Oral rehabilitation considerations for partially edentulous periodontal patients

Traditional tooth-supported and implant-supported fixed/removable restorations are currently used to replace teeth lost due to periodontal disease. This article reviews the existing literature for oral rehabilitation of partially edentulous periodontal patients with various designs of removable dental prosthesis (RDP), fixed dental prosthesis (FDP) and implant-supported single crown (SC), by addressing their (a) general features, (b) survival and complication rates, along with considerations for treatment planning in periodontal patients, and (c) preference by patients. To answer these issues, relevant articles were searched and critically analyzed, and their data were extracted. Data reviewed indicated that despite many advantages, implant-supported restorations have higher complication rates than tooth-supported restorations. Systematic reviews on conventional RDPs are lacking, but existing literature reviews provide limited evidence suggesting the use of RDPs with design modifications along with strict periodontal care in periodontal patients. Numerous systematic reviews on conventional FDPs and implant-supported restorations provide a moderate level of evidence favoring their survival in periodontal patients; however, for long-term success of these restorations, the patient's periodontal condition needs to be stabilized. In terms of patient preference, no restoration is superior, as they all are governed by their cost, advantages, and disadvantages. Thus, in the wake of existing weak evidence for prosthodontic rehabilitation of periodontal patients by these restorations (especially, conventional RDPs and for FDPs and SCs in implant-supported restorations), longitudinal studies with standardized treatment protocol and methodology are needed to evaluate and compare tooth-supported and implant-supported restorations in periodontal patients with regard to survival rates, cost, maintenance, and patient-centered outcomes.     

Failures and complications in patients with birth defects restored with fixed dental prostheses and single crowns on teeth and/or implants

Objectives: To assess retrospectively, over at least 5 years, the incidences of technical and biological complications and failures in young adult patients with birth defects affecting the formation of teeth. Material and methods: All insurance cases with a birth defect that had crowns and fixed dental prostheses (FDPs) inserted more than 5 years ago were contacted and asked to participate in a reexamination. Results: The median age of the patients was 19.3 years (range 16.6–24.7 years) when prosthetic treatment was initiated. Over the median observation period of 15.7 years (range 7.4–24.9 years) and considering the treatment needs at the reexamination, 19 out of 33 patients (58%) with reconstructions on teeth remained free from all failures or complications. From the patients with FDPs and single unit crowns (SCs) on implants followed over a median observation period of 8 years (range 4.6–15.3 years), eight out of 17% or 47% needed a retreatment or repair at some point due to a failure or a complication. From the three groups of patients, the cases with amelogenesis/dentinogenesis imperfecta demonstrated the highest failure and complication rates. In the cases with cleft lip, alveolus and palate (CLAP) or hypodontia/oligodontia, 71% of the SCs and 73% of the FDPs on teeth (FDP T) remained complication free over a median observation period of about 16 years. Sixty‐two percent of the SCs and 64% of the FDPs on implants remained complication free over 8 years. Complications occurred earlier with implant‐supported reconstructions. Conclusions: Because healthy, pristine teeth can be left unprepared, implant‐supported SCs and FDPs are the treatment choice in young adults with birth defects resulting in tooth agenesis and in whom the edentulous spaces cannot be closed by means of orthodontic therapy. However, the trend for earlier and more frequent complications with implant‐supported reconstructions in young adults, expecting many years of function with the reconstructions, has to be weighed against the benefits of keeping teeth unprepared. In cases with CLAP in which anatomical conditions render implant placement difficult and in which teeth adjacent to the cleft require esthetic corrections, the conventional FDP T still remains the treatment of choice.     

To what extent does the crown–implant ratio affect the survival and complications of implant-supported reconstructions? A systematic review

Objective: To evaluate the occurrence of biological and technical complications with respect to the crown–implant ( C/I ) ratio of implant-supported reconstructions.
Material and methods: Electronic (MEDLINE) and hand searches were conducted for longitudinal prospective studies with a follow-up period of at least 4 years. One reviewer performed screening and data abstraction. The following complications were evaluated: implant survival, peri-implant crestal bone loss, implant fracture, and technical complications related to implant components and suprastructure.
Results: The search provided 41 articles and abstracts, seven of which were selected for full-text analysis. Only two articles were finally included. A qualitative data analysis revealed that the survival rate of implant-supported reconstructions with a C/I ratio of more than 2 was 94.1%. In addition, peri-implant crestal bone loss seemed not to be influenced by the C/I ratio of the implant rehabilitation, except in one study, which noted greater crestal bone loss with lower (<1) compared with higher (>2) C/I ratios. Technical complications related to implant components and suprastructure according to different C/I ratios were not found in any of the studies.
Conclusions: Despite the diversity among studies with respect to data collection and study design, the current literature shows that the C/I ratios of implant-supported reconstructions do not influence peri-implant crestal bone loss.     

Prosthetic treatment planning on the basis of scientific evidence

Summary  The objective of this report is to summarize the results on survival and complication rates of different designs of fixed dental prostheses (FDP) published in a series of systematic reviews. Moreover, the various parameters for survival and risk assessment are to be used in attempt to perform treatment planning on the basis of scientific evidence. Three electronic searches complemented by manual searching were conducted to identify prospective and retrospective cohort studies on FDP and implant-supported single crowns (SC) with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analyzed using random-effects Poisson regression models to obtain summary estimates of 5- and 10-year survival proportions. Meta-analysis of the studies included indicated an estimated 5-year survival of conventional tooth-supported FDP of 93·8%, cantilever FDP of 91·4%, solely implant-supported FDP of 95·2%, combined tooth-implant-supported FDP of 95·5% and implant-supported SC of 94·5% as well as resin-bonded bridges 87·7%. Moreover, after 10 years of function the estimated survival decreased to 89·2% for conventional FDP, to 80·3% for cantilever FDP, to 86·7% for implant-supported FDP, to 77·8% for combined tooth-implant-supported FDP, to 89·4% for implant-supported SC and to 65% for resin-bonded bridges. When planning prosthetic rehabilitations, conventional end-abutment tooth-supported FDP, solely implant-supported FDP or implant-supported SC should be the first treatment option. Only as a second option, because of reasons such as financial aspects patient-centered preferences or anatomical structures cantilever tooth-supported FDP, combined tooth-implant-supported FDP or resin-bonded bridges should be chosen.     

No osteonecrosis in jaws of young patients with osteogenesis imperfecta treated with bisphosphonates

Background:  Recent reports of osteonecrosis of the jaw (ONJ) after dental surgery in patients treated with second- and third-generation nitrogen-containing bisphosphonates instigated this retrospective study. As treatment with bisphosphonates in patients with osteogenesis imperfecta (OI) has become an important symptomatic therapy, especially for severe forms of the disease, we found it important to investigate whether healing after surgical exposure of jaw bone was influenced by the bisphosponate treatment in our group of children, adolescents and young adults with OI.
Subjects and methods:  Disodiumpamidronate was given as monthly intravenous infusion to 64 patients with OI aged 3 months to 20.9 years at the start of treatment (mean 8.1, median 7.7). During 0.5–12.5 years of treatment (mean 4.5, median 4.0), a total individual dose of 140–4020 mg/m² disodiumpamidronate was given (mean 1623 and median 1460). Ten patients continued with oral alendronate and two with zoledronic acid therapy. In 22 of these patients, 38 dental surgery procedures were performed at the age of 3.4–31.9 years (mean 12.2, median 12.3) after 0.03–7.9 years of treatment (mean 3.6, median 3.4).
Results:  Despite long-term intravenous monthly disodiumpamidronate treatment, none of the 64 patients had any clinical signs of ONJ.
Conclusions:  The risk of ONJ in these patients must be considered so low that the patients with indications for treatment should be treated and get the chance to experience the well-documented beneficial effect for children with severe OI.     

Clinical performance of extended zirconia frameworks for fixed dental prostheses: two-year results

Summary  The purpose of this prospective cohort study was to assess the performance of tooth-supported, extended zirconia, fixed dental prostheses (FDPs). Thirty FDPs with span-lengths between 36 and 46 mm (mean: 40·33 mm), four to seven units and with connector dimensions of ∼9 mm² were inserted (19 in the posterior region, 11 including anterior teeth) using glass–ionomer cement and assessed (aesthetic evaluation, failures, hypersensitivity/tooth vitality, secondary caries, pocket depth, decementation and chipping) at baseline and after 2 years. Differences between baseline and 2-year recall were analysed using the Wilcoxon signed-rank test for matched pairs. There were five failures. One FDP revealed a core fracture at the base of the connector, probably caused by a damage induced during fabrication. Two FDPs had to be recemented, one abutment tooth had to be treated endodontically and one cohesive failure of the veneer was observed. There were no significant changes of pocket depth and hypersensitivity between baseline and 2-year recall. The aesthetics were rated as excellent by the patients at both baseline and recall. Two year clinical results of extended zirconia based FDPs with 9 mm² connectors are promising.     

Dens invaginatus: a retrospective study of prophylactic invagination treatment

Aim . To evaluate the prognosis for pulp survival in teeth with dens invaginatus (DI) subjected to prophylactic invagination treatment.
Design . A retrospective study by examination of dental records and radiographs.
Sample and methods. The dental records of all patients referred to the Eastman Dental Institute, Stockholm, Sweden, with the diagnosis dens invaginatus between the years 1969–1997 were reviewed. Clinical data was collected from the dental records and the diagnosis DI was confirmed on the radiographs from the time of referral. 95 teeth in 66 patients had been subjected to prophylactic invagination treatment. The retrospective evaluation was based on an examination of the radiographs available from the follow-ups.
Results . 11·3% of the teeth that were followed for 6 months or longer ( n  = 80) were judged as failures, All failures were initially classified as Oehlers type 2.
Conclusion . The findings stress the importance of a follow-up program for teeth subjected to prophylactic invagination treatment in order to avoid serious periradicular complications that could influence the outcome of the endodontic treatment.     

Prosthetic reconstruction of dentitions seriously compromised by periodontal disease

Dentitions seriously compromised by periodontal disease are often in need not only of cause-related periodontal therapy of high quality but also of relevant prosthetic rehabilitation. Contrary to traditional claims, clinical investigations published during the last 2 decades demonstrate that, if adequately treated and controlled, such dentitions can carry fixed, cross-arch bridges on an extremely reduced amount of periodontium, with a good long-range prognosis. It has also been shown that a markedly reduced but healthy and favourably distributed periodontium supporting such constructions can withstand occlusal forces of considerable magnitude. Another controversial topic, related to fixed bridges, involves indications and contra-indications for cantilever segments. Some clinical investigations demonstrate a markedly increased risk of failure if the fixed bridge is provided with cantilever units, while other controlled studies with defined specifications on the design of the constructions exhibit a high success rate after 8 years or more also for bridgework where 2 or 3 cantilever units are included. The force pattern along cantilever segments of both tooth-supported and implant-supported bridges has been extensively studied. The results show that the force distribution depends not only on the occlusal contact pattern and the dimensioning of the cantilever beam, but also on the type of prosthetic construction in the opposite jaw occluding with the cantilever segment. The free-standing, implant-supported bridge has recently become an important treatment modality for rehabilitation of the partially edentulous jaw, and follow-up studies demonstrate a high success rate.(ABSTRACT TRUNCATED AT 250 WORDS)     

An audit of the time to initial treatment in avulsion injuries

Abstract –  The prognosis of avulsed teeth depends on prompt and appropriate treatment. Good outcome requires education of the general public and non-dental professionals.
Aim:  Retrospective observational survey of case records of avulsion injuries attending a dental hospital trauma clinic.
Method:  Data collected included: hospital number, date of birth, gender, source of patient's referral, date of trauma, number of avulsed teeth, place of initial presentation, storage, hours till initial presentation, and initial treatment.
Results:  One hundred and twenty teeth with avulsion were identified in 75 children. The mean age of the patients was 9.8 years (SD = 2.3 years) at the time of trauma with avulsions recorded in 44 (58.7%) boys and in 31 (41.3%) girls. Only 51 (42.5%) teeth were stored in an appropriate medium before attendance at any site and only 48 (40%) of the teeth were seen within 1 h. 83.3% received emergency treatment at general hospital, 89.7% in dental practice and 92.9% at dental hospital.
Conclusions:  A minority of avulsion injuries were seen within the first hour and a minority were in appropriate storage medium at presentation. Geographical location plays a huge role in the time taken to reach secondary care. However, improving public and non-dental professional knowledge about tooth storage in avulsion injuries is critical to long-term prognosis of the teeth.     

Consequences of crown fractures with pulpal exposure: histopathological evaluation in dogs

Abstract  – When a crown fracture involving pulpal exposure is produced, the therapeutic treatment to be applied depends to a great extent on the general histopathological condition of the exposed pulp. Hence, the objective of this study was to evaluate histopathological and bacteriological changes occurring in dental tissue and periradicular tissue of crown-fractured teeth with pulpal exposure. Twenty-four anterior teeth (central and lateral incisors) from the maxillary teeth of four young, adult Mongrel dogs were used. At 48 and 72 h after performing the crown fractures, the animals were sacrificed and the results evaluated. Both observation periods revealed the existence of an area of superficial inflammation with the formation of hyperplastic tissue towards the external surface. Intense neutrophilic infiltrate was observed below it. Mean depth of inflammation was greater at 48 h (4633.33 µm) than at 72 h (3933.33 µm), perhaps coinciding with the bigger pulp chamber opening (×1332.14 µm at 48 h vs. ×479.52 µm at 72 h). Upon approaching the cervical portion, the inflammation became less. Bacterial contamination was constant in all the cases evaluated, worsening the histopathological findings with exposure time. This study demonstrates that when a crown fracture with pulpal exposure is produced, the success in treating it depends partly on how quickly therapeutic treatment is administered.     

Molecular identification and quantification of bacteria from endodontic infections using real-time polymerase chain reaction

Introduction:  It was the aim of the present study to evaluate root canal samples for the presence and numbers of specific species as well as for total bacterial load in teeth with chronic apical periodontitis using quantitative real-time polymerase chain reaction (PCR).
Methods:  Forty adult patients with one radiographically documented periapical lesion were included. Twenty teeth presented with primary infections and 20 with secondary infections, requiring retreatment. After removal of necrotic pulp tissue or root canal filling, a first bacterial sample was obtained. Following chemo-mechanical root canal preparation a second sample was taken and a third sample was obtained after 14 days of intracanal dressing with calcium hydroxide. Analysis by real-time PCR enabled the quantification of total bacterial counts and of nine selected species.
Results:  Root canals with primary infections harbored significantly more bacteria (by total bacterial count) than teeth with secondary infections ( P  < 0.05). Mean total bacterial count in the retreatment group was 2.1 × 10⁶ and was significantly reduced following root canal preparation (3.6 × 10⁴) and intracanal dressing (1.4 × 10⁵). Corresponding values for primary infections were: 4.6 × 10⁷, 3.6 × 10⁴, and 6.9 × 10⁴. The numbers of the selected bacteria and their detection frequency were also significantly reduced.
Conclusion:  Root canals with primary infections contained a higher bacterial load. Chemo-mechanical root canal preparation reduced bacterial counts by at least 95%.     

Trauma to anterior implants

Abstract –  The replacement of anterior teeth with an implant-supported restoration is recognized as an efficient and successful treatment. One of the rare complications that can occur with dental implants is the fracture of either the implant or the superstructure because of biomechanical overload or occlusal force. In contrast to the permanent dentition, there is limited information about how osseointegrated implants or the periimplantary bone behave after dental trauma. This article presents a case of trauma to anterior implants and illustrates the effects to the titanium screw and the surrounding tissue.     

Survival analysis and clinical evaluation of implant-retained prostheses in oral cancer resection patients over a mean follow-up period of 10 years

STATEMENT OF PROBLEM: Dental implants have been increasingly used for prosthodontic rehabilitation of patients following oral tumor resection and postsurgical radiotherapy. However, only a few long-term studies have examined the implant survival rate and other factors related to prosthodontic treatment in oral tumor resection patients. PURPOSE: The purpose of this study was to evaluate the long-term survival of dental implants and implant-retained prostheses in oral cancer resection patients. MATERIAL AND METHODS: Ninety-three patients (63 men, 30 women) with a mean age of 59 years (range of 26-89 years) received 435 implants after the resection of a head and neck tumor. Twenty-nine patients received postsurgical radiotherapy prior to implant placement. The factors related to implant survival or failure were monitored over a mean observation period of 10.3 years (range of 5 to 161 months). Prosthodontic rehabilitation was evaluated with respect to the rates of technical failures and complications. Data were analyzed using a Kaplan-Meier curve and comparisons were made with the log-rank test or the Wilcoxon test (a=.05). RESULTS: Of the 435 implants, 43 implants were lost; the cumulative survival rate was 92%, 84%, and 69% after 3.5, 8.5, and 13 years, respectively. Twenty-eight implants in 6 patients were counted as lost since the patients had died. Twenty-nine irradiated patients received 124 implants, of which 6 implants were lost prior to prosthodontic rehabilitation. In 68 patients with 78 rigid bar-retained dentures, only minor technical complications were identified. However, all 25 fixed implant-supported restorations had no technical component failures and did not require technical maintenance. CONCLUSIONS: This study demonstrates that implant-retained and -supported prostheses in oral cancer resection patients, irrespective of the cancer treatment procedure, show lower long-term survival rates than those in patients without prior cancer surgery. Rigid fixation of the implant-supported prosthesis appears to minimize the complication rates. The poor implant survival rate was due to the higher mortality rate among these patients, and not to a lack of osseointegration.     

Molecular analysis of the root canal microbiota associated with endodontic treatment failures

Introduction:  The failure of endodontic treatment is usually caused by persistent/secondary intraradicular infections and Enterococcus faecalis has been considered to be the main pathogen involved. Nevertheless, the breadth of bacterial diversity involved with endodontic treatment failures remains to be consistently explored by culture-independent approaches.
Methods:  This study determined the intraradicular microbiota of root-canal-treated teeth with post-treatment apical periodontitis using 16S ribosomal RNA gene clone library analysis.
Results:  Bacteria were present in all cases, confirming the infectious etiology of post-treatment disease. Seventy-four bacterial taxa belonging to six phyla were found in the nine cases investigated. Of these, 55% were identified as as-yet-uncultivated phylotypes, which also made up a significant proportion of the microbiota in many cases. Twenty-five new phylotypes were identified. Most teeth harbored a mixed consortium, with a mean number of 10 taxa per case. Only 11 taxa were found in more than one case, revealing a high interindividual variability in the composition of the microbiota.
Conclusion:  The current findings revealed new candidate endodontic pathogens, including as-yet-uncultivated bacteria and taxa other than E. faecalis , which may participate in the mixed infections associated with post-treatment apical periodontitis.     

Immediate loading of implants in the edentulous maxilla: use of an interim fixed prosthesis followed by a permanent fixed prosthesis: a 32-month prospective radiological and clinical study

Purpose: The aim of this study was to prospectively evaluate the survival rate of splinted and immediately loaded Straumann sandblasted, large-grit, acid-etched, solid-screw dental implants in the edentulous maxilla after 32 months of loading.
Materials and Methods: Twenty-eight patients (mean age 63 years) with edentulous maxillae received 168 implants (six each) and an implant-supported fixed interim prosthesis within 24 hours after surgery. After a mean healing time of 15 weeks, the patients received permanent screw-retained prostheses. Clinical and radiological examinations were made at implant placement and after 8, 20, and 32 months of loading. All permanent prostheses were removed at the 32-month follow-up; implant stability was checked with a torque device, and the implant stability quotient was determined with resonance frequency analysis.
Results: Mean marginal bone loss from baseline to 8 months after loading was 1.6 mm (SD 1.16; p  = .094), from 8 to 20 months 0.41 mm (SD 0.63; p  = .094), and from 20 to 32 months 0.08 mm (SD 0.49; p  = .039). The 32-month cumulative survival rate was 98.2%.
Conclusions: The 32-month survival of solid-screw implants – immediately loaded within 24 hours after placement – was similar to survival rates reported for solid-screw implants with conventional loading. Immediate loading and splinting of implants in the edentulous maxilla is a viable treatment alternative.     

Clinical success of implant-supported and tooth–implant-supported double crown-retained dentures

The objective of this retrospective study was to compare biological and technical complications of implant-supported and tooth-implant-supported double crown-retained dentures (DCRDs) with those of tooth-supported DCRDs. Sixty-three DCRDs were monitored. One study group included 16 prostheses with a combination of implants and natural teeth as double crowns (ti group), whereas in the second study group, 19 dentures were retained exclusively on implants (ii group); a third study group with 28 exclusively tooth-supported dentures served as controls (tt group). Tooth loss, implant failure, and technical complications (loss of retention of primary crown, abutment screw loosening, loss of facing, fracture of resin denture teeth and fracture of saddle resin) were analysed. During the observation period of 24 months, no implants or teeth were lost in the ti group and three technical complications were recorded. In the ii group, two implants were lost, two cases of peri-implantitis occurred and four technical complications were observed. In the tt group, two cases of tooth loss and seven technical complications were observed. At the time of the last examination, all prostheses of the ti group and the ii group were functional. Patients of these two study groups reported high satisfaction with both function and aesthetics with no significant difference between the two groups. Treatment with DCRDs showed comparable results in the three study groups. The 2-year results indicate that double crowns can be recommended for implant and combined tooth-implant-retained dentures.     

悬臂梁式种植固定义齿的回顾性研究

目的:评价悬臂梁式种植固定义齿的长期临床效果。方法 :采用回顾性研究方法 ,收集2005-01—2011-06,在我科室采用悬臂梁式种植固定义齿修复58例患者(60个修复体,共103枚种植体)的临床及影像学资料。记录种植体的失败个数、修复体失败个数、边缘骨吸收情况、机械及生物并发症情况。结果:随访期内无种植体失败,有3个修复体失败。种植体7年累计存留率100%,修复体7年累计存留率为92.3%。随访期内并未见严重的边缘骨吸收,近悬臂端种植体周边缘骨吸收为(0.08±0.12)mm,远悬臂端种植体周边缘骨吸收为(0.09±0.14)mm。8个修复体(13%)、14枚种植体(14%)发生生物学并发症,11个修复体(18.3%)出现机械并发症。结论:本研究初步证实悬臂梁式种植固定义齿的修复方式临床效果是可靠的,可作为临床种植设计的一个可选方案。因较高的机械并发症,在选择螺丝固位方式时需加以注意。     

Root resorption in dental trauma: 45 cases followed for 5 years

Abstract –  We aimed to: (i) study the prevalence of root resorption after luxation or avulsion injuries on permanent teeth referred to our dental clinic over a 3-year period; (ii) study the relationship between type of injury and resultant type of resorption complication; and (iii) evaluate success of treatment protocols for various resorption complications. We observed 1943 patients with dental trauma, aged between 2 and 26 years, referred to the Accident and Emergency Department of the Dental Clinic, University of Brescia, from 1st September 1997 to 31st December 2001. Of these, 261 permanent teeth had sustained luxation ( n  = 188) or avulsion ( n  = 73) injuries. Permanent teeth luxation and avulsion injuries occurred most often in upper incisors (75%) of patients mostly aged 12–21 years, with males more commonly affected than females (68.3% vs. 31.7%). These cases were followed for 5 years, and complications and response to treatment were recorded. Root resorption was observed in 45 (17.24%) of these cases. Of the 45 cases with resorption, 9 were associated with luxation injury (20%) while 36 (80%) with avulsion. We distinguished 30 cases of inflammatory root resorption (18 transient and 12 progressive) and 15 cases of ankylosis and osseous replacement. When resorption was recognized, quick and effective treatment could still result in an excellent functional and aesthetic outcome for these teeth.     

Effect of abutment's height and framework alloy on the load distribution of mandibular cantilevered implant-supported prosthesis

Objectives: In cantilevered implant-supported complete prosthesis, the abutments' different heights represent different lever arms to which the abutments are subjected resulting in deformation of the components, which in turn transmit the load to the adjacent bone. The purpose of this in vitro study was to quantitatively assess the deformation of abutments of different heights in mandibular cantilevered implant-supported complete prosthesis.
Material and methods: A circular steel master cast with five perforations containing implant replicas (Ø3.75 mm) was used. Two groups were formed according to the types of alloy of the framework (CoCr or PdAg). Three frameworks were made for each group to be tested with 4, 5.5 and 7 mm abutments. A 100 N load was applied at a point 15 mm distal to the center of the terminal implant. Readings of the deformations generated on the mesial and distal aspects of the abutments were obtained with the use of strain gauges.
Results: Deformation caused by tension and compression was observed in all specimens with the terminal abutment taking most of the load. An increase in deformation was observed in the terminal abutment as the height was increased. The use of an alloy of higher elastic modulus (CoCr) also caused the abutment deformation to increase.
Conclusion: Abutment's height and framework alloy influence the deformation of abutments of mandibular cantilevered implant-supported prosthesis.     

Idiopathic generalized apical root resorption: a report of three cases

Background.   Idiopathic apical root resorption usually presents as a chance radiographic finding. It may be widespread, affecting the majority of teeth, with implications for the longevity of the dentition.
Case report.   Three cases of significant idiopathic apical resorption resulting, respectively, in prevention, abandonment, and alternative methods of orthodontic treatment are described.
Conclusion.   Significant idiopathic resorption may present as a chance radiographic finding, as pain, or excessive mobility. The prognosis for affected teeth is often poor with very limited scope for orthodontic movement due to the likelihood of uncontrolled resorption. Definitive prosthetic rehabilitation is often best deferred until adulthood due to the potential for further resorption during adolescence in addition to vertical growth considerations.