Treatment of replacement resorption by intentional replantation, resection of the ankylosed sites, and Emdogain®– results of a 6-year survey

Abstract –  The present clinical study investigated the outcome of intentional replantation using resection of the ankylosed sites of the root, extraoral endodontic treatment using titanium posts and Emdogain^® for periodontal healing following trauma-related ankylosis. During an evaluation period of 6 years, 16 ankylosed teeth affected by replacement resorption were treated as described. Evaluation parameters before treatment and during the follow-up period included Periotest^® scores, percussion sound and periapical radiographs. All findings were compared to those of the adjacent teeth. In a second accident, one tooth was lost after 7 months and was excluded as a dropout. Ankylosis did not recur in seven replanted teeth, which were observed for an average of 52.3 months (range: 24–68 months). Ankylosis recurred in eight teeth after an average period of 12 months (range: 4–26 months). An infraocclusion, normal or only slightly reduced Periotest^® scores and normal percussion sound were preoperatively found in six of seven successfully replanted teeth, which corresponded to a relatively small area of ankylosis. The majority of the teeth showing recurrent ankylosis preoperatively presented with normal position, negative Periotest^® scores and a high percussion sound which corresponded to an extended area of ankylosis. Statistically significant relationship between preoperative findings and the treatment outcome ( P  = 0.031) have become apparent. The results indicate that the treatment of minor areas of ankylosis by intentional replantation, resection of the ankylosed sites and Emdogain^® appeared to prevent or delay the recurrence of ankylosis in 7 of 15 teeth.     

The conservative treatment of pediatric mandibular fracture with prefabricated surgical splint: a case report

Abstract –  The use of rigid fixation in children is controversial and may cause growth retardation along cranial suture lines. Intermaxillary fixation for mandibular fractures should be used cautiously as bony ankylosis in the temporomandibular joint (TMJ) and trismus may develop. The high osteogenic potential of the pediatric mandible allows non-surgical management to be successful in younger patients with conservative approaches. In this case, successful conservative treatment of mandibular fracture of a 3-year-old patient is presented.     

Replantation of 45 avulsed permanent teeth: a 1-year follow-up study

Abstract –  Thirty-four patients with 45 avulsed and replanted permanent teeth were followed for 1 year. All teeth were soaked in tetracycline before replantation. In addition, enamel matrix derivative was used in teeth with dry storage times exceeding 30 min. Splinting was carried out with a non-rigid titanium splint and was limited to 7–10 days. Within that period, root canal treatment was begun in all teeth with a closed apex, whereas teeth with an open apex and ideal post-traumatic storage were not instrumented. All patients were given tetracycline systematically for 10 days. The survival rate of replanted avulsed permanent teeth was 95.6% at the 1-year follow-up. In 82.2%, root canal treatment was performed. Pulp survival was never observed, but three teeth had pulp canal obliteration. Normal periodontal healing was observed in 57.7% of teeth; 42.3% of teeth showed external root resorption (28.9% replacement resorption, 6.7% infection-related resorption, 6.7% surface resorption). The occurrence of replacement resorption correlated with the period of extraoral dry storage. Compared with other clinical studies on avulsed and replanted teeth, the present study reports a higher percentage of periodontal healing. The favorable treatment outcome may be associated with a strict protocol to enforce endodontic treatment, the use of topical and systemic tetracycline, and the relatively high number of ideally stored teeth following avulsion. In contrast, the present study has a follow-up period limited to 1 year.     

Effect of different splinting methods and fixation periods on root development of autotransplanted immature third molars.

PURPOSE: The aim of the present study was to assess the influence of suture splinting for 1 week or rigid fixation for 4 weeks on final root length, root length increment, and mobility of autotransplanted immature third molars. PATIENTS AND METHODS: The sample consisted of 63 patients with a total of 65 transplanted immature third molars. All transplants had reached one-half (n = 29) to three-fourths (n = 36) of their expected root length. In 24 of the transplants, postoperative fixation was carried out with a rigid acid-etch composite and wire splint for 4 weeks (rigid group), and in 41 transplants, with a suture splint for 1 week (suture group). The fixation method depended on the initial stability of the transplants. All transplants were followed up clinically and radiologically for a mean period of 3.9 years. RESULTS: Transplants in the rigid group revealed a significantly lower final root length ( P = .002) and root length increment ( P = .001) than those in the suture group. The differences were found to be more pronounced in transplants at earlier developmental stages. No differences were found in transplant mobility. CONCLUSIONS: The results of the present study indicate that prolonged rigid fixation of autotransplanted immature third molars has a significantly negative influence on final root length and root length increment, especially in transplants at earlier developmental stages.     

Influence of surgical repositioning of mature permanent dog teeth following experimental intrusion: a histologic assessment

Abstract –  The aim of this study was to evaluate, through histologic examination, the effect of surgical repositioning of intruded dog teeth upon the pulpal and surrounding tissues. Thirty teeth in 10 adult dogs, aged 2–3 years, were used. Fifteen teeth were intruded, surgically repositioned and fixed using orthodontics wire, composite resin, and enamel acid conditioning. All these teeth served as the experimental group. The remaining intruded teeth were not treated (control group). The animals were sacrificed to allow observations at 7, 15, and 30 post-operative days. The maxillary and mandibular archs were removed and processed for histologic exam. Based on the methodology and observed results, we concluded that: pulpal necrosis, external root resorption and ankylosis were common sequelae to severe traumatic intrusion; a careful immediate surgical repositioning of severed intruded permanent tooth with complete root formation has many advantages with few disadvantages.     

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.     

Intentional surgical repositioning of an ankylosed permanent maxillary incisor

Abstract –  Replacement resorption (ankylosis) may be a significant complication after replantation of avulsed permanent incisor teeth. This report explains the aetiology, diagnosis, management and current treatment options in ankylosis and then describes an alternative surgical technique, intentional luxation and repositioning. This technique, in the presence of an acceptable root length, may be a realistic treatment option in adolescence until osseointegrated implants can be considered at the age of 18–20 years.     

Emdogain® does not prevent progressive root resorption after replantation of avulsed teeth: a clinical study

Abstract –  Emdogain^® has been shown in clinical and experimental studies to promote regeneration of all periodontal tissues: cementum with anchoring fibres, a functional, periodontal ligament and alveolar bone in connection with treatment of marginal periodontitis.
The intention of this study was to analyse whether this regenerative capacity upon the periodontal ligament also worked in a trauma situation where a significant number of PDL cells have been eliminated because of unphysiologic storage or actual damage during avulsion or replantation. Furthermore if ankylosis sites already established because of earlier replantation after avulsion could be surgical removed and application of Emdogain^® could revert the ankylosis stage to a normal PDL situation. The first treatment situation was tested in seven patients with a total of 16 avulsed teeth with varying time of extra oral storage. The teeth were extra-orally endodontically treated and the root and socket covered with Emdogain^® before replantation. All teeth demonstrated subsequent ankylosis, primarily diagnosed by a percussion test. The second treatment situation where an ankylosis was already established constituted of seven patients with a total of 11 teeth because of previous replantation after avulsion. These teeth were all extracted, the ankylosis sites removed and the root and socket treated with Emdogain^®. After 6 months all teeth showed recurrence of ankylosis. It is concluded that Emdogain^® was not able to prevent or cure ankylosis.     

Long-term effects of local pretreatment with alendronate on healing of replanted rat teeth

Background and Objective:  Our previous study showed that topical alendronate, an inhibitor of bone resorption, reduces root resorption and ankylosis for 21 d after replantation of rat teeth. The aim of the present study was to evaluate the long-term inhibitory effects of topical alendronate in the replanted teeth.
Material and Methods:  The rat maxillary first molars were extracted, placed in saline containing 1 m m alendronate (alendronate group) or saline (saline group) for 5 min and then replanted. The maxillae were dissected at 60 and 120 d. Microcomputed tomography horizontal sections at three root levels were analyzed for root and bone resorption, ankylosis and pulp mineralization.
Results:  In the alendronate group at 60 and 120 d, the frequencies of resorption of roots and bone were lower than those in the saline group. The p values show statistical significances of lower frequencies in the alendronate group than in the saline group by chi-square test (see Table 1 ). Ankylosis and pulp mineralization occurred in the alendronate and saline groups. Bone marrow spaces were narrowed in conjunction with bone tissue expansion around the replanted teeth in the alendronate group.  

  Table 1.  Percentage of sites with ankylosis, root resorption, bone resorption and pulp mineralization for the alendronate and saline groups at 60 and 120 d after tooth replantation     

10.

Tooth transplantation after dental injury sequelae in children   总被引：2，自引：0，他引：2  

Jaime Andrés Díaz  rés Marcelo Almeida  Anibal Adrián Benavente 《Dental traumatology》2008,24(3):320-327

Abstract –  Ten immature autotransplanted lower premolars from six patients from 7 to 12 years of age were studied and assessed clinically and radiographically at Regional Clinical Hospital in Temuco between January 2004 and April 2006. All transplantations were performed both because of a missing anterior tooth by dental trauma or by healing complications after injuries. The mean age at the time of the surgery was 10 years (range 7–12 years) and the postoperative follow-up period varied from 5 to 27 months with a mean of 16.9 months. All teeth were stabilized with flexible composite resin wire splints. Within the follow-up period, clinical evaluation was made through percussion and mobility tests. At radiographic evaluation, pulpal canal obliteration (PCO), presence of perirradicular area, inflammatory root resorption (IRR), replacement resorption (RR), stage of root development, lamina dura formation, outline of the periodontal membrane, and arrest in root growth were registered. Pulp healing was observed in 6 of 10 teeth; the other transplanted teeth developed pulp necrosis after 6–8 months possibly related to operative aesthetic procedures. Four teeth showed different grades of PCO at radiographic examination. None of transplanted teeth developed replacement resorption or ankylosis. In this 27-month follow-up period, the survival rate was 100%, regarding aesthetics, function, clinical appearance, and radiographic image of alveolar process.     

11.

Effect of immediate calcium hydroxide treatment and permanent root-filling on periodontal healing in contaminated replanted teeth     

ANNELIE LENGHEDEN  LEIF BLOMLOF  SVEN EINDSKOG 《European journal of oral sciences》1991,99(2):139-146

Abstract – The effect of immediate permanent root-filling and immediate intracanal calcium hydroxide treatment on experimentally contaminated and necrotized periodontal membranes (PDM) in avulsed and subsequently replanted monkey teeth was studied. Almost the entire root surface in the non-endodontically treated control teeth were covered with inflammatory resorp-tion, A significant shift towards ankylosis not associated with root resorption (> 80% of the total root surface area) was noted following calcium hydroxide treatment. About two thirds of the root surfaces from the teeth with permanent root fillings showed surface resorptions or ankylosis preceded by root resorption. The root surface area which would have been covered by inffammatory resorption, unless endodontic treatment had been implemented, were instead predominantly covered by either surface resorption (permanent root filling) or ankylosis (calcium hydroxide treatment), Ankylosis compared with surface resorption may in the long term lead to progressive loss of root substance due to replacement resorption. It was concluded that calcium hydroxide may be an excellent initial intracanal treatment in teeth with healthy PDM, but care should be taken not to risk unnecessary development of ankylosis by prolonged treatment of teeth with compromised PDM.     

12.

Tooth loss and prosthodontic rehabilitation among 35- to 44-year-old Iranians     

Hessari H  Vehkalahti MM  Eghbal MJ  Murtomaa H 《Journal of oral rehabilitation》2008,35(4):245-251

Summary  This study aimed to investigate the frequency of tooth loss and the magnitude of prosthodontic rehabilitation based on socio-demographic information among 35- to 44-year-old Iranians. Data ( n  = 8240) were collected by 33 examiners as part of a national survey using WHO criteria for sampling and clinical diagnosis. Gender, age, place of residence and level of education served as socio-demographic information. The number of teeth, functional dentition (subjects with 20 or more teeth) and prosthodontic rehabilitation were used as clinical variables. The chi-square test and logistic regression analysis were the methods of statistical evaluation. Of all subjects, 3% were edentulous. Of dentate subjects, 3% had 1–9 teeth, 21% had 10–19 teeth, 37% had 20–24 teeth and 39% had 25–28 teeth. In total, 76% of dentate subjects enjoyed a functional dentition. Among dentate subjects, 11% of the men and 16% of the women had prosthodontic rehabilitation with higher figures ( P  < 0·001) among women, older subjects and urban residents. Having a functional dentition was more likely among those with higher levels of education [odds ratios (OR) = 1·8, 95% confidence intervals (CI) = 1·6–2·1]. Women (OR = 2·4, 95% CI = 1·8–3·0) and urban residents (OR = 2·4, 95% CI = 1·8–3·3) were the most likely groups to have prosthodontic rehabilitation. Having prosthodontic rehabilitation was more likely among those lacking a functional dentition (OR = 6·0, 95% CI = 4·8–7·6). The greatest unmet treatment needs were found among those without a functional dentition. Functional dentition should be set as a primary oral health goal among working-age adults.     

13.

Induction of traumatic temporomandibular joint ankylosis in growing rats: a preliminary experimental study     

Zhi Li  Wei Zhang  Zu-Bing Li 《Dental traumatology》2009,25(1):136-141

Abstract –  There are many reports on the management of pediatric temporomandibular joint (TMJ) ankylosis. However, few authors have investigated the etiology of this disease in children. The purpose of this study was to determine the role of damage to both the condylar cartilage and disk in the induction of traumatic TMJ ankylosis during the growth period. The study was performed in growing rats by a common condyle fracture model. Intentional damage was performed to both the disk and condylar cartilage in the experimental group ( n  = 12), while the disk and condylar cartilage in the control group was left untouched ( n  = 12). Sham-operated growing rats were deemed the blank group ( n  = 10). Two rats from the experimental group and two from the control group were killed 24 h after the operation, and the result following surgical intervention was observed. Each rat's body weight in the three groups was monitored and recorded at 1, 2, 4, 6, 8, 10, and 12 weeks after surgery. Twelve weeks after the operation, all animals were killed. The prognosis was compared by mandible deviation measure, body weight evaluation, and histological observation. Animals from the experimental group presented a slow body weight increase and obvious mandible deviation while all involved TMJs showed fibrous ankylosis in various degrees. The damage to both the condylar cartilage and disk in the condylar fracture might play a vital role in traumatic TMJ ankylosis development during the growth period. The results of this study suggest that more attention should be paid to condylar fractures in children that are accompanied with severe cartilage and disk damage, which is a matter of significance for pediatric TMJ ankylosis prevention.     

14.

Intentional replantation for periodontally involved hopeless teeth     

Burak Demiralp  Rahime Meral Nohutçu  Durul I&#;ik Tepe  Kenan Eratalay 《Dental traumatology》2003,19(1):45-51

Abstract –  The aim of this study was to evaluate the clinical and radiographic results of intentional replantation of periodontally involved teeth after conditioning of root surfaces with tetracycline–HCl. Thirteen patients (seven female, six male; age range: 35–52 years) with 15 periodontally involved hopeless teeth were included in this study. During the replantation procedure, the affected teeth were gently extracted, then the granulation tissues, calculus, remaining periodontal ligament and necrotic cementum on the root surfaces were removed. Tetracycline–HCl, at a concentration of 100 mg ml⁻¹, was applied for 5 min to the root surfaces. The teeth were then replaced into the socket and splinted. Patients were clinically and radiographically evaluated at baseline (time of surgery) and 6 months after the surgery. The following measurements were recorded: probing depth (PD), gingival recession (R), the amount of bone loss (BL) and bone gain (BG). Results indicated a reduction in PD and in the amount of bone loss and healthy gingiva. Mean PD was decreased from 5.25 to 2.36 mm, gingival recession was increased from 3.73 to 4.0 mm, and BL was reduced from 73.20 to 56.86%. At the end of 6 months, no root resorption or ankylosis was observed radiographically. Even during the short period of evaluation, it may be suggested that intentional replantation can be an alternative approach to extraction in cases where advanced periodontal destruction is present and no other treatments could be considered.     

15.

Clinical outcomes for permanent incisor luxations in a pediatric population. II. Extrusions     

Raymond Lee  Edward J. Barrett  David J. Kenny 《Dental traumatology》2003,19(5):274-279

Abstract  – A longitudinal outcome study was undertaken to identify variables that significantly influenced outcomes for extruded permanent maxillary incisors of children and adolescents. Clinical and radiographic data was available for 35 patients (18 males, 17 females) representing 55 incisors. Mean age at the time of injury was 10.6 years (range: 7.1–17.8 years). Mean time elapsed to follow up was 1320 days (range: 423–2887 days). Survival analysis was used to identify variables significantly related to the prognosis of these teeth. The loss of an incisor following extrusion was uncommon as only one tooth (1/55) required extraction. There was no statistically significant difference in survival between severely extruded teeth and avulsions that had been stored in physiological media ( P  > 0.10). Pulp necrosis (PN) was the most common complication following injury (43%) and it most often occurred during the first year. Although not statistically significant, a trend towards increased PN was found with more severely extruded teeth ( P  = 0.20, relative risk = 2.08). Pulp canal obliteration (PCO) was the second most common outcome (35%). The degree of extrusion was proven to be significantly associated with the development of PCO ( P  = 0.03, relative risk = 0.33). Root resorption was an uncommon outcome (3/55). This study represents the first outcome data on extrusions to permanent maxillary incisors in an exclusively pediatric population.     

16.

Dental injury among Brazilian schoolchildren in the state of São Paulo     

Sylvia Grimm  Paulo Frazão  José Leopoldo Ferreira Antunes  Roberto Augusto Castellanos  Paulo Capel Narvai 《Dental traumatology》2004,20(3):134-138

Abstract  – To describe the distribution of dental trauma in Brazilian schoolchildren and its association with demographic, environmental and clinical factors. A random sample of 73 243 schoolchildren's oral examination records from private and public units, selected from 131 cities within the state of São Paulo, Brazil, was analysed. Trauma was assessed based on international methodological standards prescribed by the World Health Organization for Oral Health Surveys (1997). Proportions obtained were compared between urban and rural schools, as well as between private and public units. Oral health status indices were estimated based on the decayed, missing and filled teeth (DMFT) index – the average number of decayed, missing and filled teeth; the proportion of caries-free 5-year-old schoolchildren and anterior maxillary overjet among 12-year-old schoolchildren. The prevalence of dental trauma in anterior dentition was of 2.4, enrolling average 1.2 teeth per child. A rate of 2.4 impaired anterior teeth per thousand was obtained, upper central incisors being those that were most affected – 7.7 in every 10. Among 8- to 11-year-old children, the rates grew regularly. The proportion of dental trauma was significantly higher in boys than in girls ( P  < 0.01), and gender prevalence ratio was of 1.58 for boys. The results showed positive associations between dental trauma and caries-free 5-year-old schoolchildren ( P  = 0.003), anterior maxillary overjet ≥3 mm ( P  < 0.001), and private school as a socio-economic proxy indicator ( P  = 0.048).     

17.

Effect of delayed calcium hydroxide treatment on periodontal healing in contaminated replanted teeth     

ANNELIE LENGHEDEN  LEIF BLOMLÖF  SVEN LINDSKOG 《European journal of oral sciences》1991,99(2):147-153

Abstract – The effect of delayed intracanal calcium hydroxide treatment on experimentally induced extensive inflammatory root resorption in monkeys was studied. A significant shift from inflammatory resorption to ankylosis was noted following calcium hydroxide treatment. Furthermore, calcium hydroxide treatment appeared to change the pattern of ankylosis over time, although the total ankylotic area remained the same. Ankylosis preceded by root resorption (replacement resorption) increased, while ankylosis not associated with root resorption decreased. It was concluded that intracanal calcium hydroxide treatment of teeth with compromised PDM may cause unnecessary replacement resorption if left in the root canal for a long time or changed repeatedly.     

18.

Tooth auto-transplantation with double periodontal ligament stimulation to replace periodontally compromised teeth     

Gault PC  Warocquier-Clerout R 《Journal of periodontology》2002,73(5):575-583

BACKGROUND: The healing process of autotransplantation puts 2 different tissues in competition: the ligament on the root surface and the bone tissue of the alveolus. This study shows the effects of a protocol with 2 surgical stages, which promote ligament repair, inhibit adhesion between bone and dental root, and reduce the occurrence of the ankylosis-root resorption phenomenon. METHODS: Forty-three patients, 33 to 73 years old, received 47 transplantations of mature teeth (including retained teeth) during a 5-year period. During the first surgical step, the transplanted tooth is extracted, measured, immediately replaced in its origin site, and maintained with an original suture technique. The alveolus to which the tooth will be transplanted is adapted after extraction of the periodontally compromised tooth. The second surgery occurs at day 14, when regeneration of periodontal ligament (PDL) is at a maximum (first stimulation). The tooth is transplanted in its new alveolus and retained using the same suture technique to avoid a rigid splint and to create mechanical stimulation of the PDL (second stimulation). RESULTS: The results were 95.75% positive with normal PDL, with a 4.25% failure rate (transplant loss) and no ankylosis. Mean probing reduction was 8.37 +/- 3.0 mm. Mean radiographic bone gain was 7.73 +/- 4.32 mm. CONCLUSIONS: This study suggests that auto-transplantation with double PDL stimulation can be a viable treatment in clinical practice, especially to replace teeth with large periodontal lesions, deep furcation defects, and/or root fractures. This study shows the high potential of stimulated PDL to regenerate alveolar bone and periodontal structures in severe destruction sites.     

19.

Influence of age on the behavior of dental pulp of dog teeth after capping with an adhesive system or calcium hydroxide     

Sandra R. Mestrener  Roberto Holland  Eloi Dezan Jr 《Dental traumatology》2003,19(5):255-261

Abstract  – This study evaluated histomorphologically the influence of chronological age of the dog on the dental pulp-healing process after capping with the All Bond 2 system or with calcium hydroxide paste. The animals were divided according to age into young and adult groups. Class 5-type cavities were prepared, and the pulp was submitted to an exposure of a diameter of 0.5 mm. The pulp of the teeth was then protected with the adhesive system or with a calcium hydroxide paste. Sixty days after treatment, the results obtained with the adhesive system in the young group were significantly better than those in the adult group. With calcium hydroxide, the results were similar for both groups. The pulp treated with calcium hydroxide exhibited a complete hard tissue bridge and a pulp without inflammatory reaction, a fact not observed when the adhesive system was used. In conclusion, the chronological age of the pulp influenced the comparative results only for the adhesive system ( P  = 0.1), and the total results were better with calcium hydroxide than with the All Bond 2 system ( P  = 0.01).     

20.

Impact of treated and untreated dental injuries on the quality of life of Ontario school children     

Kausar Sadia Fakhruddin  Herenia P Lawrence  David J Kenny  David Locker 《Dental traumatology》2008,24(3):309-313

Abstract –  A population-based, matched case–comparison study was undertaken in 30 schools in two Ontario communities to measure the impact of dental trauma on quality of life (QoL) in Canadian school children. Dental hygienists screened 2422 children aged 12–14 years using the dental trauma index, the decayed, missing and filled teeth index (DMFT) and the aesthetic component of the index of orthodontic treatment needs (AC-IOTN). Cases ( n  = 135) were children with evidence of previous dental trauma. Controls ( n  = 135) were classmates matched for age and gender. Oral-health-related QoL was assessed using mailed Child Perception Questionnaires (CPQ_11-14) completed by all children. Data were analyzed using simple and multiple conditional logistic regressions after adjusting for DMFT and AC-IOTN, CPQ_11-14, overall impact and item-specific impacts. Approximately 64% of injuries were untreated enamel fractures and just over 30% were previously injured restored teeth. Untreated children experienced more chewing difficulties ( P  = 0.026), avoided smiling ( P  = 0.029) and experienced affected social interactions ( P  = 0.032) compared with their non-injured peers. When treated and non-injured groups were compared, the only statistically significant effect was difficulty in chewing ( P  = 0.038). Injured children who were untreated experienced more social impact than their non-injured peers. Restoration of injured teeth improved aesthetics and social interactions but functional deficiencies persisted as a result of periodontal or pulpal pain.     

Tooth transplantation after dental injury sequelae in children

Abstract –  Ten immature autotransplanted lower premolars from six patients from 7 to 12 years of age were studied and assessed clinically and radiographically at Regional Clinical Hospital in Temuco between January 2004 and April 2006. All transplantations were performed both because of a missing anterior tooth by dental trauma or by healing complications after injuries. The mean age at the time of the surgery was 10 years (range 7–12 years) and the postoperative follow-up period varied from 5 to 27 months with a mean of 16.9 months. All teeth were stabilized with flexible composite resin wire splints. Within the follow-up period, clinical evaluation was made through percussion and mobility tests. At radiographic evaluation, pulpal canal obliteration (PCO), presence of perirradicular area, inflammatory root resorption (IRR), replacement resorption (RR), stage of root development, lamina dura formation, outline of the periodontal membrane, and arrest in root growth were registered. Pulp healing was observed in 6 of 10 teeth; the other transplanted teeth developed pulp necrosis after 6–8 months possibly related to operative aesthetic procedures. Four teeth showed different grades of PCO at radiographic examination. None of transplanted teeth developed replacement resorption or ankylosis. In this 27-month follow-up period, the survival rate was 100%, regarding aesthetics, function, clinical appearance, and radiographic image of alveolar process.     

Effect of immediate calcium hydroxide treatment and permanent root-filling on periodontal healing in contaminated replanted teeth

Abstract – The effect of immediate permanent root-filling and immediate intracanal calcium hydroxide treatment on experimentally contaminated and necrotized periodontal membranes (PDM) in avulsed and subsequently replanted monkey teeth was studied. Almost the entire root surface in the non-endodontically treated control teeth were covered with inflammatory resorp-tion, A significant shift towards ankylosis not associated with root resorption (> 80% of the total root surface area) was noted following calcium hydroxide treatment. About two thirds of the root surfaces from the teeth with permanent root fillings showed surface resorptions or ankylosis preceded by root resorption. The root surface area which would have been covered by inffammatory resorption, unless endodontic treatment had been implemented, were instead predominantly covered by either surface resorption (permanent root filling) or ankylosis (calcium hydroxide treatment), Ankylosis compared with surface resorption may in the long term lead to progressive loss of root substance due to replacement resorption. It was concluded that calcium hydroxide may be an excellent initial intracanal treatment in teeth with healthy PDM, but care should be taken not to risk unnecessary development of ankylosis by prolonged treatment of teeth with compromised PDM.     

Tooth loss and prosthodontic rehabilitation among 35- to 44-year-old Iranians

Summary  This study aimed to investigate the frequency of tooth loss and the magnitude of prosthodontic rehabilitation based on socio-demographic information among 35- to 44-year-old Iranians. Data ( n  = 8240) were collected by 33 examiners as part of a national survey using WHO criteria for sampling and clinical diagnosis. Gender, age, place of residence and level of education served as socio-demographic information. The number of teeth, functional dentition (subjects with 20 or more teeth) and prosthodontic rehabilitation were used as clinical variables. The chi-square test and logistic regression analysis were the methods of statistical evaluation. Of all subjects, 3% were edentulous. Of dentate subjects, 3% had 1–9 teeth, 21% had 10–19 teeth, 37% had 20–24 teeth and 39% had 25–28 teeth. In total, 76% of dentate subjects enjoyed a functional dentition. Among dentate subjects, 11% of the men and 16% of the women had prosthodontic rehabilitation with higher figures ( P  < 0·001) among women, older subjects and urban residents. Having a functional dentition was more likely among those with higher levels of education [odds ratios (OR) = 1·8, 95% confidence intervals (CI) = 1·6–2·1]. Women (OR = 2·4, 95% CI = 1·8–3·0) and urban residents (OR = 2·4, 95% CI = 1·8–3·3) were the most likely groups to have prosthodontic rehabilitation. Having prosthodontic rehabilitation was more likely among those lacking a functional dentition (OR = 6·0, 95% CI = 4·8–7·6). The greatest unmet treatment needs were found among those without a functional dentition. Functional dentition should be set as a primary oral health goal among working-age adults.     

Induction of traumatic temporomandibular joint ankylosis in growing rats: a preliminary experimental study

Abstract –  There are many reports on the management of pediatric temporomandibular joint (TMJ) ankylosis. However, few authors have investigated the etiology of this disease in children. The purpose of this study was to determine the role of damage to both the condylar cartilage and disk in the induction of traumatic TMJ ankylosis during the growth period. The study was performed in growing rats by a common condyle fracture model. Intentional damage was performed to both the disk and condylar cartilage in the experimental group ( n  = 12), while the disk and condylar cartilage in the control group was left untouched ( n  = 12). Sham-operated growing rats were deemed the blank group ( n  = 10). Two rats from the experimental group and two from the control group were killed 24 h after the operation, and the result following surgical intervention was observed. Each rat's body weight in the three groups was monitored and recorded at 1, 2, 4, 6, 8, 10, and 12 weeks after surgery. Twelve weeks after the operation, all animals were killed. The prognosis was compared by mandible deviation measure, body weight evaluation, and histological observation. Animals from the experimental group presented a slow body weight increase and obvious mandible deviation while all involved TMJs showed fibrous ankylosis in various degrees. The damage to both the condylar cartilage and disk in the condylar fracture might play a vital role in traumatic TMJ ankylosis development during the growth period. The results of this study suggest that more attention should be paid to condylar fractures in children that are accompanied with severe cartilage and disk damage, which is a matter of significance for pediatric TMJ ankylosis prevention.     

Intentional replantation for periodontally involved hopeless teeth

Abstract –  The aim of this study was to evaluate the clinical and radiographic results of intentional replantation of periodontally involved teeth after conditioning of root surfaces with tetracycline–HCl. Thirteen patients (seven female, six male; age range: 35–52 years) with 15 periodontally involved hopeless teeth were included in this study. During the replantation procedure, the affected teeth were gently extracted, then the granulation tissues, calculus, remaining periodontal ligament and necrotic cementum on the root surfaces were removed. Tetracycline–HCl, at a concentration of 100 mg ml⁻¹, was applied for 5 min to the root surfaces. The teeth were then replaced into the socket and splinted. Patients were clinically and radiographically evaluated at baseline (time of surgery) and 6 months after the surgery. The following measurements were recorded: probing depth (PD), gingival recession (R), the amount of bone loss (BL) and bone gain (BG). Results indicated a reduction in PD and in the amount of bone loss and healthy gingiva. Mean PD was decreased from 5.25 to 2.36 mm, gingival recession was increased from 3.73 to 4.0 mm, and BL was reduced from 73.20 to 56.86%. At the end of 6 months, no root resorption or ankylosis was observed radiographically. Even during the short period of evaluation, it may be suggested that intentional replantation can be an alternative approach to extraction in cases where advanced periodontal destruction is present and no other treatments could be considered.     

Clinical outcomes for permanent incisor luxations in a pediatric population. II. Extrusions

Abstract  – A longitudinal outcome study was undertaken to identify variables that significantly influenced outcomes for extruded permanent maxillary incisors of children and adolescents. Clinical and radiographic data was available for 35 patients (18 males, 17 females) representing 55 incisors. Mean age at the time of injury was 10.6 years (range: 7.1–17.8 years). Mean time elapsed to follow up was 1320 days (range: 423–2887 days). Survival analysis was used to identify variables significantly related to the prognosis of these teeth. The loss of an incisor following extrusion was uncommon as only one tooth (1/55) required extraction. There was no statistically significant difference in survival between severely extruded teeth and avulsions that had been stored in physiological media ( P  > 0.10). Pulp necrosis (PN) was the most common complication following injury (43%) and it most often occurred during the first year. Although not statistically significant, a trend towards increased PN was found with more severely extruded teeth ( P  = 0.20, relative risk = 2.08). Pulp canal obliteration (PCO) was the second most common outcome (35%). The degree of extrusion was proven to be significantly associated with the development of PCO ( P  = 0.03, relative risk = 0.33). Root resorption was an uncommon outcome (3/55). This study represents the first outcome data on extrusions to permanent maxillary incisors in an exclusively pediatric population.     

Dental injury among Brazilian schoolchildren in the state of São Paulo

Abstract  – To describe the distribution of dental trauma in Brazilian schoolchildren and its association with demographic, environmental and clinical factors. A random sample of 73 243 schoolchildren's oral examination records from private and public units, selected from 131 cities within the state of São Paulo, Brazil, was analysed. Trauma was assessed based on international methodological standards prescribed by the World Health Organization for Oral Health Surveys (1997). Proportions obtained were compared between urban and rural schools, as well as between private and public units. Oral health status indices were estimated based on the decayed, missing and filled teeth (DMFT) index – the average number of decayed, missing and filled teeth; the proportion of caries-free 5-year-old schoolchildren and anterior maxillary overjet among 12-year-old schoolchildren. The prevalence of dental trauma in anterior dentition was of 2.4, enrolling average 1.2 teeth per child. A rate of 2.4 impaired anterior teeth per thousand was obtained, upper central incisors being those that were most affected – 7.7 in every 10. Among 8- to 11-year-old children, the rates grew regularly. The proportion of dental trauma was significantly higher in boys than in girls ( P  < 0.01), and gender prevalence ratio was of 1.58 for boys. The results showed positive associations between dental trauma and caries-free 5-year-old schoolchildren ( P  = 0.003), anterior maxillary overjet ≥3 mm ( P  < 0.001), and private school as a socio-economic proxy indicator ( P  = 0.048).     

Effect of delayed calcium hydroxide treatment on periodontal healing in contaminated replanted teeth

Abstract – The effect of delayed intracanal calcium hydroxide treatment on experimentally induced extensive inflammatory root resorption in monkeys was studied. A significant shift from inflammatory resorption to ankylosis was noted following calcium hydroxide treatment. Furthermore, calcium hydroxide treatment appeared to change the pattern of ankylosis over time, although the total ankylotic area remained the same. Ankylosis preceded by root resorption (replacement resorption) increased, while ankylosis not associated with root resorption decreased. It was concluded that intracanal calcium hydroxide treatment of teeth with compromised PDM may cause unnecessary replacement resorption if left in the root canal for a long time or changed repeatedly.     

Tooth auto-transplantation with double periodontal ligament stimulation to replace periodontally compromised teeth

BACKGROUND: The healing process of autotransplantation puts 2 different tissues in competition: the ligament on the root surface and the bone tissue of the alveolus. This study shows the effects of a protocol with 2 surgical stages, which promote ligament repair, inhibit adhesion between bone and dental root, and reduce the occurrence of the ankylosis-root resorption phenomenon. METHODS: Forty-three patients, 33 to 73 years old, received 47 transplantations of mature teeth (including retained teeth) during a 5-year period. During the first surgical step, the transplanted tooth is extracted, measured, immediately replaced in its origin site, and maintained with an original suture technique. The alveolus to which the tooth will be transplanted is adapted after extraction of the periodontally compromised tooth. The second surgery occurs at day 14, when regeneration of periodontal ligament (PDL) is at a maximum (first stimulation). The tooth is transplanted in its new alveolus and retained using the same suture technique to avoid a rigid splint and to create mechanical stimulation of the PDL (second stimulation). RESULTS: The results were 95.75% positive with normal PDL, with a 4.25% failure rate (transplant loss) and no ankylosis. Mean probing reduction was 8.37 +/- 3.0 mm. Mean radiographic bone gain was 7.73 +/- 4.32 mm. CONCLUSIONS: This study suggests that auto-transplantation with double PDL stimulation can be a viable treatment in clinical practice, especially to replace teeth with large periodontal lesions, deep furcation defects, and/or root fractures. This study shows the high potential of stimulated PDL to regenerate alveolar bone and periodontal structures in severe destruction sites.     

Influence of age on the behavior of dental pulp of dog teeth after capping with an adhesive system or calcium hydroxide

Abstract  – This study evaluated histomorphologically the influence of chronological age of the dog on the dental pulp-healing process after capping with the All Bond 2 system or with calcium hydroxide paste. The animals were divided according to age into young and adult groups. Class 5-type cavities were prepared, and the pulp was submitted to an exposure of a diameter of 0.5 mm. The pulp of the teeth was then protected with the adhesive system or with a calcium hydroxide paste. Sixty days after treatment, the results obtained with the adhesive system in the young group were significantly better than those in the adult group. With calcium hydroxide, the results were similar for both groups. The pulp treated with calcium hydroxide exhibited a complete hard tissue bridge and a pulp without inflammatory reaction, a fact not observed when the adhesive system was used. In conclusion, the chronological age of the pulp influenced the comparative results only for the adhesive system ( P  = 0.1), and the total results were better with calcium hydroxide than with the All Bond 2 system ( P  = 0.01).     

Impact of treated and untreated dental injuries on the quality of life of Ontario school children

Abstract –  A population-based, matched case–comparison study was undertaken in 30 schools in two Ontario communities to measure the impact of dental trauma on quality of life (QoL) in Canadian school children. Dental hygienists screened 2422 children aged 12–14 years using the dental trauma index, the decayed, missing and filled teeth index (DMFT) and the aesthetic component of the index of orthodontic treatment needs (AC-IOTN). Cases ( n  = 135) were children with evidence of previous dental trauma. Controls ( n  = 135) were classmates matched for age and gender. Oral-health-related QoL was assessed using mailed Child Perception Questionnaires (CPQ_11-14) completed by all children. Data were analyzed using simple and multiple conditional logistic regressions after adjusting for DMFT and AC-IOTN, CPQ_11-14, overall impact and item-specific impacts. Approximately 64% of injuries were untreated enamel fractures and just over 30% were previously injured restored teeth. Untreated children experienced more chewing difficulties ( P  = 0.026), avoided smiling ( P  = 0.029) and experienced affected social interactions ( P  = 0.032) compared with their non-injured peers. When treated and non-injured groups were compared, the only statistically significant effect was difficulty in chewing ( P  = 0.038). Injured children who were untreated experienced more social impact than their non-injured peers. Restoration of injured teeth improved aesthetics and social interactions but functional deficiencies persisted as a result of periodontal or pulpal pain.