Intra-alveolar surgical uprighting of impacted teeth: a case report

Abstract Although orthodontic repositioning of impacted teeth is widely used, the treatment has its limitations. Autotransplantation or intra-alveolar surgical repositioning of teeth is an alternative therapy that may be used in selected cases of desperate impactions, when orthodontic extrusion is unsuccessful or when orthodontic treatment is rejected by the patient. A case report is presented to stress both the indications and limitations of a modified technique of intra-alveolar surgical uprighting of impacted teeth.     

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自体牙移植术从20世纪中叶开始有文献记载（PubMed）至今仅有50年的历史,此间其经过不断地发展与进步,现已成为一种安全和具有可预测性的操作。虽然目前自体牙移植术尚未被列入缺牙的常规治疗方法之中,但随着技术和材料的不断进步,其必将对保持牙列完整,恢复牙槽突高度,并提供可接受的美学和生理学结果做出更大的贡献。     

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在满足适应证条件下,自体牙移植是很多病例值得尝试的选择,良好的牙移植术及围手术期处理会取得超过90％以上的成功预期,自体牙移植术的操作过程应该注意采用微创方法拔除患牙、预备受区和植入供牙,并且术前检查和准备应做到有备无患,术后应采用合理方式固定以及根据牙根发育情况进行根管治疗等,以保证移植牙实现牙周韧带愈合和长期保有良好功能。     

The evaluation of direct composite restorations for the worn mandibular anterior dentition - clinical performance and patient satisfaction

This prospective split-mouth clinical trial evaluated the performance and patient satisfaction of 168 Herculite XRV direct composite restorations bonded to the worn anterior dentition of 18 patients with localized anterior tooth surface loss. One hundred and six of these restorations were placed on the mandibular anterior teeth. The restorations increased the anterior occlusal vertical dimension between 0.5 and 5 mm and the posterior occlusal contacts were restored after a mean duration of 6.2 months (range: 3-13 months) in 14 out of the 15 'Dahl' sub-group patients. The restorations were evaluated after 2.5 years of service by five examiners. Four patients and 23 mandibular restorations were lost to follow-up. Multiple clinical and restorative variables were assessed to determine their influence on restoration performance. Complete failure occurred in 6% of the restorations. Circumferential preparation and height of the restorative addition did not influence the performance of the restorations. A Visual Analogue Scale (VAS) was used to assess the patient's opinion regarding sensitivity, aesthetics, longevity and function of the worn mandibular anterior teeth. A statistically significant difference (95% CI) was found between the pre-operative and 1-month review VAS responses for aesthetics and longevity and this was maintained at the 2.5-year review. Direct composite restorations placed at an increased occlusal vertical dimension are a simple and time-efficient method of managing the worn mandibular anterior dentition. Patient's acceptance and adaptation to the technique is good and the results are accompanied with a high level of patient satisfaction that is maintained for the medium-term.     

阻生恒牙的影像学调查分析

目的：对患者除第三磨牙之外其他恒牙的阻生情况进行影像学分析。方法：通过全口曲面断层片,研究548例阻生牙的阻生情况,记录患者的性别、年龄、阻生牙位以及阻生类型,分析导致恒牙阻生的局部因素。结果：除第三磨牙外的恒牙阻生的发生率是6.15%,女性发生率高于男性,上颌牙阻生发生率高于下颌牙。尖牙阻生发生率最高,占所有阻生牙的28.10%。垂直阻生最多（49.09%）。发生阻生的最常见的局部因素是间隙不足（49.64%）。结论：所有恒牙均有可能发生阻生。口腔科医师在制定治疗计划前首先要有一个全面的评估。     

手术定位导板在埋伏多生牙拔除中的应用

目的 探讨基于锥形束CT（CBCT）和计算机辅助设计/制造（CAD/CAM）技术的手术定位导板在埋伏多生牙拔除中的应用。方法 选择上颌前区埋伏多生牙患者15例,通过CBCT确定手术入路方式,CAD/CAM技术设计制作唇侧入路手术导板或腭侧入路手术定位导板,并应用到手术中定位拔除埋伏多生牙。结果 手术定位导板在术中均贴附良好,可迅速定位并暴露多生牙,同时避让邻近重要解剖结构。结论 手术定位导板在埋伏多生牙拔除中可以精确定位及减少手术创伤。     

A retrospective clinical and radiologic study of teeth re-implanted following traumatic avulsion

Abstract Re-implantation is the recommended therapeutic procedure following traumatic exarticulation of teeth though its long-term prognosis remains controversial. The purpose of the following study was to evaluate the periodontal healing of 33 reimplanted incisors lost after trauma. The sample, which included 24 upper and 9 lower incisors, was divided in two groups: 15 teeth were reimplanted within 1 hour (=Group A) and 21 teeth after 3 hours or more (=Group B). The reimplanted teeth were followed for different radiographic evaluation periods up to 5 years (mean = 2–9 years). The results showed a high rate of periodontal healing in Group A (66.7%), while Group B demonstrated a high percentage (83.3%) of both inflammatory and replacement resorption. Thus, even if the whole sample was prevented from drying before reimplantation, the teeth were affected by different rates of root resorption. Among the various prognostic factors suggested by the literature, bacterial contamination during extra-alveolar storage seemed the most critical.     

闭合式开窗术在完全骨内阻生埋伏牙导萌中的应用

目的：探讨闭合式开窗术配合正畸牵引在骨内阻生埋伏牙导萌中的应用效果。方法：对需要进行导萌的22例23颗完全骨内埋伏牙进行闭合式开窗术,粘接正畸附件,并对没有自主萌出倾向的埋伏牙进行牵引治疗。结果：20例患者21颗埋伏牙成功达到正常咬合位置,牙周健康,牙髓活力正常,无邻牙损伤,1例放弃治疗后再次开窗取出牵引装置,1例因与邻牙牙根关系密切牵引未成功而拔除埋伏牙。结论：闭合式开窗术配合正畸牵引是一种较好的埋伏牙导萌方法,成功率高,容易获得较好的治疗效果。     

Accuracy and surgical feasibility of a CBCT‐based stereolithographic surgical guide aiding autotransplantation of teeth: in vitro validation

Summary The aims of this study were to determine the accuracy of a 3D computer model and stereolithographic (STL) replica when compared to the real tooth and to develop a cone beam computed tomography (CBCT)‐based planning technique including surgical guide fabrication. A STL surgical guide and a tooth replica were fabricated using SimPlant Pro 12.1. To validate this process, tooth segmentation and replica design were prepared for comparison to an optical scan of the corresponding tooth. For surgical intervention, a dry dentate mandible was scanned using a Scanora CBCT and the donor tooth was segmented. The donor tooth was repositioned, and two guides were designed. These tooth replica and guides were used in socket preparation of the dry mandible. The 3D computer model of the segmented teeth and related STL models showed satisfactory results with an acceptable accuracy. The surfaces were within 0·25 mm distance, but in some areas up to 2·5 mm deviation were seen. The results showed that 79% of the points was between 0·25 and ?0·25 mm, 3% was overestimated (>0·25 mm) and 18% was underestimated (in vivo planning of CBCT‐based autotransplantation.     

Effect of maxillary impaction on mandibular surgical accuracy in virtually-planned orthognathic surgery: A retrospective study

Although surgical accuracy has been evaluated in bi-maxillary procedures, few studies have investigated the relationship between maxillary and mandibular accuracy. The present study evaluated the effect of maxillary impaction accuracy on mandibular surgical outcome.This cohort study analyzed skeletal class III patients who underwent planned maxillary impaction in bi-maxillary surgery. The primary predictor was the difference between the virtual plan and surgical outcome in the maxilla, as determined by three-dimensional (3D) and vertical differences. The secondary predictors were the planned 3D distances in the maxilla and mandible. The primary outcome was mandibular surgical accuracy, defined as the difference between the planned and actual outcomes, calculated as 3D Euclidean distance.The study included 73 patients. Increased differences between the planned and actual outcomes in the maxilla were associated with increased differences in the mandible. The post-operative position of the mandible was closer to the planned position when the position of the impacted maxilla was superior than when it was inferior to the planned position.Moving the maxilla closer to the planned position resulted in a more accurate mandibular position. These findings suggest that careful surgical procedures are needed to avoid inferior positioning of the maxilla during maxillary impaction surgery.     

Implant‐retained mandibular overdentures compared with complete dentures; a 5‐years' follow‐up study of clinical aspects and patient satisfaction

The aim of this prospective randomized controlled clinical trial was to evaluate and compare clinical aspects and satisfaction during the first year following treatment and consecutively the change in treatment during the next 4 years of follow-up. Patients were allocated to one of the following treatment modalities: an implant-retained overdenture (IRO-group, 2 endosseous implants, n = 61) or a complete denture (CD-group, n = 60). One year after placement of the denture, unsatisfied patients of the CD-group got the opportunity for a retreatment including an implant-retained overdenture. In the IRO-group 4 implants were lost during the first year and again 4 implants were lost during the next 4 years (survival rate: 93%). All patients could be re-operated successfully. In the CD-group 14 patients (23%) chose an implant-retained overdenture after 1 year. Patients of the IRO-group were significantly more satisfied than patients of the CD-group after 1 year (satisfaction score 8.3 versus 6.6, scale 1-10) and after 5 years (7.4 versus 6.4). From this study it can be concluded that endosseous implants have a high survival rate after 5-years' follow-up. Satisfaction score of the IRO-group is diminishing in time, probably because patients get used to an improved situation. After 5 years, the mean satisfaction score of the CD-group (including patients who got implants) was still lower than of the IRO-group, in spite of the opportunity to a retreatment and have implant-retained overdentures.     

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.     

Bone regeneration after surgical repositioning of impacted mandibular second molars: a case report

Abstract  – A case is presented where the mesially impacted mandibular second molar teeth were surgically uprighted in an 11-year-old female patient. Bone regeneration is shown in the areas occupied by the impacted second molars with maturation of bone and cortication of the crest of the alveolar bone. The probing depths are also normal with no residual bony defects. This healing was achieved with no bone grafting procedure, emphasizing two important factors: to prevent/minimize any trauma to the tissues at the site of elevation and uprighting of the tooth (i.e. maintaining viable periodontal ligament cells and minimal cementum damage); and to obtain primary closure whilst allowing the tissue in the mesial defect to reorganize against the scaffold of bone. However, the procedure on the one side was complicated with necrosis and infection of the pulp space with external inflammatory root resorption. Endodontic therapy of this tooth proved to be successful with periradicular healing radiographically and re-establishment of the lamina dura. At the 3-year follow-up, the endodontically treated tooth showed no clinical and radiographic signs of pathology. The left second mandibular molar had no pulpal or periodontal postsurgical complications, which may be attributed to apparently more open apices allowing for pulp revascularization after manipulation at the time of surgery. This report illustrates unassisted wound healing that occurs in the area of uprighting with complete reconstitution of periodontal anatomy without additional regenerative procedures to augment bone.     

Surgical and orthodontic treatment of an impacted permanent incisor: case report

Abstract –  This case report presented a combined surgical/orthodontic treatment of an impacted permanent incisor of a 10-year-old boy. Trauma to the primary dentition caused the impaction of the maxillary left permanent central incisor. Application of push coil spring between the adjacent teeth created space for the impacted tooth. A button with an extension of ligature wire was bonded to the maxillary left permanent central incisor to bring it into the arch. The maxillary left permanent central incisor was brought to its proper position after 16 months of active orthodontic treatment.     

Dental implant placement in alveolar cleft patients: a retrospective comparative study on clinical and aesthetic outcomes

The aim of this retrospective study was to assess the clinical and aesthetic outcomes, and patient satisfaction, following dental implant therapy in cleft patients. Implant survival, changes in marginal bone level, pocket probing depths, plaque and bleeding indices, aesthetics, and patient satisfaction were assessed in 17 alveolar cleft patients and 17 matched controls. At follow-up (mean 72.4 ± 46.4 months), one implant had been lost in the cleft group. Mean marginal bone loss at follow-up was −0.4 ± 0.4 mm in cleft patients and −0.2 ± 0.4 mm in controls. Aesthetics of the peri-implant soft tissues (pink aesthetic score) were less favourable (P = 0.025) in cleft patients (5.0 ± 1.9) than in controls (6.5 ± 1.7), while peri-implant parameters were comparable in the two groups. Overall patient satisfaction was 8.6 ± 0.9 in cleft patients and 8.9 ± 1.1 in controls (P = 0.331). In cleft patients, no difference in aesthetics was observed between patients who received additional bone augmentation at 3 months prior to implant placement and those who did not (P = 0.092). Dental implant therapy in cleft patients is associated with high implant survival, minor marginal bone loss, healthy peri-implant soft tissues, and high patient satisfaction. Only the aesthetics of the soft tissues was worse in cleft patients compared to augmented non-cleft patients.