Adjacent tooth migration after maxillary first molar loss in patients with sinus augmentation: A retrospective research.

PURPOSE: The objectives of this study are to: (1) investigate the extent of antagonistic and distal neighboring tooth migration in the maxillary posterior single tooth-missing site during the healing period of bone augmentation and implant surgery; (2) identify factors associated with tooth migration. MATERIALS AND METHODS: One hundred and forty-three cases that lost the maxillary first molar were included, and their CBCT data during the edentulous period were obtained. Dentition models were reconstructed from CBCT, and superimpositions were performed, followed by measuring migration distances and calculating migration rates of antagonistic and distal neighboring teeth. Factors were analyzed using multivariate generalized estimating equations (GEE). RESULTS: The mean migration distances were 208 ± 137 µm and 403 ± 605 µm for antagonistic teeth and distal teeth, and the mean migration rates were 26.8 ± 21.2 µm/month and 48.5 ± 76.7 µm/month, respectively. One hundred and nineteen out of 143 distal neighboring teeth migrated toward the edentulous site, and all antagonistic teeth migrated occlusally. Occlusal contact loss and chronic apical periodontitis both significantly accelerated antagonistic tooth migration (p < 0.05), the latter also accelerated distal tooth migration (p < 0.05). Besides, the displacement of the distal teeth was somewhat accelerated by the impacted adjacent third molar and root protrusion into the sinus. CONCLUSIONS: The neighboring teeth tend to migrate toward the edentulous gap in the maxillary posterior region. Occlusal contact loss and chronic apical periodontitis are two significant risk factors for accelerating antagonistic tooth migration, and for distal teeth, chronic apical periodontitis is the risk factor. The impacted adjacent third molar and root protrusion into the sinus are also potential risk factors for accelerating the migration of the maxillary distal tooth. Thus, to prevent maxillary edentulous gap reduction, the factors mentioned above should be taken into consideration when planning treatment flow.

Pathological tooth migration-spontaneous correction of diastema after surgical periodontal therapy: a case report.

A common consequence of moderate to extreme periodontitis is pathologic migration. This denotes tooth movement when the periodontal disease interjects the equilibrium among the elements that preserve physiological tooth position. The balancing factors can migrate the teeth in any direction. The etiology of pathological migration tends to be multifactorial, thus achieving early diagnosis is imperative, which will ultimately lead to the prompt removal of the etiological factors while avoiding severe bone destruction. In this case maxillary central incisors had diastema due to pathological migration with mobility grade I in maxillary left central incisor. Many cases of moderate to severe pathological migration need a suitable, interdisciplinary approach. Nevertheless, since it is possible to detect mild cases of Pathological tooth migration (PTM) at an early stage, spontaneous correction of migrated teeth can be accomplished by periodontal therapy alone. Regardless of the treatment selected, maintenance of stable results should be considered as an aim of treatment.

Comprehensive treatment for severe periodontitis with pathologic tooth migration-related bimaxillary protrusion: A case report with 3-year follow-up.

BACKGROUND AND OVERVIEW: Patients with severe periodontitis often experience pathologic tooth migration (PTM), which impairs esthetics and leads to occlusal disharmony (for example, premature contacts and traumatic occlusion) that can further exacerbate periodontitis. The authors describe a patient who exhibited severe periodontitis with PTM-related bimaxillary protrusion. This report includes 3-year clinical outcomes after periodontal regenerative therapy, implant-anchored orthodontic therapy, and implant prosthodontics intended to achieve both functional and esthetic improvements. CASE DESCRIPTION: A 63-year-old woman sought treatment with the chief complaint of maxillary anterior tooth mobility. Clinical examination revealed excessive tooth mobility, deep periodontal pockets, and infrabony defects in all teeth. All teeth exhibited PTM; the mandibular anterior teeth exhibited marked protrusion caused by the progression of periodontitis. After initial periodontal therapy, periodontal regenerative therapy was performed in all molar regions. At 6 and 9 months postoperatively, comprehensive orthodontic treatment was initiated for the mandible and maxilla, respectively, using orthodontic anchorage devices to achieve acceptable functional occlusion. After orthodontic treatment, staged guided bone regeneration was performed and dental implants were placed in the severely resorbed maxillary anterior ridge. This comprehensive treatment yielded favorable periodontal conditions, stable occlusion, and good esthetic outcomes. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Favorable esthetics, stable occlusion, and highly cleansable periodontal tissues were achieved with well-planned interdisciplinary and comprehensive treatment, although the patient had severe periodontitis and PTM-related bimaxillary protrusion.

Factors affecting root migration after coronectomy of the mandibular third molar.

ABSTRACT: Nerve injury especially inferior alveolar nerve (IAN) is the one of the complications that occur when the mandibular third molar (M3) is extracted and in case of high risk patients, coronectomy might be an alternative to tooth extraction. The purpose of this retrospective study was to analyze root migration and its influencing factors at 6 months after coronectomy in both 2- and 3-dimensions using periapical view and cone-beam computed tomography (CBCT). We analyzed 33 cases of root remnant after coronectomy and measured the amount of migration in CBCT. The following factors that could possibly affect root migration were also analyzed: age, gender, number of M3 roots, shape of M3s, Pell, and Gregory classification, mesiodistal (MD) angulation, buccolingual (BL) angulation, contact point with the second molar, root curvature, and complete removal of the coronal portion. Migration of greater than 2 mm was found in 64% of the roots in the 2-dimensional (2D) analysis, and the average root migration was 4.11 mm in the 3-dimensional (3D) analysis. The factors affecting migration were the root morphology, complete removal of the coronal portion, impaction depth, and MD angulation in the 2D analysis, and MD and BL angulation in the 3D analysis. Ensuring sufficient space for root migration especially considering angulation, depth and complete removal of the coronal portion might be important factors after coronectomy of the M3. Root remnant after coronectomy of M3 may migrate in young patients who has sufficient empty coronal space and this may reduce the nerve damage by the separation of IAN and M3.

A retrospective study of orthodontic treatment on anterior tooth displacement caused by periodontal disease.

ABSTRACT: This retrospective study aimed to explore the effect of orthodontic treatment (ODT) on anterior tooth displacement (ATD) caused by periodontal disease (PD).A total of 72 patients were selected and were divided into a control group (n = 36) and an experimental group (n = 36). Patients in both groups received conventional periodontal treatment. In addition, patients in the experimental group also received ODT. Outcomes include probing depth, percentage of bleeding sites, clinical attachment loss, clinical crown length, tooth root length, and periodontal tissue of the affected tooth (alveolar bone height, periodontal pocket depth, bleeding index).After treatment, the patients in the experimental group achieved more improvements in probing depth (P < .01), percentage of bleeding sites (P < .01), clinical attachment loss (P < .01), clinical crown length (P = .04), and periodontal tissue of the affected tooth (periodontal pocket depth (P < .01), and bleeding index (P < .01)), than those of patients in the control group.This study suggests that ODT is beneficial for ATD caused by PD. Future studies are still needed to verify the findings of this study.

Interproximal Open Contacts Between Implant Restorations and Adjacent Teeth. Prevalence - Causes - Possible Solutions.

PURPOSE: To present the prevalence and contributing factors of interproximal contact loss (ICL) between implant restorations and adjacent teeth, and to provide recommendations for possible prevention and treatment of this complication. MATERIALS AND METHODS: The authors explored the dental literature on PubMed on ICL between implants and adjacent teeth, interproximal contacts, open contacts, teeth migration causes, facial bone formation, and facial bone changes. RESULTS: ICL between fixed implant prostheses and adjacent teeth has been reported. A literature search revealed 7 studies showing a high prevalence of ICL between implant prostheses and adjacent teeth. The literature indicates that this ICL is greater in the mesial aspect in comparison with the distal. As identified by the literature review, ICL in the maxilla ranged between 18% and 66% versus 37% to 54% in the mandible. ICL might occur as early as 3 months after prosthetic treatment. The literature review documented possible tooth migration causes, crown-related causes, and bone formation/growth-related causes of ICL. CONCLUSIONS: ICL is a common multifactorial implant complication. The clinical condition will dictate if the implant crown needs to be modified/replaced or the natural tooth needs to be restored to reestablish interproximal contact between an implant prosthesis and adjacent tooth. Periodic evaluations of interproximal contacts between implant restorations and the adjacent teeth and the use of screw-retained restorations due to ease of removal is recommended to diagnose and mitigate the problem. An orthodontic retainer or occlusal guard may help prevent ICL between the implant restoration and the adjacent tooth.

Tooth Movement Associated With CPAP Therapy.

ABSTRACT: We report on a rarely documented side effect-tooth movement-associated with positive airway pressure therapy. A 64-year-old woman presented to an orthodontic practice for evaluation of unexplained tooth movement and spaces opening between her anterior teeth. The patient recently received a diagnosis of mild obstructive sleep apnea, for which she had been using continuous positive airway pressure (CPAP) delivered by a nasal pillows interface for the past 18 months. Follow-up questioning revealed that shifting of the teeth was first noticed in the months following the initiation of CPAP and the result of forward thrusting of the tongue during use. Following 12 months of orthodontic treatment, the malocclusion was corrected and teeth returned to their pretreatment positions. Unwanted tooth movement, although a minor sequela, can have a meaningful effect on quality of life. With improved awareness of this issue, the patient experience and ultimately adherence with CPAP treatment can be improved.

Radiographic prognostic factors determining spontaneous space closure after loss of the permanent first molar.

INTRODUCTION: Permanent first molars (PFM) with a poor prognosis are routinely extracted in children throughout the United Kingdom. National guidelines suggest that to achieve spontaneous closure for the mandibular arch, the PFM should be extracted at 8 to 10 years of age, during bifurcation formation of the second molar. The literature is of limited quality and has suggested alternative variables that may be associated with successful space closure. Our aim was to investigate the radiographic prognostic factors associated with space closure after extraction of PFM. Two objectives of the research are reported in this article: to determine factors that might predict space closure of the second molar after extraction of the PFM, and to develop a tool kit to aid clinical decision making. METHODS: We assessed 148 maxillary and 153 mandibular PFM extracted from 81 participants retrospectively. Dental age, second molar developmental stage, second premolar and second molar angulations, and presence or absence of the third molar were assessed on the preextraction orthopantomograms. Outcome was assessed via visual examination, study models, or radiographs. RESULTS: Closure occurred in 89.9% of the maxillary and 49.0% of the mandibular quadrants. Dental age was statistically, but not clinically, significant in the maxillary arch (P <0.05). For the mandibular arch, presence or absence of the third molar and second molar angulation were statistically and clinically significant (P <0.01 and P <0.05, respectively). A tool kit was developed in relation to the mandibular arch variables. CONCLUSIONS: These findings are contradictory to the Royal College of Surgeons guidelines and suggest that the presence of the third molar and a mesially angulated second molar are favorable for space closure. The developed tool kit requires further validity testing.

Extra-Gingival Pyogenic Granuloma Displacing Teeth.

Pyogenic granuloma is a common cause of growth of soft tissue in the oral cavity, especially in the gingiva. It is mainly associated with local and chronic irritants besides hormonal changes during pregnancy. Here, the authors present an unusual patient of an extra-gingival pyogenic granuloma with large dimensions and displacing teeth arising in a male patient. This is an interesting patient to be reported due to its exacerbated and atypical clinical features.

Impacted and transmigrant mandibular canines incidence, aetiology, and treatment: a systematic review.

Background: The incidence of impacted and transmigrant mandibular canines in the mandible is not as high as that in the maxilla; consequently, it is more difficult to find clinical guidelines derived from sound studies based on large patient samples. Objectives: The aim of this systematic review was to summarize currently available data pertaining to the incidence and aetiology of impacted and transmigrant mandibular canines and the success rates of different treatment strategies. Methods: This review was registered with PROSPERO (CRD42014006175) and was conducted using PRISMA and CRD (Centre for Reviews and Dissemination, University of York) statement. A computerized search of studies published up to February 2016 was conducted using the following databases: PubMed, Cochrane Central Register of Controlled Clinical trials, ISI Web of Knowledge, and Scopus. To identify any relevant publications not included in this list, we manually searched the references lists of the selected articles. The Newcastle-Ottawa Scale quality assessment tool was utilized to classify the included articles. Results: In total, 630 articles were identified after the removal of duplicates. A total of 13 studies published between 2001 and 2015 met all the eligibility criteria and were included for the final analysis. The sample size in these studies ranged from 14 to 112873 teeth, while their methodological quality ranged from low to medium. Conclusions: According to the findings from our review, the incidence of canine impaction in the mandible ranges from 0.92 to 5.1 per cent, while that of canine transmigration ranges from 0.1 to 0.31 per cent. Various etiologies may play a role, including odontomes (up to 20 per cent) and lateral incisor anomalies (16 per cent). Surgical extraction (89 per cent in some studies) and orthodontic traction (20-32 per cent) are the most commonly used treatment strategies, with the latter showing a failure rate of 17 per cent in two studies.

Prevalence of Interproximal Open Contacts Between Single-Implant Restorations and Adjacent Teeth.

PURPOSE: The aim of this study was to determine the prevalence of interproximal open contacts between singleimplant prostheses and adjacent teeth, as well as to provide guidelines to prevent interproximal contact loss (ICL). MATERIALS AND METHODS: This was a retrospective, cross-sectional study. One hundred twenty-eight patients (174 single-implant restorations) from Columbia University College of Dental Medicine and a private faculty clinic with a single-implant restoration in the posterior or anterior region were selected to participate in this study. Patients between the ages of 19 and 91, both male and female, were included in this pilot study. The period of evaluation after implant restoration insertion was between 3 months and 11 years. Participants were seen at random intervals to identify ICL. Interproximal contacts were evaluated with 0.07-mm-thickness dental floss and visual confirmation. Contact was considered open if floss passed without resistance from adjacent teeth. RESULTS: The results of this study revealed a significant percentage of ICL, 52.8%, between single-implant restorations and adjacent teeth; 78.2% were identified on the mesial surfaces and 21.8% on the distal surfaces. ICL was noted in 57.9% of the maxillary implant restorations and 49% of the mandibular implant restorations. Eight implant restorations in women demonstrated mesial and distal openings. Among the patients with ICL, a significant percentage, 40%, were aware of the presence of ICL and food impaction. CONCLUSION: In this study, 52.8% of implant restorations demonstrated ICL. This result dictates that ICL should be included as a prosthetic implant complication. The high prevalence of ICL is justification for proper informed consent, and associated clinical problems need to be addressed. Possible causative factors were presented, but further research is necessary to identify the causative factors for ICL. The authors suggest the use of an Essix retainer to prevent ICL between single-implant restorations and adjacent teeth. Evaluation of interproximal contact between implant restorations and the adjacent teeth should be periodically monitored.

AXIAL MODIFICATIONS OF PERMANENT LOWER MOLARS AFTER PREMATURE LOSSES OF TEMPORARY MOLARS.

AIM: The aim of our study was to determine the impact of premature loss of temporary lower molars upon the longitudinal axis of the first and second permanent molars. MATERIAL AND METHODS: The study groups included 61 patients, 6-9 year olds with premature loss of primary molars and a control group of 24 patients with intact temporary teeth. We evaluated the angle between longitudinal axis of first and second lower permanent molars and occlusal plane. RESULTS: It was observed that premature loss of lower second deciduous molar modifies more the vertical axis of first and second permanent molars than the premature loss of first lower primary molar. Reducing space occurs mainly through mesial inclination of molars that separates the edentulous breach. Temporary loss of both lower first molars on the same quadrant causes an accelerated eruption of both premolars increasing the prevalence of eruption sequence: "4-5-3-7". CONCLUSIONS: The preservation of the occlusal morpho-functional complex using space maintainers mainly when the premature loss of the second primary molars occurs is the best interceptive treatment option.

Open contacts adjacent to dental implant restorations: Etiology, incidence, consequences, and correction.

BACKGROUND: The aim of this investigation was to evaluate the potential causes, clinical significance, and treatment of open contacts between dental implant restorations and adjacent natural teeth. TYPES OF STUDIES REVIEWED: The authors searched the dental literature for clinical trials in humans that addressed the incidence of open contacts that develop after implant restorations are placed next to teeth. RESULTS: The authors found 5 studies in which the investigators addressed the incidence of open contacts after implant restorations are inserted next to teeth. Results from these studies indicated that an interproximal gap developed 34% to 66% of the time after an implant restoration was inserted next to a natural tooth. This event occurred as early as 3 months after prosthetic rehabilitation, usually on the mesial aspect of a restoration. CONCLUSIONS: The occurrence of an interproximal separation next to an implant restoration was greater than anticipated. It appears that force vectors cause tooth movement and an implant functions like an ankylosed tooth. PRACTICAL IMPLICATIONS: Clinicians should inform patients of the potential to develop interproximal gaps adjacent to implant restorations, which may require repair or replacement of implant crowns or rehabilitation of adjacent teeth. Furthermore, steps should be taken to check the continuity of the arch periodically. If the clinician detects an open contact, it is prudent to monitor for signs or symptoms of pathosis so that prosthetic repair of the gap can be initiated, if needed. These problems could add to treatment costs and decrease overall patient satisfaction related to implant treatment.

Orthodontic decompensation in skeletal Class III malocclusion: redefining the amount of movement assessed by Cone-Beam Computed Tomography.

INTRODUCTION: Cone-Beam Computed Tomography (CBCT) is essential for tridimensional planning of orthognathic surgery, as it allows visualization and evaluation of bone structures and mineralized tissues. Tomographic slices allow evaluation of tooth inclination and individualization of movement performed during preoperative decompensation. The aim of this paper was to assess maxillary and mandibular incisors inclination pre and post orthodontic decompensation in skeletal Class III malocclusion. METHODS: The study was conducted on six individuals with skeletal Class III malocclusion, surgically treated, who had Cone-Beam Computed Tomographic scans obtained before and after orthodontic decompensation. On multiplanar reconstruction view, tomographic slices (axial, coronal and sagittal) were obtained on the long axis of each incisor. The sagittal slice was used for measurement taking, whereas the references used to assess tooth inclination were the long axis of maxillary teeth in relation to the palatal plane and the long axis of mandibular teeth in relation to the mandibular plane. RESULTS: There was significant variation in the inclination of incisors before and after orthodontic decompensation. This change was of greater magnitude in the mandibular arch, evidencing that natural compensation is more effective in this arch, thereby requiring more intensive decompensation. CONCLUSION: When routinely performed, the protocols of decompensation treatment in surgical individuals often result in intensive movements, which should be reevaluated, since the extent of movement predisposes to reduction in bone attachment levels and root length.

Orthodontic decompensation in skeletal Class III malocclusion: redefining the amount of movement assessed by Cone-Beam Computed Tomography

Introduction:Cone-Beam Computed Tomography (CBCT) is essential for tridimensional planning of orthognathic surgery, as it allows visualization and evaluation of bone structures and mineralized tissues. Tomographic slices allow evaluation of tooth inclination and individualization of movement performed during preoperative decompensation. The aim of this paper was to assess maxillary and mandibular incisors inclination pre and post orthodontic decompensation in skeletal Class III malocclusion.Methods:The study was conducted on six individuals with skeletal Class III malocclusion, surgically treated, who had Cone-Beam Computed Tomographic scans obtained before and after orthodontic decompensation. On multiplanar reconstruction view, tomographic slices (axial, coronal and sagittal) were obtained on the long axis of each incisor. The sagittal slice was used for measurement taking, whereas the references used to assess tooth inclination were the long axis of maxillary teeth in relation to the palatal plane and the long axis of mandibular teeth in relation to the mandibular plane.Results:There was significant variation in the inclination of incisors before and after orthodontic decompensation. This change was of greater magnitude in the mandibular arch, evidencing that natural compensation is more effective in this arch, thereby requiring more intensive decompensation.Conclusion:When routinely performed, the protocols of decompensation treatment in surgical individuals often result in intensive movements, which should be reevaluated, since the extent of movement predisposes to reduction in bone attachment levels and root length.

Introdução: a tomografia computadorizada de feixe cônico (TCFC) é essencial para o planejamento tridimensional de cirurgias ortognáticas, pois permite a visualização e avaliação de estruturas ósseas e tecidos mineralizados. Os cortes tomográficos permitem avaliar a inclinação dos dentes e individualizar o movimento realizado durante a descompensação dentária.Objetivo: o objetivo do presente estudo foi avaliar a inclinação dos incisivos superiores e inferiores antes e depois da descompensação ortodôntica da má oclusão de Classe III esquelética.Métodos:o estudo foi realizado em seis indivíduos com má oclusão de Classe III esquelética que passaram por tratamento cirúrgico e apresentaram exames de TCFC feitos antes e depois da descompensação ortodôntica. A reconstrução multiplanar foi feita a partir dos cortes tomográficos (axial, coronal e sagital) adquiridos no eixo longitudinal de cada incisivo. O corte sagital foi usado para a realização de medições, e as referências usadas para avaliar a inclinação dentária foram o eixo longitudinal dos dentes superiores em relação ao plano palatino e o eixo longitudinal dos dentes inferiores em relação ao plano mandibular.Resultados:houve uma variação significativa entre a inclinação dos incisivos antes e depois da descompensação ortodôntica. A alteração foi maior na arcada inferior, evidenciando que a compensação natural é mais efetiva nessa arcada, o que exige uma descompensação mais extensa.Conclusão:quando realizados rotineiramente, os protocolos de tratamento para descompensação em pacientes cirúrgicos geralmente resultam em movimentação extensa, que deve ser reavaliada, já que a extensão do movimento predispõe à perda de inserção e à redução do comprimento da raiz.

Orthodontic treatment of a mandibular incisor fenestration resulting from a broken retainer.

This article describes the orthodontic relapse with mandibular incisor fenestration in a 36-year-old man who had undergone orthodontic treatment 21 years previously. The patient reported that his mandibular 3 × 3 bonded retainer had been partially debonded and broken 4 years earlier. The mandibular left lateral incisor remained bonded to the retainer and received the entire load of the incisors; consequently, there was extreme labial movement of the root, resulting in dental avulsion. As part of the treatment, the root was repositioned lingually using a titanium-molybdenum segmented archwire for 8 months, followed by endodontic treatment, an apicoectomy, and 4 months of alignment and leveling of both arches. The treatment outcomes were excellent, and the tooth remained stable, with good integrity of the mesial, distal, and lingual alveolar bones and periodontal ligament. The 1-year follow-up showed good stability of the results.

The influence of premature loss of temporary upper molars on permanent molars.

AIM: Premature loss of primary molars due to dental caries and their complications has been associated with space loss and eruptive difficulties, especially when the loss occurs early. The aim of our study was to determine the impact of premature loss of temporary upper molars upon the longitudinal axis of the first and second upper permanent molar. MATERIAL AND METHODS: The study group included 64 patients 6-9 years old with premature loss of primary molars and a control group of 48 patients with intact temporary teeth. It was evaluated the angle between longitudinal axis of first and second upper permanent molars and occlusal plane. The sofware used is Easy Dent 4 Viewer®.The data were analyzed by using the Statistical Package for the Social Sciences (version 20.0; SPSS, Chicago, III). RESULTS: It was observed that premature loss of upper second deciduous molars modifies greater the vertical axis of the permanent molars than the premature loss of first upper primary molar. First upper primary molar loss cause an acceleration eruption of first premolar, which will produce a distal inclintion of the both permanent molars. CONCLUSIONS: The use of space maintainers after premature loss of the second upper temporary molar is a last solution in preventing tridimensional lesions in the dental arch and occlusion.

Follow-up problems with fixed appliances in pediatric dentistry.

Fixed appliances are commonly used in managing early orthodontic problems. Despite their widespread use, they have the potential to impinge on the soft tissues, interfere with the eruption of adjacent teeth and become dislodged or broken. These two case reports present the poor outcomes of fixed appliance treatments if the patient fails to attend follow-up appointments. A successful outcome of treatment with fixed appliances depends upon proper patient selection and the communication skills of the dentist to help patients/parents understand the importance of regular checkups.