Retrospective study of teeth with a poor prognosis following non-surgical periodontal treatment

Aim: The aim of this retrospective study was to assess teeth with a poor prognosis and the proximal periodontium of adjacent teeth, and to identify the risk factors associated with the loss of teeth with a poor prognosis following non-surgical periodontal treatment.
Material and Methods: Teeth with a poor prognosis ( n =113), teeth adjacent to those of poor prognosis ( n =105) and non-adjacent teeth ( n =51) were evaluated in 25 non-smoking patients who had received supportive periodontal treatment for 5–16 years following non-surgical periodontal treatment at a university hospital.
Results: Probing pocket depth (PPD), percentage of alveolar bone loss, presence of tooth mobility and bleeding on probing in all teeth improved significantly after treatment. Logistic regression analysis showed that loss of teeth with a poor prognosis depended on the initial deepest PPD, tooth mobility and multi-rooted tooth.
Conclusions: Teeth with a poor prognosis did not affect the proximal periodontium of the adjacent teeth, and progression of periodontal disease in these teeth and adjacent teeth can be prevented by non-surgical periodontal treatment in non-smokers. The risk factors for loss of teeth with a poor prognosis were the initial deepest PPD, tooth mobility and multi-rooted tooth.     

Repair characteristics of horizontal root fracture: a case report

Abstract  – Radicular fractures in permanent teeth are uncommon injuries among dental traumas, comprising 0.5–7% of the cases. Fracture occurs most often in the middle-third of the root and rarely at the apical-third. The present paper reports a clinical case of a horizontal radicular fracture located between the middle- and apical-third of a upper left-central incisor followed-up for over 3 years. The tooth was extracted owing to periodontal reasons. Histomorphologically, it showed pulp-vitality preservation and root healing by hard-tissue deposition.     

Repair of a horizontal mid-root fracture accompanied by labial luxation and partial alveolar fracture: a 21-year follow up

Abstract –  The prognosis of injured teeth involving horizontal mid-root fractures is poor and depends heavily on pulpal vitality, periodontal health and the repositioning of the tooth to its original position. Here, we report the case of an upper right central incisor presenting a horizontal mid-root fracture, complicated by impaction of the coronal fragment in the external alveolar bone, which in turn prevented the repositioning of the tooth fragment. As a consequence, it was necessary to raise a full-thickness flap and perform window-osteotomy to free the coronal fragment and reset the fractured fragment. Short-term follow up revealed pulpal vitality of the affected incisor and tissue repair at the level of the line of fracture, without any signs of periapical or periradicular pathology. In this paper, we describe some of the clinical features found upon revising this case 21 years later. The affected tissues are in good health, the root fracture is repaired and the pulp maintains its vitality.     

Autotransplantation of first premolar to replace a maxillary incisor – 3D-volume tomography for evaluation of the periodontal space

Abstract –  The anterior maxilla is the most traumatized region during childhood and tooth loss is frequently involved. Space closure with implants is contraindicated in growing patients and maintenance of space is necessary over a long period. Transplantation of premolars from the mandible with two-third to three-quarter root formation wide open foramen provides the best prognosis for permanent survival.
Case report:  This report describes the management of a 10 year old girl with autotransplantation to replace an upper incisor by a lower premolar under consideration of special care for the periodontal ligament during surgical procedure. A 3-D imaging with digital volume tomography (DVT) was used 20 months after transplantation to evaluate the periodontal morphology.
Discussion:  Autotransplantation of premolars with incomplete root formation to replace maxillary incisor is a treatment alternative after traumatic loss of teeth. There were no signs of pathosis like resorption or ankylosis and a normal periodontal space demonstrated with DVT. There is no need for endodontic treatment before transplantation. In this case of autotransplantation of a premolar, the DVT after 20 months gives evidence of a successful regeneration of the periodontal ligament.     

Tooth loss during maintenance following periodontal treatment in a periodontal practice in Norway

BACKGROUND: Periodontal therapy coupled with careful maintenance has been shown to be effective in maintaining periodontal health; however, a small number of teeth are still lost because of progressive periodontitis. AIM: To investigate factors associated with tooth loss due to periodontal reasons during maintenance following periodontal treatment in patients in a Norwegian specialist periodontal practice. The study also examined how initial prognosis related to actual outcome as measured by periodontal tooth loss. METHODS: Hundred consecutive patients (68 females, 32 males) who had comprehensive periodontal treatment and attended for 9.8 (SD: 0.7), range: 9-11 years of maintenance care, were studied. All teeth classified as being lost due to periodontal disease over the period were identified. RESULTS: Only 36 (1.5%) of the 2436 teeth present at baseline were subsequently lost due to periodontal disease. There were 26 patients who lost at least one tooth. Logistic regression analysis showed that tooth loss was significantly related to male gender (p=0.049; adjusted odds ratio: 2.8; confidence interval (c.i.): 1.0-8.1), older age, i.e.>60 years (p=0.012; adjusted odds ratio: 4.0; c.i.: 1.3-12.0) and smoking (p=0.019; adjusted odds ratio: 4.2; c.i.: 1.4-13.8). The majority 27 (75%) of the teeth lost due to periodontal disease had been assigned an uncertain, poor or hopeless initial prognosis; however, nine teeth (25%) lost had been assigned a good prognosis at baseline. The prognosis for 202 teeth was judged to have worsened over the period of the study. CONCLUSION: Compliance with maintenance following periodontal treatment was associated with very low levels of tooth loss in a referral practice in rural Norway. Male gender, older age (>60 years) and smoking were predictors of tooth loss due to progressive periodontitis.     

Comparison of intraoral radiography and limited cone beam computed tomography for the assessment of root-fractured permanent teeth

Abstract –  Aim : To compare intraoral occlusal (OC) and periapical (PA) radiographs vs. limited cone beam computed tomography (CBCT) in diagnosing root-fractured permanent teeth. Material and methods :  In 38 patients (mean age 24 years, range 8–52 years) with 44 permanent teeth with horizontal root fractures, intraoral radiographs (PA and OC) and limited CBCT were used to evaluate the location (apical, middle, cervical third of the root) and angulation of the fracture line. Furthermore, the conventional radiographs and CBCT images were compared for concordance of fracture location. Results :  In the PA and OC radiographs, 28 fractures (63.6%) were located in the middle third of the root, 11 (25.0%) in the apical third and 5 (11.4%) in the cervical third. The PA/OC radiographs and the sagittal CBCT images (facial aspect) yielded the same level of root fracture in 70.5% of cases (31 teeth; 95% CI: 54.1–82.7%). The PA/OC radiographs and sagittal CBCT images (palatal aspect) showed the same level of root fracture in 31.8% of cases. There was a statistically significant association between the angle at which the root fracture line intersected the axis of the tooth and the level of root fracture in the facial aspect of the sagittal CBCT images. Conclusions :  The diagnosis of the location and angulation of root fractures based on limited CBCT imaging differs significantly from diagnostic procedures based on intraoral radiographs (PA/OC) alone. The clinical significance for treatment strategies and for the prognosis of root-fractured teeth has to be addressed in future studies.     

Root fracture in immature tooth: report of a case

Abstract –  Root fracture injuries affect 0.5–7% of permanent teeth. Although this type of injury is rarely seen in teeth with immature root formation, the prognosis is generally good depending on the site of the fracture. A case report of horizontal root fracture in maxillary central incisor of an 8-year and 3-month-old girl and its treatment was presented.     

Periodontal and microbiological parameters in children and adolescents with cleft lip and /or palate

Objective.  To evaluate the oral hygiene and the periodontal condition of children and adolescents with cleft lip and/or palate (CLP).
Methods.  Forty-one children and adolescents, 4–18 years, with CLP and 41 normal controls participated. Clinical parameters examined were the plaque and gingival index and Community Periodontal Index of Treatment Needs. For teeth in the cleft area, probing pocket depth, bleeding on probing, and tooth mobility were also evaluated. Samples of subgingival plaque were collected from 21 randomly selected patients of each group.
Results.  The CLP group had generally poorer oral hygiene (plaque index significantly higher) compared with the control. Children in both groups presented mild degree of gingivitis. Teeth in the cleft area had significantly higher pocket probing depth and tooth mobility, compared with corresponding teeth in the control group. The microbial analysis did not reveal significant differences in the composition of the subgingival microbiota between groups. Teeth in the cleft presented higher isolation frequencies and mean percentages of periodontopathic bacteria.
Conclusion.  Youngsters with CLP showed poor oral hygiene and worse periodontal condition, compared with controls. The above results advocate their participation in an intensive preventive dental programme that should start at an early age, possibly decreasing the risk of future periodontal disease.     

Vertical root fracture in endodontically versus nonendodontically treated teeth: a survey of 315 cases in Chinese patients

OBJECTIVE: The purpose of this study was to compare endodontically versus nonendodontically treated teeth with respect to clinical features, including patient age and gender and tooth types of vertical root fractures. STUDY DESIGN: A total of 315 consecutive cases of vertical root fracture occurring in 274 Chinese patients during a 1 3-year period were reviewed. Age and gender, as well as tooth type and root distribution of vertical root fractures, were presented and compared in endodontically versus nonendodontically treated teeth. RESULTS: Most patients (87%) had 1 fractured tooth; the others had 2 or 3 fractured teeth. Of all vertical root fractures, 40% occurred in nonendodontically treated teeth. In comparison with those in endodontically treated teeth, vertical root fractures in nonendodontically treated teeth tended to occur in patients with a higher mean age (55 years vs. 51 years) and were more frequent in male patients (78% vs. 58%). Vertical root fractures occurred in nonendodontically treated teeth more often in molars (84% vs. 53%), less often in premolars (16% vs. 33%), and seldom in anteriors (1 tooth vs. 27 teeth). CONCLUSIONS: Vertical root fractures in nonendodontically treated teeth are not uncommon and comprise a large proportion of such fractures in Chinese patients. Differences between endodontically and nonendodontically treated teeth in patient age and gender, as well as in tooth types of vertical root fractures, were demonstrated.     

Horizontal root fractures. Treatment and repair.

When root-fractured teeth are treated adequately with repositioning, stabilization, and occlusal adjustment the prognosis for healing is favorable. The common sequelae of root canal obliteration and transitory resorption are usually of little clinical concern. The sequelae of pulpal necrosis usually can be treated successfully by endodontic therapy or surgery. Even with the loss of the fractured crown the root often can be restored with the assistance of the modern techniques of extrusion or periodontal surgery. The prognosis for tooth survival following a horizontal root fracture can be summarized as quite good.     

Root fracture of immature permanent incisors – a case report

Abstract –  This 7-year-old girl experienced pain in her upper central incisors following a fall to the ground. Radiographic examination revealed immature upper central incisors with mid-root oblique and horizontal root fractures. Splinting was performed. When at 3 months, an electric pulp test was positive for both injured teeth, and after 5 months, the fracture lines had disappeared on the radiographs, the splint removed. After 2 years, clinical examination showed normal tooth color and position, with a positive response to the pulp test. Radiographs demonstrated continuous root development, although root canal narrowing was noted at the healed fracture sites.     

Traumatic intrusion of permanent teeth. Part 2. A clinical study of the effect of preinjury and injury factors, such as sex, age, stage of root development, tooth location, and extent of injury including number of intruded teeth on 140 intruded permanent teeth

Abstract –  A prospective study of 140 intruded permanent teeth was done to evaluate the following healing complications: pulp necrosis (PN), root resorption (surface, inflammatory and replacement resorption) (RR) and defects in marginal periodontal healing (MA). These complications were related to various preinjury and injury factors. Age appeared to be related to all three healing complications in that patients younger than 12 years had the lowest complication rate. Stage of root formation at the time of the injury was very strongly related to PN and MA, with immature root formation (i.e. incomplete root formation or completed root formation with wide open apex) having better prognosis than more mature root development. Lateral incisors showed significantly more defects in MA, a finding possibly explained by the observation that lateral incisors were more often involved in multiple intrusions compared to other teeth and noting that multiple intrusions had a significantly higher frequency of MA. An associated crown fracture with exposed dentin resulted in more frequent PN, a finding possibly related to bacterial invasion through dentinal tubules into an ischemic pulp. The presence of a gingival laceration added to both PN and MA. The extent of intrusion (in mm) showed some relation to both RR with intrusion 1–3 mm having the lowest frequency of RR, whereas PN and MA showed no significant relation to the extent of intrusion. Finally, multiple adjacent intruded teeth were more frequently involved in a significantly greater loss of interproximal marginal bone (MA) than single intrusions. In conclusion, the relationship between healing complications and preinjury and injury factors could generally be explained by better healing possibilities in teeth with immature root formation. A possible explanation for that could be the softer bone surrounding the tooth, whereby trauma to the periodontium might be diminished.     

Technical quality of root canal fillings performed in a dental school and the associated retention of root-filled teeth: a clinical follow-up study over a 5-year period

Summary  The aim of this study was to examine the technical quality of root canal fillings performed in a dental school and to investigate the associated effect on the survival/retention of root-filled teeth. A review of case notes of patients who had root canal treatment performed in the department of Restorative Dentistry, University Dental School and Hospital, Cork, Ireland was carried out. The technical quality of the root canal filling was described according to its relationship with the radiographic apex on a post-treatment radiograph. Tooth status at review was defined as 'tooth present' or 'tooth absent' based on the presence or absence of the root-filled tooth recorded in the treatment records at a review appointment following placement of the root canal filling. One hundred and forty-eight teeth (129 patients) were considered. Of these, 69·6% ( n  = 103) were of acceptable technical quality, 23·6% ( n  = 35) were under-extended, and 6·8% ( n  = 10) were overextended. An increased number of intra-treatment radiographs to confirm the relationship of the canal preparation to the radiographic apex and operator experience were significant predictors of adequate root canal fillings ( P  < 0·05). Eighty-three per cent ( n  = 123) of teeth were present at a review appointment held an average of 40 months following completion of treatment (12–60 months). The technical quality of the root canal filling was the only significant factor in predicting tooth survival ( P  < 0·05), while the presence of pre-treatment periapical pathology had no significant effect on survival of the root-filled tooth. Determination and maintenance of the working length of the canal system is an important feature in producing good quality root canal fillings, which in turn, is associated with increased likelihood of survival/retention of root-filled teeth.     

牙周再生性手术联合正畸移动治疗垂直型骨缺损

牙周再生性手术能够使牙周炎患者的垂直型骨缺损获得最佳的治疗效果,正畸患者在牙周手术后炎症得到控制,正畸牙齿的移动也相对安全。牙周再生性手术后,可通过早期牙齿移动,使牙根在不牺牲安全性的情况下尽早进入移植部位,手术过程中使用的骨替代物或屏障膜等移植材料可能会阻碍牙齿移动,但是另一方面也会降低牙根吸收发生的概率。牙周再生性手术联合正畸治疗垂直型骨缺损能否维持长期较好的临床效果,受到牙周维护频率、正畸加力频率及大小等多方面因素的影响,术后疗效有待进一步观察和研究。     

Survival of 534 incisors after intra-alveolar root fracture in patients aged 7–17 years

Abstract –  The purpose of the study was to evaluate and assess the survival rate of 534 root fractured teeth, including factors that may affect the survival rate but were not included in previous long-term studies. Location of fracture was registered as in the cervical, cervical/middle, middle and apical one-third of the root, and root development was categorized into five stages. Altogether, 383 (78%) showed healing of the fracture, with either formation of hard tissue or interposition of soft tissue between the fragments. In these teeth, no significant difference was found between positions in the root or types of healing. In 325 teeth, the healing remained unchanged throughout the control period, while 58 teeth showed a posthealing complication. A new injury occurred in 47 teeth; in 21 of these, the injury healed spontaneously, in four after endodontic treatment. Increased mobility of the coronal fragment was recorded for 32 teeth, and in 11 of these, the looseness of the fragment was so pronounced that the teeth had to be extracted. No healing, i.e. radiolucency in the alveolar bone, adjacent to fracture, took place in 109 teeth (22%). Of these teeth, 34 were extracted during the observation time while 75 (69%) showed healing after endodontic therapy. At the final assessment of survival (including all parameters) of 534 root fractured teeth, 425 (80%) showed survival and 109 (20%) were extracted during the observation period. It was concluded that the survival of root-fractured teeth was high for up to10 years of observation (mean = 63 months). The highest frequency of tooth loss (70%) was found in 77 teeth with horizontal fractures restricted to the cervical part of the root. When these teeth were excluded, the frequency of survival in remaining teeth rose to 88%.     

Effectiveness of limited cone-beam computed tomography in the detection of horizontal root fracture

Abstract –  To compare the diagnostic accuracy of conventional film radiography, charge coupled device (CCD) and photostimulable phosphor plate (PSP) digital images and limited cone-beam computed tomography in detecting simulated horizontal root fracture. Root fractures were created in the horizontal plane in 18 teeth by a mechanical force and fragments were relocated. Another 18 intact teeth with no horizontal root fracture served as a control group. Thirty-six teeth were placed in the respective empty maxillary anterior sockets of a human dry skull in groups three by three. Intraoral radiographs were obtained in three different vertical views by utilizing Eastman Kodak E-speed film, CCD sensor, RVG 5.0 Trophy and a PSP sensor Digora, Optime. Cone beam CT images were taken with a unit (3D Accuitomo; J Morita MFG. Corp, Kyoto, Japan). Three dental radiologists separately examined the intraoral film, PSP, CCD and cone beam CT images for the presence of horizontal root fracture. Specificity and sensitivity for each radiographic technique were calculated. Kappa statistics was used for assessing the agreement between observers. Chi-square statistics was used to determine whether there were differences between the systems. Results were considered significant at P  < 0.05. Cone beam CT images revealed significantly higher sensitivities ( P  < 0.05) than the intraoral systems between which no significant differences were found. Specificities did not show any statistically significant differences between any of the four systems. The kappa values for inter-observer agreement between observers (four pairs) ranged between 0.82–0.90 for the 3DX evaluations and between 0.63–0.71 for the different types of intraoral images. Limited cone beam CT, outperformed the two-dimensional intraoral, conventional as well as digital, radiographic methods in detecting simulated horizontal root fracture.     

Clinical study on prognostic factors for autotransplantation of teeth with complete root formation

Autotransplantation is often performed to replace a missing tooth, but tooth autotransplantation has been reported in fewer teeth with complete root formation than those with incomplete root formation. The aim of this prospective study was to evaluate the factors that affect the prognosis of autotransplantation of teeth with complete root formation. 109 patients with 117 transplants were studied. Of the 117 transplants investigated, 14 (12%) failed during the observation period. The overall 1-year survival rate was 96%; the 5-year survival rate was 84%. The major causes of failure were unsuccessful initial healing and replacement root resorption with periodontal inflammation. Factors significantly associated with unsuccessful transplantation, in single factor analysis, were age 40 years or more, molar tooth as donor, probing pocket depth to 4 mm or more, history of root canal treatment, multi-rooted teeth and fixation with sutures. Pocket depth of 4 mm or more and history of root canal treatment appeared to increase the risk of unsuccessful transplantation in multivariate analysis. It is suggested that the pocket depth of the donor tooth and history of root canal treatment are related to the healing of paratransplantal tissue and root resorption.     

The effect of Emdogain® and 24% EDTA root conditioning on periodontal healing of replanted dog's teeth

Abstract –  Controversies still exist as for the regenerative role of enamel matrix derivatives and the need for removal of the periodontal ligament in replanted teeth. The purpose of this study was to evaluate the effect of Emdogain^® and 24% ethylenediamine tetraacetic acid (EDTA) root conditioning on periodontal healing of replanted dog's teeth. Teeth were extracted, endodontically treated and preconditioned as follows: group 1, Emdogain^®; group 2, Emdogain^® + EDTA and group 3, EDTA. Teeth were replanted after 30 min extraoral time, splinted for 15 days and animals sacrificed after 8 weeks of observation. Histological evaluation was performed using hematoxylin/eosin and Masson trichrome and results scored based on previously reported criteria for histological evaluation. Replacement root resorption was histologically diagnosed in all groups except in the negative control. A parametric analysis showed no statistically significant differences between experimental groups. Root preconditioning with Emdogain^® alone or in combination with 24% EDTA showed no evidence of regeneration of collagen fibers and consequently did not prevent the development of replacement root resorption on replanted dog's teeth.     

Treatment of avulsed teeth with Emdogain®– a case report

Abstract –  The present case report describes the reimplantation of avulsed teeth with the treatment of Emdogain^®. Case was avulsed right maxillary permanent central and lateral incisor in a 9-year-old girl suffering from a traumatic injury. After pretreatment of avulsed teeth, Emdogain^® was applied to the root surface and into the extraction socket with subsequent replantation of the tooth. Evaluation parameters included horizontal and vertical percussion sound and periapical radiographs. At 1–2–6–12-month follow-up period, the clinical and radiographic appearance of the teeth showed resolution of mobility and no signs of replacement resorbption.