Autotransplantation of premolars to premolar sites. A long-term follow-up study of 40 consecutive patients.

This article describes the long-term outcome of 40 consecutive patients having transplanted premolars. The objective of this ongoing study is to investigate survival rate, pulp survival rate, periodontal condition, and root development of autotransplanted premolars in orthodontic patients. This report covers 17 years; 32 orthodontic patients had 40 premolars transplanted into contralateral or opposing jaw quadrants where a premolar was missing. The teeth were examined systematically with clinical and radiographic measures at 1, 2, 6, 12, and 60 months or more after autotransplantation. The observation time varied from 2 years 5 months to 22 years 3 months, with a mean of 10 years 4 months. Bonded.018-in edgewise appliances were used, subjecting 87.5% of the transplanted teeth to normal orthodontic forces. One tooth was removed because of root fracture during the observation period, and 2 more had complications possibly related to the transplantation. The remaining 37 teeth and their supporting structures were all healthy at the last examination--a 92.5% success rate. Transplants with closed apices received endodontic therapy, but, in those with open or half-open apices, a 66% pulp survival rate was observed. No teeth in the sample had signs of replacement resorption or developed periodontal attachment loss. Inflammatory resorption in 2 teeth was arrested after endodontic treatment. Root formation, when not complete, continued on transplanted teeth, giving normal root form and adequate root length for normal function. It is concluded that autotransplantation of premolars combined with orthodontic treatment should be the first treatment alternative in cases of missing premolars, when a suitable donor tooth is available.

Periodontal repair in dogs: a bioabsorbable calcium carbonate coral implant enhances space provision for alveolar bone regeneration in conjunction with guided tissue regeneration.

BACKGROUND: Collapse or compression of a barrier device into a periodontal defect or onto the root surface compromises outcomes following guided tissue regeneration (GTR). Bone biomaterials have been suggested to support regeneration of alveolar bone and to improve space provision with GTR devices. The objective of this study was to evaluate space provision, alveolar bone, and cementum regeneration following use of a bioabsorbable, calcium carbonate biomaterial in conjunction with GTR. METHODS: Routine, critical size, 5 to 6 mm, supraalveolar, periodontal defects were created in 5 young adult beagle dogs. Alternate jaw quadrants in consecutive animals received GTR and the coral biomaterial (cGTR) or GTR alone. The animals were euthanized 4 weeks postsurgery and tissue blocks processed for histometric analysis. RESULTS: The coral implant particles were surrounded by newly-formed bone or immersed in connective tissue and appeared to resorb and be replaced by bone. There was limited, if any, appreciable cementum regeneration. Space provision was enhanced in cGTR compared to GTR sites (6.1 +/- 1.6 versus 2.4 +/- 0.8 mm2; P<0.05). Bone regeneration (height) was significantly increased in cGTR compared to GTR sites averaging 1.9 +/- 0.6 and 1.2 +/- 0.6 mm, respectively (P<0.05). Bone regeneration (area) was 2-fold greater in cGTR sites compared to the GTR control (3.3 +/- 1.8 versus 1.4 +/- 0.5 mm2), however the difference was not statistically significant (P>0.05). CONCLUSIONS: The coral implant significantly enhanced space provision for GTR while alveolar bone formation appeared to be enhanced by its use. Increased healing intervals are needed to fully understand the biologic value of the coral implant as an adjunct to GTR.

Probing bone level measurements for determination of the depths of Class II furcation defects.

BACKGROUND: Probing bone measurements as an alternative to open bone measurements to evaluate regenerative procedures in furcation defects do not seem to be used as yet. The purpose of the present study was to investigate the reliability of probing bone measurements in such defects. METHODS: Fifteen patients scheduled for surgical treatment of a total of 30 mandibular molars with buccal or lingual Class II furcation defects were studied. During treatment, duplicate vertical and horizontal recordings of probing attachment levels, probing bone levels, and open bone levels were taken by independent examiners. RESULTS: Deviations of both vertical and horizontal recordings between the first and second examiners were within +/-1 mm in 90% to 100% of examined sites for all 3 measurements. Standard deviations of differences between pairs of duplicate recordings were also similar for the 3 measurements both for vertical and horizontal defect dimensions and amounted to 0.7 to 0.9 mm. On average, vertical and horizontal open bone levels were 0.9 to 1.1 mm deeper than probing bone levels. Probing bone levels, in turn, were 1.1 to 1.5 mm deeper than probing attachment levels. CONCLUSIONS: In view of the consistency demonstrated between probing bone level and open bone level measurements in mandibular Class II defects, coupled with the additional discomfort for the patient of a reentry surgery and a possible reentry traumatic effect, open bone level measurements do not seem necessary or even justified to evaluate effects of periodontal therapy in these defects, and can be substituted by probing bone measurements.

Pain experienced by patients during periodontal maintenance treatment.

BACKGROUND: The aims of this study were to assess the degree of pain experienced by patients during probing and debridement and to determine whether the pain responses could be predicted by the patient's age, gender, percentage of sites > or = 4 mm deep, and responses to a questionnaire on dental anxiety. METHODS: Prior to the maintenance procedures, 26 adult patients completed an anxiety questionnaire. Subsequently, measurements of probing depths were performed. The patients activated a tallying device at each probe entry that evoked pain (pain frequency). Pain levels for each quadrant were also assessed with a visual analog scale (VAS). Following probing, the same protocol was repeated during instrumentation (debridement). RESULTS: Most patients showed low pain responses to both probing and instrumentation as evaluated by both methods of measurement. However, using arbitrary thresholds of pain frequency > or = 50% and VAS > or = 40 mm, approximately 15% of the patients had a painful experience. Stepwise multiple regression analyses disclosed that significant portions of the pain levels could be predicted by gender and the patients' answers to 2 of the dental anxiety questions. CONCLUSIONS: Recognition of patients who are likely to experience pain during periodontal treatment can be facilitated by the use of 2 questions on dental anxiety and the VAS response to probing during examination.