular anterior human teeth were embedded in acrylic resin in True Form I Arch type and 3D reconstruction of Digital Volume Tomography (DVT) images (0.4 mm3 voxels) were obtained. The anatomy of each tooth was segmented and digitally reconstructed using 3D visualization software for medical images (AMIRA, FEI SVG). The digital models of the teeth were repositioned to form an arch with constant curvature using a CAD software (Rhinoceros) and a base holder was designed fitting the shape of the roots. The clearance between the roots and their slot in the holder was kept constant at 0.3 mm to replicate the periodontal ligament thickness. The holder and the teeth were then manufactured by 3D printing (Objet Eden 260VS, Stratasys) using a resin material for dental applications (E = 2-3 GPa). The 3D-printed teeth models were then positioned in the holder and the root compartments were filled with silicone. The procedure was repeated to obtain three identical arch models. Each model was tested for tooth mobility by applying force increasing from 5 to 30 N with 5 N increments applied perpendicular on the lingual tooth surface on the incisal one third (crosshead speed: 0.1 mm/s). The teeth on each model were first tested without retainer (control) and subsequently with the bonded retainers (braided bonded retainer wire; Multi-strand 1 × 3 high performance wire, 0.022″ × 0.016″). Tooth displacement was measured in terms of complicance (F/Δ movement) (N/mm) using custom-built optoelectronic motion tracking device (OPTIS) (accuracy: 5 µm; sampling rate: 200 Hz). The position of the object was detected through three LEDs positioned in a fixed triangular shape on a metal support (Triangular Target Frame). The measurements were repeated for three times for each tooth. Data were analyzed using mixed model with nesting (alpha = 0.05). RESULTS: The use of retainer showed a significant effect on tooth mobility (0.008 ±â€¯0.004) compared to non-bonded teeth (control) (0.014 ±â€¯0.009) (p < 0.0001). The amount of displacement on the tooth basis was also significantly different (p = 0.0381) being the most for tooth no. 42 (without: 0.024 ±â€¯0.01; with: 0.012 ±â€¯0.002) (p = 0.0018). No significant difference was observed between repeated measurements (p = 0.097) and the incremental magnitude of loading (5-30 N: 0.07 ±â€¯0.01-0.09 ±â€¯0.02) (p > 0.05). CONCLUSION: Mandibular anterior teeth showed less tooth mobility when bonded with stainless steel wire as opposed to non-bonded teeth but the tooth mobility varied depending on the tooth type. Intermittent increase in loading from 5 to 30 N did not increase tooth displacement.

Valor pronóstico de la densidad ósea y de la movilidad en el éxito implantológico / Prognostic value of bone density and mobility in implant success

Objetivos. Evaluar el valor pronóstico de la movilidad primaria (momento de inserción del implante) y secundaria (fase protésica), así como el de la densidad ósea en el resultado de éxito o fracaso del implante durante un seguimiento continuado al año, a los 5 años y a los 10 años. Material y métodos. Se realizó un estudio longitudinal prospectivo con un seguimiento a 10 años en el que se incluyeron 151 implantes colocados en 71 pacientes, no fumadores, durante los años 2005 y 2006. A cada uno de los implantes se les midió las estabilidades primaria y secundaria a través de un valor Periotest® (VPT) y se anotó la densidad ósea presente en el momento de la implantación. De los 151 implantes colocados inicialmente, completaron el estudio 109. Resultados. No se observaron diferencias estadísticamente significativas respecto a la movilidad del implante en el momento de inserción o en la fase protésica y el éxito o fracaso del mismo al año, a los 5 años, o transcurridos 10 años desde su inserción. Sí encontramos diferencias estadísticamente significativas con relación al tipo de densidad ósea donde se colocó el implante a los 5 y 10 años (p<0,05). Conclusiones. La movilidad primaria o secundaria del implante carece de valor pronóstico significativo sobre el éxito del mismo transcurridos 10 años desde su inserción. Por el contrario, la densidad de hueso inicial tiene una clara influencia en el éxito del implante a los 10 años, siendo más proclives al fracaso los huesos de alta densidad ósea (AU)

Purposes. To prospectively analyze the prognosis value of the primary mobility (at the moment of implant insertion) and secondary (prosthetic phase), as well as bone density, in the implant success or failure after one year, five years and ten years. Materials and methods. Between 2005 and 2006, 151 implants were placed in 71 non-smoking patients. Primary (at the moment of surgery) and secondary (once osseointegrated) stabilities were measured in each implant through a Periotest® value (PTV) and the bone density was scored at the moment of implantation. One hundred nine of 151 implants placed initially completed the study. Results. There were no statistically significant differences regarding implant mobility at the moment of its insertion or once osseointegrated and the implant success or failure after 10 years. However, statistically significant differences were found respect to the bone density where the implant was placed after 5 and 10 years (P<.05). Conclusions. Primary or secondary mobility of the implant has no significant prognosis value on the implant success after 10 years. On the other hand, bone density has a clear influence on long time implant success. High density bones are more predictable to fail than low density bones after a long time (AU)

A cross-sectional, clinical study to evaluate mobility of teeth during pregnancy using periotest.

BACKGROUND AND OBJECTIVE: Over a century, an increased prevalence of gingival diseases associated with increasing plasma sex steroid hormone levels has been reported. These situations present unique challenges to the oral health-care professional. It is believed that hormonal fluctuations such as those associated with pregnancy, menstruation, and use of hormonal contraceptives lead to an increase in tooth mobility. However, this effect of female sex hormones on periodontal ligament and tooth-supporting alveolar bone has rarely been investigated. Hence, this study was conducted to understand the effect of hormonal changes during pregnancy on tooth mobility. MATERIALS AND METHODS: Mobility of index teeth 16, 13, 21, 23, 24, 36, 33, 41, 43, and 44 was measured with periotest for fifty pregnant females at first trimester (12th week), second trimester (24th week), and third trimester (35th week). Simplified oral hygiene index, plaque index, Gingival index (GI), and probing depth were also evaluated during the three trimesters of pregnancy for each subject participating in the study. STATISTICAL ANALYSIS: The results of the study were subjected to statistical analysis. Data analysis was done by applying Z-test for comparing difference between two sample means. RESULTS: A small but statistically significant influence on the periotest value was seen during the three trimesters of pregnancy. GI scores significantly increased throughout pregnancy despite no significant change in plaque levels. CONCLUSION: Pregnancy had a significant influence on tooth mobility. Highest value of tooth mobility was seen in the last month of pregnancy. The maximum severity of gingivitis was also seen during the third trimester of pregnancy.

In vivo determination of tooth mobility after fixed orthodontic appliance therapy with a novel intraoral measurement device.

OBJECTIVE: Valid measurement systems recording tooth mobility upon displacement within the subtle range of physiological strains are missing. Here, we introduce a novel in vivo measurement device and demonstrate a first clinical application by monitoring tooth mobility changes during retention after fixed multibracket appliance therapy. MATERIALS AND METHODS: Tooth mobility was measured in vivo on 21 patients (11 female, 10 male; mean age 16.1 ± 3.1 years) by displacing the upper first incisor 0.2 mm lingually for 0.2, 0.5, 1, 2, 5, and 10 s with the novel intraoral device. Measurements were recorded directly after, as much as 2, 7, and 14 days and up to 6 months after appliance debonding. RESULTS: Device performance was precise and valid in clinical use. Data revealed significant interindividual varying tooth mobility, which was very high during the first 2 days after appliance removal. After 1 week, mobility values decreased, but were generally higher upon short loadings compared to long ones. After 3 months, tooth mobility was significantly lower than directly after debonding. Interestingly, males exhibited significantly less mobility than females. CONCLUSIONS: Our work is the first using an in vivo measurement device capable of performing and recording tooth displacements within this delicate range and in such precision. Furthermore, our findings elucidate tooth mobility changes after multibracket treatment, giving important information for retention periods. CLINICAL RELEVANCE: Establishment of this novel measurement device in clinical use is an important improvement when approaching the complexity of tooth mobility in vivo regarding different issues like orthodontics, periodontal disease, or bruxism.

[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.

A rare case report and appraisal of the literature on spontaneous tooth exfoliation associated with trigeminal herpes zoster.

BACKGROUND: Reports of post herpetic maxillofacial complications have been very rarely documented in the literature that includes periapical lesions, calcified and devitalized pulps, resorption of roots, osteonecrosis, and spontaneous exfoliation of teeth. The atypical feature of the case of concern to the dental surgeon is the rare complication of spontaneous tooth exfoliation following herpes zoster. CASE REPORT: This case reports a male patient of age 47 years who reported to the Department of Periodontology with the chief complaint of mobility in the left upper central incisor. Patient history revealed herpes zoster infection that began 11 days earlier along with underlying diabetes mellitus condition. We hereby report a known diabetic patient with history of herpes zoster infection who presented with rare complication of spontaneous tooth exfoliation involving the maxillary division of the trigeminal nerve. DISCUSSION: Limited number of cases has been reported in the literature regarding spontaneous teeth exfoliation secondary to herpes zoster. The exact pathogenesis regarding the spontaneous exfoliation of teeth in herpes zoster patient is still controversial. Thus, an oral health care provider should be aware of this rare complication while managing a case of tooth mobility with the previous history of herpes zoster of trigeminal nerve.

Manejo de dientes natales y neonatales: reporte de dos casos / Management of natal and neonatal teeth: report of two cases

Los dientes natales son órganos dentarios que se presentan al nacimiento, y los neonatales son aquellos que erupcionan durante el primer mes de vida. La etiología exacta es desconocida. El manejo de estos dientes depende de múltiples factores. La extracción está indicada cuando eldiente es un supernumerario o presenta movilidad excesiva debido al riesgo de broncoaspiración. Cuando tienen ligera movilidad, generalmente se estabilizan conforme van erupcionando. El objetivo de este reporte es la presentación de dos casos clínicos de dientes natales yneonatales que se manejaron con abordajes diferentes, el primero demanera conservadora y el segundo con la extracción del órgano dental.

Natal teeth are those present at birth. Those erupting during the fi rst month of life are neonatal teeth. The etiology is not known. Natal teeth management is dependent on multiple factors. If the natal tooth is su-pernumerary, the treatment of choice is extraction; likewise, when the teeth are excessively mobile, extraction is indicated due to the risk of aspiration. When natal teeth are only slightly mobile, they often stabilize soon after eruption. The aim of this report is to present two cases of natal and neonatal teeth that were managed with different approaches; the fi rst with a more conservative treatment and the second one with the extraction of the teeth.

Proximal contact loss between implant-supported prostheses and adjacent natural teeth: a retrospective study.

OBJECTIVES: To determine the prevalence of proximal contact loss between posterior implant-supported prostheses and the adjacent anterior natural tooth and to identify potential contributing factors. MATERIALS AND METHODS: Forty-five consecutive patients, who had received either implant-supported fixed partial denture (FPD) or implant-supported single crown (SC) in the posterior region and were under regular review, were recruited. Interproximal space was assessed by the number of matrix bands that could be placed, and tooth mobility was assessed by Periotest®. A self-reported questionnaire was administered. Effects of various patient and prosthesis parameters on interproximal space were analyzed by Kruskal-Wallis test or Mann-Whitney U test. Correlations were tested by Spearman's rank correlation coefficient. Differences were considered significant if P < 0.05. RESULTS: Forty-three of 66 (65%) prostheses showed proximal contact loss. Frequent food packing was reported in 40% of the prostheses. The mean interproximal space was 167 (SD = 125) µm, and it was positively correlated with patients' age (P = 0.031) and time since prostheses delivery (P = 0.002). The interproximal space in the FPD group was significantly larger than the SC group (P = 0.008). CONCLUSION: Proximal contact loss is not uncommon in posterior implant-supported prostheses. In this study, age of the patient, prosthesis type and time since delivery of prosthesis were found to be contributing factors.

Validity of screening methods for periodontitis using salivary hemoglobin level and self-report questionnaires in people with disabilities.

BACKGROUND: The aim of this study is to evaluate the validity of screening methods in predicting periodontitis in people with disabilities using the objective salivary hemoglobin level, a subjective self-report questionnaire, and a combined model of the two methods with demographic characteristics. METHODS: The participants were 195 patients with disabilities aged >18 years who were examined using the community periodontal index (CPI), salivary hemoglobin level, and answers to 10 self-report questions (n = 192). Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to evaluate the validity of the methods and the combined model in predicting the prevalence of ≥CPI 3 (probing depth [PD] ≥4 mm) or CPI 4 (PD ≥6 mm). RESULTS: Overall, 75.9% of the study group (148 of 195) were diagnosed with ≥CPI 3, and 38.5% of the study group (75 of 195) were diagnosed with CPI 4. The areas under the ROC curve (AUCs) of the salivary hemoglobin level were 0.578 (sensitivity of 41% and specificity of 77%) and 0.662 (sensitivity of 53% and specificity of 75%) for predicting the prevalence of ≥CPI 3 and CPI 4, respectively. Multivariable modeling incorporating four different questions for predicting ≥CPI 3 or CPI 4 indicated higher AUCs of 0.710 and 0.732, respectively, yielding higher sensitivity (55% for ≥CPI 3 and 69% for CPI 4) than that of salivary hemoglobin level. The most useful prediction models for ≥CPI 3 or CPI 4 were combined models, which yielded AUCs of 0.773 and 0.807, respectively, with sensitivity values of 70% and specificity values >75%. CONCLUSION: The salivary hemoglobin level, self-report questionnaire, and the combined method demonstrated screening potential that could predict the population prevalence of ≥CPI 3 or CPI 4.

Performance of self-reported measures for periodontitis in rheumatoid arthritis and osteoarthritis.

BACKGROUND: This study evaluates the performance of self-report against the reference standard of clinically defined periodontitis in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) after accounting for factors associated with periodontitis. METHODS: Six self-report periodontitis questions were evaluated in patients with RA and OA. Questions were validated against a reference standard of severe and moderate-to-severe periodontitis based on full-mouth examination. Multivariable logistic regression was used to evaluate the performance of: 1) self-report alone; 2) age, sex, education, and smoking status; and 3) a combination of the above. Model performance was assessed using the c-statistic. Convergent validity of self-reported "bone loss/deep pockets" and "loose teeth" was assessed; associations of self-report with RA disease characteristics were explored. RESULTS: Self-report performed similarly in RA and OA, with individual question specificity for periodontitis ≥ 68% and sensitivity from 9.8% to 45%. Question-only models yielded c-statistics of 0.66 to 0.72, whereas risk factor-only models yielded c-statistics of 0.74 to 0.79. The highest-performing models incorporated both self-report questions and periodontitis risk factors, with c-statistics ≥ 0.79. Greater radiographic alveolar bone loss was observed among participants reporting "bone loss/deep pockets" (P < 0.001) and "loose teeth" (P < 0.001). Among patients with RA, "loose teeth," but not other self-report items, was associated with rheumatoid factor positivity (P = 0.047) and higher disease activity (P < 0.001). CONCLUSIONS: Patient self-report, when combined with other risk factors, performs well in identifying periodontitis among patients with RA and OA. Self-report questions related to alveolar bone loss exhibit excellent convergent validity in these patient subsets.

Rare case of generalised aggressive periodontitis in the primary dentition.

BACKGROUND: Generalised aggressive periodontitis (AP) in the prepubescent age is an exceptionally rare disease in the primary dentition of otherwise healthy children. Characteristics of AP are gingival inflammation, deep periodontal pockets, bone loss, tooth mobility and even tooth loss. The most common way of treating this disease is the extraction of all the involved primary teeth. CASE REPORT: A 4-year-old girl presented with signs of severe gingival inflammation. Clinical examination revealed deep pockets, increased tooth mobility and bone loss. Microbiological testing revealed the presence of a typical periopathogenic flora consisting of Aggregatibacter actinomycetemcomitans and the typical members of the red complex (Porphyromonas gingivalis, Prevotella intermedia and Treponema denticola). The patient underwent tooth extraction of all primary teeth except the primary canines, followed by thorough root debridement and treatment with systemic antibiotics (amoxicillin plus metronidazole). FOLLOW-UP: Regular clinical and microbiological examinations over 4 years showed no signs of recurrence of a periodontitis, even in the erupted permanent teeth. CONCLUSION: Early diagnosis and consequent early treatment of aggressive periodontitis can stop the disease and therefore avoid the development of a periodontal disease in the permanent dentition. A close collaboration between specialists of different disciplines is required for a favourable outcome.

Salivary biomarkers of bacterial burden, inflammatory response, and tissue destruction in periodontitis.

AIM: Chronic periodontitis has an episodic and multifactorial character, with fluctuations in bacterial burden, inflammatory response, and tissue destruction. We investigated the association of selected salivary biomarkers with periodontal parameters and validated the use of a novel salivary diagnostic approach, the cumulative risk score (CRS), in detection of periodontitis in subjects with angiographically verified coronary artery disease diagnosis. MATERIALS AND METHODS: The concentrations of matrix metalloproteinase (MMP)-8, interleukin (IL)-1ß, and Porphyromonas gingivalis were analysed from saliva of 493 subjects. The subjects participated in a detailed clinical and radiographic oral examination. The CRS index, combining the three salivary biomarkers, was calculated for each subject. RESULTS: High salivary concentrations of MMP-8, IL-1ß, and P. gingivalis were associated with deepened periodontal pockets and alveolar bone loss, and MMP-8 and IL-1ß with bleeding on probing. The CRS index had a stronger association with moderate to severe periodontitis (OR 6.13; 95% CI 3.11-12.09) than any of the markers alone. CONCLUSIONS: Salivary concentrations of MMP-8, IL-1ß, and P. gingivalis are associated with various clinical and radiographic measures of periodontitis. The CRS index, combining the three salivary biomarkers, is associated with periodontitis more strongly than any of the markers alone regardless of the coronary artery disease status of the patients.

[Comparative analysis of the various instrumental diagnostics methods to the assessment of tooth supporting structure].

The tooth resonance frequency method for periodontal condition diagnostics was compared with apparatus measurement of the tooth mobility in vivo. Tooth natural frequency and tooth mobility were correlated with clinical condition of tooth supporting structure. According to the condition of tooth supporting structure stability zones were indentified. The squared dependence between tooth natural frequency and the value of tooth mobility was revealed. The resonance frequency method is more exact for clinical assessment of periodontal tissues in comparison with instrumental measurement of the tooth mobility.

Correlations between tooth mobility and the Periotest method in periodontally involved teeth.

OBJECTIVE: The aim of this clinical study was to evaluate whether a correlation exists between three-dimensional tooth mobility (TM) and Periotest values for maxillary anterior periodontally involved teeth (pocket depth > 3 mm) before and after periodontal therapy. METHOD AND MATERIALS: Force-related TM was measured in 3 N intervals in 19 participants as they bit down on a load cell. Periotest values were evaluated at reproducible measurement points. Both measurement techniques were performed on maxillary central and lateral incisors and canine teeth before periodontal treatment and after a healing period of 3 months. The Pearson product-moment correlation coefficient was calculated to determine exploratory associations. RESULTS: The comparison between TM and Periotest values indicated "high" and "optimum" correlations for maxillary central incisors before and after periodontal therapy. Lateral incisors exhibited "moderate" and "high" correlations, whereas canines exhibited "weak" and "moderate" correlations before and after periodontal therapy. CONCLUSION: Periotest values may provide valuable information about quantitative metric tooth mobility in periodontally involved teeth. In future investigations, the study design can expand on various dental fields, such as implantology and traumatology.

Solitary myofibroma of the adult mandible: a case report.

A 43-year-old woman presented with a swelling in the anterior mandible appearing radiographically as a well-defined radiolucency causing mobility of the anterior teeth. A clinical diagnosis of a radicular cyst led to removal of the lesion and the associated mobile teeth. Postoperative histopathology led to a diagnosis of intraosseous solitary myofibroma of the mandible. Solitary lesions of myofibroma are exceedingly rare in adult jaws, with only 3 previously documented cases.

[Periodontal tissue spectral assessment].

The periodontal condition was investigated by means of tooth natural frequency assessment. The correlation between tooth natural frequency and mobility was found out. The comparative estimation of percussion and spectral methods for natural frequency assessment revealed the percussion method to be more complicates because the initial acoustic signal is disturbed by external noises and hammer sound. The spectral method allows receiving reliable and reproducible results when using modified two-parametrical periodontometer.