A retrospective analysis of autotransplanted teeth including an evaluation of a novel surgical technique.

OBJECTIVES: To assess survival rates and frequency of complications for immature and mature autotransplanted teeth after at least 1 year in function. MATERIALS AND METHODS: All consecutive patients who had undergone tooth autotransplantation between 2000 and 2018 were invited to a clinical and radiographic follow-up examination. First, survival rates were calculated on the basis of a phone inquiry. A clinical follow-up examination allowed for the calculation of the success rate, i.e., absence of any potentially adverse clinical and radiographic findings of the autotransplanted teeth. Moreover, the effect of demographic, dental, and surgical variables on survival/success was analyzed statistically. RESULTS: Thirty-eight teeth in 35 patients were transplanted during the study period. Three teeth in 3 patients were excluded due to missing records. All other patients were successfully contacted and interviewed by phone. Out of these 35 transplants, 32 were still in function, and 3 had been extracted, yielding a 91.4% survival probability after a median follow-up of 3.4 years. Of the 32 teeth qualifying for the success analysis, 20 (62.5%) showed absence of potentially adverse findings, while 3 (9.4%) required root canal treatment (RCT). Out of the 9 mature, root-end resected transplants, 4 exhibited ongoing pulp canal obliteration, all with a single root canal. Postoperative and potentially adverse findings or failures were found more frequently in the group of mature transplants (55.6%) than immature transplants (30.4%) and for molars (72.7%) than premolars (17.6%) or canines (25%). None of the potential predictors had a statistically significant effect on survival or success. CONCLUSION: Autotransplanted teeth yielded a satisfying midterm survival rate regardless of their stage of development. An additional, extraoral root-end resection of mature transplants may lead to rates of revascularization and postoperative pulp canal obliteration higher than the data reported on unmodified mature transplants. CLINICAL RELEVANCE: Extraoral root-end resection of mature teeth shows promising outcomes for transplants especially with a single root canal and uncomplicated root morphology.

Analysis of trends in implant therapy at a surgical specialty clinic: Patient pool, indications, surgical procedures, and rate of early failures-A 15-year retrospective analysis.

OBJECTIVES: To evaluate the patient population over a 3-year period and to compare it to observations of the population at the same clinic over a period of 15 years. MATERIAL AND METHODS: Records of patients receiving dental implants in the Department of Oral Surgery and Stomatology, University of Bern, between January 2014 and December 2016 were analyzed and then compared with data from patients treated between 2002 and 2004 and between 2008 and 2010. Patients were analyzed for demographics and for indications for therapy, as well as for presence or absence and type of complications. Inserted implants were analyzed for type, length, and diameter, as well as for the number and type of associated tissue regeneration procedures. RESULTS: Analysis revealed a continuous linear increase in the average age of patients seeking implant treatment. The most common indication for implant therapy was a single-tooth gap (STG) (50.5%), followed by distal extension situations (22.3%) and extended edentulous gaps (20.5%). A total of 60.8% of implants placed needed some type of bone augmentation, and 83.5% of implants placed in the anterior maxilla required simultaneous augmentation. Staged guided bone regeneration (GBR) was only necessary in 7% of the cases. Implant failure rates remained low at 0.6%, with postoperative hematomas being the most common postoperative complication (13.4%). CONCLUSIONS: The rising demand for dental implants continues as the patient population ages. Single-tooth gaps remained consistently the most common indication for implant therapy in recent years. Proper case selection and evidence-based surgical protocols are essential for high success rates.

Distances of root apices to adjacent anatomical structures in the anterior maxilla: an analysis using cone beam computed tomography.

OBJECTIVES: The aim was to assess the anatomical relationship of anterior maxillary teeth to the nasal floor in patients referred for apical surgery. MATERIALS AND METHODS: Cone beam computed tomographic images (CBCT) of 83 patients were analysed retrospectively to quantify the distances between the root apices of maxillary anterior teeth (canine to canine) to the nasal floor or maxillary sinus (whichever was closer). Secondary outcome variables were the distances of the periapical lesion to the nasal floor, distances of the apices to the labial and palatal bone plates as well as to the neighbouring teeth. RESULTS: A total of 93 teeth (39 central, 35 lateral incisors and 19 canines) were analysed. The mean shortest distances of the apices to the nasal floor (or maxillary sinus) were 8.54 mm for central incisors, 9.49 mm for lateral incisors and 5.39 mm for the canines. The canines exhibited a significantly shorter distance to the nasal floor/maxillary sinus. In the presence of an osteolysis, the distance to the nasal floor was significantly shorter compared to the teeth without lesions. The lateral and central incisors showed significant proximity to each other at the level of the future surgical resection (3 mm from the apex). CONCLUSIONS: A close proximity between apices and adjacent anatomical structures such as nasal floor, maxillary sinus or adjacent roots could be shown in some cases. CLINICAL RELEVANCE: CBCT could be a valuable adjunctive imaging tool prior to apical surgery in the anterior maxilla to assess the risk for and decrease the incidence of damage to neighbouring anatomical structures such as the nasal floor, maxillary sinus or adjacent roots.

Assessment of the nonoperated root after apical surgery of the other root in mandibular molars: a 5-year follow-up study.

INTRODUCTION: If a surgical approach is chosen to treat a multirooted tooth affected by persistent periapical pathosis, usually only the affected roots are operated on. The present study assessed the periapical status of the nonoperated root 5 years after apical surgery of the other root in mandibular molars. METHODS: Patients treated with apical surgery of mandibular molars with a follow-up of 5 years were selected. Patient-related and clinical parameters (sex, age, smoking, symptoms, and signs of infection) before surgery were recorded. Preoperative intraoral periapical radiographs and radiographs 5 years after surgery were examined. The following data were collected: tooth, operated root, type and quality of the coronal restoration, marginal bone level, length and homogeneity of the root canal filling, presence of a post/screw, periapical index (PAI) of each root, and radiographic healing of the operated root. The presence of apical pathosis of the nonoperated root was analyzed statistically in relation to the recorded variables. RESULTS: Thirty-seven patients fulfilled the inclusion criteria. Signs of periapical pathosis in the nonoperated root 5 years after surgery (PAI ≥ 3) could be observed in only 3 cases (8.1%). Therefore, statistical analysis in relation to the variables was not possible. The PAI of the nonoperated root before surgery had a weak correlation with signs of apical pathosis 5 years after surgery. CONCLUSIONS: Nonoperated roots rarely developed signs of new apical pathosis 5 years after apical surgery of the other root in mandibular molars. It appears reasonable to resect and fill only roots with a radiographically evident periapical lesion.

[Autoimmune hepatitis]. / Hépatite auto-immune.

Autoimmune hepatitis is a systemic disease, difficult to diagnose due the high variability of the clinical presentation and some non specific histological features. The recent identification of additional autoantibodies used as serological markers, as well as simplified diagnostic criteria should help the primary care physician to advance with the diagnostic process. These progresses are crucial as undiagnosed and therefore untreated autoimmune hepatitis has a poor prognosis, whereas immunosuppressive therapy leads to remission in a majority of cases.

[House dust mite allergy: myths and realities]. / Allergie aux acariens: mythes et réalités.

Since 1967, house dust mites have been shown to be the main allergens to be blamed in household dust allergy. In our countries, Dermatophagoides pteronyssinus and Dermatophagoides farinae are predominant. We find them by millions in our bedding. They are responsible of allergic reactions like asthma, rhinitis and atopic dermatitis. Different treatments are available of which some have proved there effectiveness, like subcutaneous immunotherapy and standard symptomatic treatments. On the other hand, the control measures remain controversial and led recently to a lively debate in the medical literature. We felt therefore that it was necessary to set the record straight.