Treatment Strategy for Guided Tissue Regeneration in Combined Endodontic-Periodontal Lesions: Case Report and Review

IntroductionEndodontic-periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis are difficult.MethodsTwenty-six cases from 14 articles involving the successful management of endodontic-periodontal lesions with concurrent regenerative procedures were reviewed. This article also presents successful treatment of an endodontic-periodontal combined lesion involving a grade II mesial furcation of a maxillary molar with root canal treatment and multiple regenerative procedures.ResultsA treatment algorithm is outlined for the application of the guided tissue regeneration (GTR) in managing endodontic-periodontal combined lesion. This treatment algorithm consists of 4 phases: (1) presurgical phase (determining periodontal/regenerative prognosis), (2) endodontic phase, (3) periodontal surgical phase, and (4) post-GTR reevaluation protocol.ConclusionsThe proposed 4-phase treatment algorithm might provide a beneficial guideline in managing the endodontic-periodontal combined lesions.     

Re-eruption of traumatically intruded mature permanent incisor: case report

Abstract –  This case report describes a case of intrusion of the right mature permanent central incisor. After gingivectomy and endodontic treatment with changes of the intracanal dressing (calcium hydroxide paste) every 30 days, spontaneous re-eruption was observed. We conclude that waiting for spontaneous re-eruption associated with gingivectomy and endodontic treatment is an alternative treatment for severe intrusive luxations in mature permanent teeth.     

Periodontal pocket--predictable treatment

Periodontal pocket depths and attachment loss are charted early in treatment to establish a benchmark against which the success of treatment regimens will be measured. They are considered both a measure of past inflammatory disease and a reservoir for periodontal pathogens capable of further destruction. The clinician must strive to identify predictable means of treating pockets. Three nonpharmaceutical approaches can be considered: maintain the present depth and hope for the best when treating a patient who has already demonstrated susceptibility; reduce the pocket by resective treatment, a frequently used and very predictable corrective methodology; reduce the probing depth by accomplishing periodontal regeneration. This last approach is the treatment of choice, but it is often impossible to achieve. This article describes a treatment regimen that recognizes the need for proper diagnosis and an initial nonsurgical debridement regimen before considering surgery. It then evaluates surgical treatment alternatives and concludes with a mandate for a well-constructed periodontal maintenance program. It also provides long-term detailed analysis of patient treatment.     

Dental management of a child with ectrodactyly ectodermal dysplasia cleft lip/palate syndrome: A case report

Ectrodactyly ectodermal dysplasia with clefting is a rare syndrome resulting from TP63 gene mutations. It is inherited in autosomal dominant manner or as a de novo transfiguration. It is characterized by a triad of ectodermal dysplasia, ectrodactyly, and facial clefts. This report represents a clinical case of 5 years and 6 months‐old male child with ectrodactyly ectodermal dysplasia cleft lip and palate syndrome requiring treatment of his carious teeth. After history taking and clinical examination, the necessary treatment was provided under general anesthesia due to the definitely negative behavior of the child. The treatment outcomes had a positive impact on the behavior and acceptance to dental treatment. This was evidenced by completion of the prosthetic and space management appliances on the dental chair. The child's quality of life was consequently improved. This was evidenced by the reduced response scores of the child perception questionnaire (CPQ_11‐14) after treatment. This report highlighted the value of proper diagnosis and fulfillment of the unmet dental needs for patients with orofacial syndromes to improve their quality of life.     

Retrospective cross sectional comparison of initial nonsurgical endodontic treatment and single-tooth implants

Initial root canal treatment and the replacement of a single tooth with implants are both viable treatment options, but various success rates have been reported for each treatment modality. This study compared 196 implant restorations and 196 matched initial nonsurgical root canal treatment (NSRCT) teeth in patients for four possible outcomes- success, survival, survival with subsequent treatment intervention and failure. Cross classifications/tabulations were analyzed using Pearson's chi(2) test for association of the two classifications (endo vs. implant and outcome). Polytomous regression with likelihood ratio tests were used in testing association with tooth location and outcome. Outcomes were as follows for implants and NSRCT outcomes, respectively: success 73.5% and 82.1%; survival with no intervention 2.6% and 8.2%; survival with intervention 17.9% and 3.6%; and failure 6.1% and 6.1%. Location of the restoration in the mouth did not affect outcome. This study suggests that restored endodontically treated teeth and single-tooth implant restorations have similar failure rates, although the implant group showed a longer average and median time to function and a higher incidence of postoperative complications requiring subsequent treatment intervention.     

Retrospective cross sectional comparison of initial nonsurgical endodontic treatment and single-tooth implants

Initial root canal treatment and the replacement of a single tooth with an implant are both viable treatment options, but various success rates have been reported for each treatment modality. This retrospective study compared 196 implant restorations and 196 matched initial nonsurgical root canal treatment (NSRCT) teeth in patients for four possible outcomes: success, survival, survival with subsequent treatment intervention and failure. Cross classifications/tabulations were analyzed using Pearson's chi2 test for association of the two classifications (endodontic vs implant and outcome). Polytomous regression with likelihood ratio tests were used in testing association with tooth location and outcome. Outcomes were as follows for implants and NSRCT respectively: success 73.5% and 82.1%; survival with no intervention 2.6% and 8.2%; survival with intervention 17.9% and 3.6%; and failure 6.1% and 6.1%. Location of the restoration in the mouth did not affect outcome. This study suggests that restored endodontically treated teeth and single tooth implant restorations have similar failure rates, although the implant group showed a longer average and median time to function and a higher incidence of postoperative complications requiring subsequent treatment intervention.     

Conference Report

Abstract

The criteria that dentists use to judge the need for orthodontic treatment are not clear. This study investigates variation in dentists' perception of orthodontic treatment need. Seventy-four dentists were asked to assess 320 dental casts in relation to aesthetic and dental health need. The results of this investigation revealed that the panel was divided as what constituted a need for orthodontic treatment on dental health grounds. It is suggested that one method of achieving a more uniform evaluation of orthodontic treatment need is the use of an occlusal index. Until an occlusal index is accepted and used by the profession, the distortion of need and demand for orthodontic treatment by dentists' unequal perceptions will continue.     

Assessment of orthodontic treatment need: a comparison of study models and facial photographs

Abstract – Objectives: The current study aims to examine how orthodontic treatment need is prioritized depending upon whether dental study models or facial photographs are used as the means of assessment. Methods: A group of three orthodontists and three postgraduate orthodontic students assessed: (i) dental attractiveness; and (ii) need for orthodontic treatment in 40 subjects (19 males, 21 females). The 40 subjects displayed a range of malocclusions. Separate assessments were made from study models and facial photographs. Results: There was a bias towards higher scores for dental attractiveness from facial photographs compared with assessment of study casts, for all examiners. This was statistically significant for five of the six examiners (P = 0.001–0.101). The need for orthodontic treatment was rated as 20% higher from study models compared with facial photographs (P < 0.001); overall the level of need for orthodontic treatment was rated as 18.9% higher from study models compared with facial photographs (P < 0.001). Reproducibility analyses showed that there was a considerable variation in the intra‐ and inter‐examiner agreement. Conclusions: This study shows that a group of three orthodontists and three postgraduate students in orthodontics: (i) rated orthodontic treatment need higher from study models compared with facial photographs and; (ii) rated dental attractiveness higher from facial photographs compared with study models. It is suggested that the variable intra‐examiner agreement may result from the assessment of orthodontic treatment need and dental attractiveness in the absence of any specific assessment criteria. The poor reproducibility of assessment of orthodontic treatment need and dental attractiveness in the absence of strict criteria may suggest the need to use an appropriate index.     

Reimplantation of primary tooth – case report

Abstract –  This article reports a clinical case of a primary tooth avulsion followed by dental reimplantation and endodontic treatment according to the protocol established by the Federal University of Santa Catarina for the treatment of traumatized primary teeth. A patient, 2 years and 6 months of age, MR, suffered the avulsion of tooth 61 because of a fall at school. The child was given dental assistance within 30 min, and the avulsed tooth was stored in milk during the period. After radiographic examination, the tooth was reimplanted and splinted. This procedure was performed after having obtained the mother's permission. Endodontic treatment was implemented a few days after the reimplantation because of the pulp necrosis that originated from a neurovascular bundle rupture. The endodontic treatment consisted of calcium hydroxide manipulated using glycol propylene dressings. After 12 months of treatment, the avulsed tooth presented the absence of periapical bone rarefaction in addition to a dry root canal, presenting ideal conditions for a definitive obturation. The obturation was applied using ZOE. The follow-up procedures on the obturated tooth were performed until the total eruption of the succeeding permanent tooth had been achieved, with no sequelae. Reimplantation, followed by endodontic treatment performed according to biological principles, has proven to be a good option for avulsed primary teeth.     

Functional and esthetic restorative treatment with preheated resins in a patient with ectodermic dysplasia: A clinical report

Ectodermal dysplasia is a heterogeneous genetic condition affecting 1.6 to 22 per 100 000 people. Oral manifestations associated with this condition include hyperdontia, hypodontia, microdontia, and conical teeth. Traditional treatment consists of a combination of orthodontic and rehabilitation therapies. The initial treatment stage uses removable prostheses and interim crowns for long periods, thus increasing risks for developing secondary caries. This clinical report describes the use of direct composite resin bonding with preheated compactable resins applied to vacuum-formed trays filled with clear silicone. This restorative treatment provides predictable, inexpensive, minimally invasive, functional, and esthetic recovery before orthodontic treatment.     

Cost-effectiveness of pulp capping and root canal treatment of young permanent teeth

Objective: To contribute with information on cost-effectiveness of pulp capping and root canal treatment of posterior permanent vital teeth in children and adolescents with pulp exposures due to caries.

Material and methods: Cost-effectiveness by means of a Markov simulation model was studied in a Scandinavian setting. In a simulated 12-year-old patient, treatment of pulpal exposure of a permanent tooth, either by the initial treatment pulp capping or root canal treatment, was followed for 9 years until the patient was 21. The model was based on outcome data obtained from published literature and cost data based on reference prices.

Results: In the simulated case, with the annual failure probalility (AFP) of 0.034 for pulp capping, the total cost for an initial treatment with pulp capping and any anticipated following treatments during the 9 years, was 367 EUR lower than for a root canal treatment as the initial treatment. After an initial treatment with pulp capping 10.4% fewer teeth, compared with initial root canal treatment, were anticipated to be extracted. Pulp capping was thus considered to be the cost-effective alternative. The sensitivity analyses showed that the AFP of a tooth requiring a root canal treatment after an initial pulp capping needed to be 0.2 before root canal treatment may be considered being the cost-effective treatment.

Conclusions: This model analysis indicated initial treatment by pulp capping to be cost-effective compared to root canal treatment in children and adolescents with pulp exposures due to caries.     

Malocclusion and orthodontic treatment need of 15–74-year-old Dutch adults

In 1986 a nationwide dental survey was performed in the Netherlands. This article describes the prevalence of dentofacial anomalies in the age group 15-74 yr, as well as the subjective and objective need for orthodontic treatment. The main findings were: severe crowding in the mandible was found in approximately 15%; an Angle Class II situation was seen in 28%; a maxillary overjet of greater than 5 mm was found in 23%; orthodontic treatment had or was being performed in approximately 25%; 45% of orthodontic treatment was carried out by a general practitioner; using professionally defined need, 39% of the population required treatment whereas only 14% of the people felt that this treatment was necessary.     

Body weight and serum albumin change after prosthodontic treatment among institutionalized elderly in a long‐term care geriatric hospital

Abstract – Objectives: An important purpose of denture treatment is the improvement of nutritional intake. This is especially important for the dependent elderly who have a high risk of protein‐energy malnutrition. To evaluate the impact of denture treatment on such a population, we compared body weight as an indicator of nutritional status before and 6 months after prosthodontic treatment. Methods: This study was conducted in a long‐term care geriatric hospital in Hiroshima, Japan from October 2004 to September 2006. One hundred and four patients received complete or partial denture treatment in both jaws. Nineteen patients were lost to the study because of the development of severe physical conditions or death. Among the remaining 85 patients, 66 used their new prostheses and 19 did not. Body weight and serum albumin levels were examined at prosthesis insertion and 6 months after treatment. Results: Six months after prosthodontic treatment body weight changes were significantly different between users and non‐users regardless of denture type and, in addition, serum albumin level were significantly increased among individuals using partial denture in either or both jaws (P < 0.05). Conclusion: It can be concluded that prosthodontic treatment may improve the nutritional status of institutionalized elderly.     

Management of a complicated crown-root fracture using adhesive fragment reattachment and orthodontic extrusion

Abstract –  Dental trauma is more common in young patients and its sequelae may impair the establishment and accomplishment of an adequate treatment plan. This paper reports a case of complicated crown-root fracture in a young adult that was treated using adhesive tooth fragment reattachment and orthodontic root extrusion. Considering the time elapsed to follow up, the fracture extension, the amount of remaining root portion and the patient's low socioeconomic status, the treatment approach proposed for this case provided good functional and aesthetic outcomes. Clinical and radiographic results after 2 years were successful. This case report demonstrates the importance of establishing a multidisciplinary approach for a successful dental trauma management.     

Individueller Gesichtsschutz nach Frakturversorgung am Nasenbein und Jochbogen bei Profifußballern

Background. The treatment of sport accidents in professional athletes requires special treatment modalities, especially concerning quick rehabilitation. Case report. As early as 5 days after treatment of a nasal bone fracture under local anesthesia on an outpatient basis, an individual nasal shield out of silicone and acrylate could be manufactured from a facial impression for a professional soccer player. This shield enabled unlimited participation in the ensuing premier league matches 7 and 14 days after the accident. The same treatment was performed for another team member after closed reposition of a zygomatic arch fracture. Treatment modalities and manufacturing of the facial protection masks in these two cases are presented as examples.     

Mental disorders in dental practice: A case report of body dysmorphic disorder

Given the high prevalence of mental disorders in Western societies, dentists may be confronted with behaviors that may interfere with the safe and efficient delivery of dental care. This paper addresses the need for dentists to be aware of patient vulnerability factors and psychological problems due, for example, to the possible negative effects of psychological distress and critical incidents, and their consequences for both symptom presentation and dental treatment planning. This need for awareness is illustrated by a case report of a patient who developed body dysmorphic disorder (BDD)—a preoccupation with some imagined defect in physical appearance—following dental treatment.     

Calendar of Meetings

Abstract

Over a 1-year period, all patients attending a consultant orthodontist's new patient clinics in North Derbyshire and whose treatment plans involved active appliance treatment, were accepted into a prospective longitudinal study. In all 294 patients were included in the study. Subsequent to the consultant's new patient clinic the patients' active treatments were undertaken in the Hospital, General, or Community Dental Services. Four years after the commencement of the study, 207 patients had completed active treatment and 50 had non-completed during active treatment. This gave an overall non-completion rare (NCR) of 19·5 percent for the study. Of the 50 patients who did not complete treatment during active treatment 23 (46 per cent) non-completed during the first 6 months of active treatment. A predictive model of non-completion of active orthodontic treatment (NCT) over time is suggested.     

Comprehensive dental treatment under general anaesthesia

Objectives

Patients unable to tolerate routine dental treatment in an ordinary dental setting may undergo a wide range of dental procedures under general anaesthesia. This report describes a practical protocol for providing full dental treatment under general anaesthesia.

Matherials and Metods

The importance of adequate treatment planning and safety measures is illustrated through the presentation of clinical cases.

Results

Suggestions are provided as to the use of techniques managing difficult treatment settings that allow the implementation of high-quality dental care in long sessions.

Conclusions

Complete treatment can be achieved in a single visit, thus avoiding repeated risk of anxiety for the patient associated with the treatment as well as subsequent further sessions with related schedule adjustment.     

British Orthodontic Society,UTG session abstracts

Abstract

The popularity and availability of virtual technology in orthodontics for the replacement of hard-copy records with electronic records is growing rapidly, with a move towards a ‘digital’ patient for diagnosis, treatment planning, monitoring of treatment progress and outcome. As part of this ongoing development, three-dimensional digital models of the dental arches have the potential to replace traditional plaster models and their associated limitations for treatment planning, appliance construction and simulated treatment outcomes. This article provides the reader with a summary of the currently available benchtop model scanners and intraoral scanners. It is likely that this technology will become increasingly common-place within the orthodontic profession over the next decade.     

Is endodontic treatment performed under general anaesthesia technically acceptable?

Objectives

Undertaking endodontic treatment under general anaesthesia (GA) is often described as difficult and hazardous, but no study reports on safe and efficacious conditions for endodontic treatment under GA. This study aims to evaluate whether compromises made for the endodontic treatment of permanent teeth under GA are acceptable. It describes the quality of endodontic treatment undertaken in two series of consecutive patients treated either under GA or local anaesthesia (LA).

Materials and methods

Post-operative data sheets and periapical radiographs were collected for 255 permanent teeth treated under GA during a 4-year period (GA group, 125 patients with special needs) and for 246 permanent teeth treated under local anaesthesia over 7?months (LA group, 180 healthy patients). The radiographic criteria for quality of endodontic treatment (RCQET) were considered satisfactory when (1) the root filling was within 2?mm of the apex; (2) the filling displayed no voids or defects; and (3) all the visible canals had been obturated. The type of tooth, pulpal status and periapical status were considered independent variables for RCQET.

Results

The proportion of satisfactory RCQET reached 63% in both groups and differed by type of tooth, being significantly lower for molars than for other teeth.

Conclusion

From a technical point of view, compromises made for the endodontic treatment of permanent teeth under GA are acceptable. Further studies should be conducted to evaluate the long-term success of endodontic treatment performed under GA.

Clinical relevance

This study supports the feasibility of endodontic treatment for patients treated under GA.