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

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

The risk of tooth root injuries using cortical screws for intermaxillary fixation and osteosynthesis plates - A retrospective analysis.

Intermaxillary fixation (IMF) and osteosynthesis plates (OP) are widely used for the non-surgical and surgical treatment of mandible and condyle fractures. The aim of this retrospective study was to analyze the frequency of tooth root injuries by IMF and OP screws. Electronic patient reports (2004-2013) were screened for patients treated with either IMF screws and/or OP in the Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Germany. The frequency and the position of endangered and injured teeth were analyzed by orthopantomogram (OPTG) and cone beam computer tomography (CBCT). Next, possible predictive factors for tooth root injuries, namely interdental- and crestal distance, screw length and distance between tooth root and screw were evaluated. Further, the accuracy of OPTG vs. CBCT concerning the diagnosis of tooth root injuries was analyzed. Three-hundred sixty-six patients were included and 3388 teeth were defined as endangered by IMF- and OP screws. Overall, 16 injured teeth (0.5%) in 13 patients (3.55%) were detected. Nine injuries (56.3%) were caused by IMF- and seven injuries (43.8%) by OP screws. Three teeth were non-vital, one tooth had to be extracted. No correlation between the predictive factors crestal distance, screw length and tooth root injuries was found. If tooth injury occurred, a significant correlation between the interdental distance and the distance between tooth root and screw was found (κ = 0.48; p < 0,0001). Comparison between OPTG vs. CBCT demonstrated that many of the injuries that were seen in the OPTG (n = 230) could not be verified in the CBCT scans (n = 16) (κ = 0.12). To conclude, screws for IMF and OP can be considered as a safe procedure concerning the risk of tooth root injuries.

Proteoglycans and dental biology: the first review.

Proteoglycans (PGs) are proteins which are vital components located in the extracellular matrix, cell surface or intracellular granules. They are linked to polysaccharides called glycosaminoglycans. There are several aspects associated with PGs, such as cell signaling and organization of the extracellular matrix (ECM), making them pivotal participants in many tissue compositions. In teeth, PGs also play an essential role, as many of its components have elaborate ECM structures. However, lack of information on how PGs constitute the various tissues of the tooth and on their roles makes it difficult to elicit the major importance associated with this class of proteins. This review seeks to detail how proteoglycans are involved in many aspects of tooth organization and development, and as far as we are concerned, this has not been performed yet. We have also exemplified the participation of small leucine-rich proteoglycans, a special class of PGs seen in dental trauma cases.

Intrusive Dislocation in Permanent Teeth: Review of Literature and Clinical Case Report / Luxación Intrusiva en Dientes Permanentes: Revisión de Literatura e Informe de Caso Clínico

ABSTRACT: Intrusive dislocation is an unusual and severe trauma, where the tooth is displaced axially into the alveolar bone, causing damage to the periodontal and pulpal tissues. The objective was to report a case of intrusive dislocation on a right maxillary central incisor of a 12-year-old patient, where the proposed treatment was immediate surgical repositioning. Clinical and radiographic examination revealed partial tooth intrusion and complete root formation. The impacted tooth was surgically repositioned and immobilized. Subsequently, the endodontic treatment of the tooth associated with intracanal medication was performed. After 10 months of successive calcium hydroxide changes, the root canal system was filled. Clinical-radiographic follow-ups were performed over 5 years and 7 months, revealing discrete root resorption. It was concluded that immediate surgical repositioning, associated with adequate root canal therapy may be an effective therapeutic option in cases of intrusive dislocation of permanent teeth.

RESUMEN: La luxación intrusiva es un trauma inusual y severo, en el que el diente se desplaza axialmente hacia el hueso alveolar, causando daño a los tejidos periodontales y pulpares. El objetivo fue informar un caso de luxación intrusiva en un incisivo central superior derecho de un paciente de 12 años, donde el tratamiento propuesto fue el reposicionamiento quirúrgico inmediato. El examen clínico y radiográfico reveló una intrusión dental parcial y la formación completa de la raíz. El diente afectado fue reposicionado e inmovilizado quirúrgicamente. Posteriormente, se realizó el tratamiento endodóntico del diente asociado con la medicación intracanal. Después de 10 meses de sucesivos cambios de hidróxido de calcio, se llenó el sistema de conductos radiculares. Los seguimientos clínico-radiográficos se realizaron durante 5 años y 7 meses, revelando la resorción discreta de la raíz. Se concluyó que el reposicionamiento quirúrgico inmediato, asociado con la terapia adecuada del conducto radicular, puede ser una opción terapéutica efectiva en casos de luxación intrusiva de dientes permanentes.

O impacto positivo na promoção de saúde bucal em jovens adolescentes / The Positive Impact on Oral Health Promotion in Young Adolescents

Introdução: o conhecimento da importância dos cuidados em saúde bucal é deficiente em âmbito escolar, ressalta-se que jovens capacitados, partilham o aprendizado assumindo papel importante na sociedade. Objetivos: capacitação de estudantes para difusão do conhecimento sobre cuidados em saúde bucal. Os temas de higienização dentária/prótese dentária e/ou implantossuportadadas e manejo após o traumatismo dentário foram abordados em escola pública. Métodos: Inicialmente, houve avaliação do conhecimento prévio dos alunos (n=25) por meio de questionários de saúde bucal, os questionários (GOHAI, higienização oral e de prótese dentária e manejo de traumatismo dentário) foram aplicados na sala de aula com supervisão. Em um próximo momento houve o treinamento dos discentes por palestras e material didático. Finalmente, após 2 meses do ciclo de formação os questionários foram aplicados novamente. Os dados foram tabulados e e análise estatística considerou o valor significativo para p<0,05, a fim de verificar o conhecimento adquirido durante o treinamento de todos os estudantes. Resultados: Identificou se pós-oficina que os jovens estavam mais satisfeitos com a aparência da boca (p<0,05). Nos questionários de higienização de próteses dentárias houve a conscientização do tempo para substituição das mesmas. Para o reimplante dentário, houve significativa percepção dos alunos como possibilidade de terapia real (p=0,016), após a realização das oficinas. Conclusão: com base nos dados, a proposta de promoção em saúde bucal para os adolescentes foi eficiente, e mais eventos (oficinas) com esta finalidade devem ser realizados em escolas de ensino médio.

Introduction: the knowledge of the importance of oral health care is deficient in the school environment, it is emphasized that empowered young people share learning, assuming an important role in society. Objectives: This study aimed to enable the training of students to disseminate knowledge about oral health care. The subjects of dental hygiene / dental prosthesis and / or implant supported and management after dental trauma were addressed in a public school. Methods: Initially, the students' prior knowledge (n = 25) was assessed through oral health questionnaires, the questionnaires (GOHAI, oral and dental hygiene and dental trauma management) were applied in the classroom with supervision. In a next moment there was the training of the students by lectures and didactic material. Finally, after 2 months of the training cycle, the questionnaires were applied again. Data were tabulated and statistical analysis considered the value significant for p students. Results: It was identified after the workshop that young people were more satisfied with the appearance of the mouth (p<0,05).In the dental prosthesis cleaning questionnaires, there was a time awareness for their replacement. For dental replantation, there was significant perception of students as a possibility of real therapy (p = 0.016), after the workshops. Conclusion: Based on the data, the proposal for oral health promotion for adolescents was efficient, and more events (workshops) for this purpose should be held in high schools.

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

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

Oral surgery II: Part 1. Acute management of dentoalveolar trauma.

The aesthetics of the mouth are important in determining overall facial attractiveness. People with a relatively normal dental appearance are perceived as more attractive, more intelligent and more desirable as friends. Although the oral region comprises only 1% of the body area it accounts for 5% of all bodily injuries, and of facial injuries, dental injuries are the most common. A US survey among people aged 6-50 years showed that 1 in 4 had evidence of dental trauma.

Manejo estético de los tejidos en implantes postextracción en el sector anterior. A propósito de un caso clínico / Aesthetic management of tissues in postextraction implants in the anterior sector. A clinical case report

La excelencia estética en los implantes del sector anterior sigue siendo un reto para los profesionales, además de una exigencia de nuestros pacientes. Para ello, un correcto diagnóstico y la utilización de técnicas para la preservación de los tejidos duros y blandos, una extracción meticulosa, el mantenimiento de los perfiles de emergencia mediante el uso de injertos de tejido conectivo y provisionales inmediatos, son fundamentales para conseguir una estética adecuada y la armonía de los tejidos periimplantarios. Se presenta el caso de una mujer de 57 años que refiere haber sufrido un traumatismo en el incisivo central superior izquierdo. El examen clínico y radiológico reveló una fractura horizontal a nivel del tercio coronal de la raíz sin pérdida ósea. Por lo que se planificó la colocación de un implante postextracción. Para la preservación de los tejidos se realizó un relleno con un sustituto óseo, un injerto de tejido conectivo del paladar tunelizado por vestibular y para el mantenimiento de la arquitectura gingival se llevó a cabo una provisionalización inmediata con su propia corona (AU)

Aesthetics excellency outcomes in anterior sector implants still is a challenge for professionals and is also the patient requirement. To ensure this, a correct diagnostic, the use of techniques to preserve the soft and hard tissues, a meticulous extraction, the use of connective tissues graft to maintain the emergence profiles and use immediate provisionalization are essential to keep the esthetics armory of periimplant tissues. In a presented case of a 57 year old woman, with an upper central incisor injury, the clinical and radiological examinations show a horizontal fracture in the upper third without any bone lost. An immediate implant was planned, bone substitute was used to tissue preservation, and a tunneling technique with a connective tissue graft taken from palatal. her own crown was use to keep the gingival architecture as an immediate restoration (AU)

Papilla Reformation at Single-Tooth Implant Sites Adjacent to Teeth with Severely Compromised Periodontal Support.

Reformation of the lost interdental papilla remains one of the most challenging goals for clinicians. When a single tooth is replaced with an implant, the papilla between the tooth and the implant can often be maintained or predictably reformed as long as the adjacent tooth's periodontal attachment and bone are preserved. However, if the periodontal support is compromised on the neighboring natural tooth, the papilla will often be deficient or missing. The cases presented herein demonstrate long-term follow-up of successful reformation of periodontal/peri-implant tissue contours, including reconstruction of lost interproximal bone and papilla at periodontally compromised sites using a combined hard and soft tissue surgical approach.

Prognosis of teeth in the line of jaw fractures.

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

Tooth autotransplantation in the anterior maxilla and mandible: retrospective results in young patients.

OBJECTIVE: This retrospective study evaluated survival rates, prognosis, and overall success of autotransplanted teeth in young patients missing anterior teeth as a result of trauma, agenesis, or developmental disturbances. STUDY DESIGN: Retrospective data were collected from the medical records of patients who had undergone tooth autotransplantations to anterior sites between January 2001 and December 2012. Clinical variables, such as gender, age, surgical indications, donor and recipient sites, type of anesthetics, bone augmentation, and complications during follow-up, were assessed. RESULTS: A total of 59 donor teeth in 46 patients (30 boys and 16 girls; average age 12.15 years) were autotransplanted to the anterior region of the maxilla and mandible. After a mean follow-up period of 17.35 months (range 10-61 months), all of the transplanted teeth remained in situ with no complications. CONCLUSIONS: This study supports the autotransplantation of teeth to the anterior alveolus as a viable option suitable in growing patients with missing anterior teeth.

Fracture Strength After Fatigue Loading of Lithium Disilicate Pressed Zirconia Crowns.

PURPOSE: The aim of this study was to evaluate the fracture resistance of fatigued lithium disilicate pressed zirconia crowns versus other ceramic crowns. MATERIALS AND METHODS: Lithium disilicate pressed zirconia, fluorapatite pressed zirconia, monolithic lithium disilicate, and monolithic zirconia crowns were fabricated. Cyclic and static loadings were applied to the mesiobuccal cusp tip after thermocycling and fracture strengths were recorded. RESULTS: Fatigued lithium disilicate pressed zirconia crowns were found to have a fracture resistance of 9,117.81 ± 727.04 N, compared with 9,240.61 ± 887.21 N for monolithic zirconia crowns, 3,030.18 ± 1,505.83 N for fluorapatite pressed zirconia crowns, and 4,173.94 ± 877.46 N for monolithic lithium disilicate crowns (P = .001). CONCLUSION: This in vitro study shows that fatigued lithium disilicate pressed zirconia and monolithic zirconia crowns have better fracture resistance than fluorapatite pressed zirconia and monolithic lithium disilicate crowns.

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

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

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

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

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

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

Analysis of the rate of maturogenesis of a traumatized Cvek's stage 3 anterior tooth treated with platelet-rich fibrin as a regenerative tool using three-dimensional cone-beam computed tomography: an original case report.

Regenerative endodontic procedures are biologically based procedures which deal with the regeneration of pulp-like tissue, more idealistically the pulp-dentin complex. The regeneration of this pulp-dentin complex in an infected necrotic tooth with an open apex is possible only when the canal is effectively disinfected. Though there are various procedures for treating open apex ranging from Ca(OH) 2 apexification, mineral trioxide aggregate apexification and surgical approach, regeneration of tissues has always taken superior hand over the repair of tissues. The mechanics behind the regenerative endodontic procedures is that despite the tooth being necrotic, some pulp tissue can survive apically which under favorable conditions proliferate to aid in the process of regeneration. In the past 2 decades, an increased understanding of the physiological roles of platelets in wound healing and after tissue injury has led to the idea of using platelets as therapeutic tools in the field regenerative endodontics. In the present case report with an open apex, high sterilization protocol is followed using triple antibiotic paste as intra-canal medicament, followed which platelet rich fibrin is used as the regenerative material of choice. Over an 18-month follow-up period, clinically patient is asymptomatic and radiographically there is complete regression of the periapical lesion and initiation of the root end closure.

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

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