Interproximal Open Contacts Between Implant Restorations and Adjacent Teeth. Prevalence - Causes - Possible Solutions.

PURPOSE: To present the prevalence and contributing factors of interproximal contact loss (ICL) between implant restorations and adjacent teeth, and to provide recommendations for possible prevention and treatment of this complication. MATERIALS AND METHODS: The authors explored the dental literature on PubMed on ICL between implants and adjacent teeth, interproximal contacts, open contacts, teeth migration causes, facial bone formation, and facial bone changes. RESULTS: ICL between fixed implant prostheses and adjacent teeth has been reported. A literature search revealed 7 studies showing a high prevalence of ICL between implant prostheses and adjacent teeth. The literature indicates that this ICL is greater in the mesial aspect in comparison with the distal. As identified by the literature review, ICL in the maxilla ranged between 18% and 66% versus 37% to 54% in the mandible. ICL might occur as early as 3 months after prosthetic treatment. The literature review documented possible tooth migration causes, crown-related causes, and bone formation/growth-related causes of ICL. CONCLUSIONS: ICL is a common multifactorial implant complication. The clinical condition will dictate if the implant crown needs to be modified/replaced or the natural tooth needs to be restored to reestablish interproximal contact between an implant prosthesis and adjacent tooth. Periodic evaluations of interproximal contacts between implant restorations and the adjacent teeth and the use of screw-retained restorations due to ease of removal is recommended to diagnose and mitigate the problem. An orthodontic retainer or occlusal guard may help prevent ICL between the implant restoration and the adjacent tooth.

Impacted and transmigrant mandibular canines incidence, aetiology, and treatment: a systematic review.

Background: The incidence of impacted and transmigrant mandibular canines in the mandible is not as high as that in the maxilla; consequently, it is more difficult to find clinical guidelines derived from sound studies based on large patient samples. Objectives: The aim of this systematic review was to summarize currently available data pertaining to the incidence and aetiology of impacted and transmigrant mandibular canines and the success rates of different treatment strategies. Methods: This review was registered with PROSPERO (CRD42014006175) and was conducted using PRISMA and CRD (Centre for Reviews and Dissemination, University of York) statement. A computerized search of studies published up to February 2016 was conducted using the following databases: PubMed, Cochrane Central Register of Controlled Clinical trials, ISI Web of Knowledge, and Scopus. To identify any relevant publications not included in this list, we manually searched the references lists of the selected articles. The Newcastle-Ottawa Scale quality assessment tool was utilized to classify the included articles. Results: In total, 630 articles were identified after the removal of duplicates. A total of 13 studies published between 2001 and 2015 met all the eligibility criteria and were included for the final analysis. The sample size in these studies ranged from 14 to 112873 teeth, while their methodological quality ranged from low to medium. Conclusions: According to the findings from our review, the incidence of canine impaction in the mandible ranges from 0.92 to 5.1 per cent, while that of canine transmigration ranges from 0.1 to 0.31 per cent. Various etiologies may play a role, including odontomes (up to 20 per cent) and lateral incisor anomalies (16 per cent). Surgical extraction (89 per cent in some studies) and orthodontic traction (20-32 per cent) are the most commonly used treatment strategies, with the latter showing a failure rate of 17 per cent in two studies.

Prevalence of Interproximal Open Contacts Between Single-Implant Restorations and Adjacent Teeth.

PURPOSE: The aim of this study was to determine the prevalence of interproximal open contacts between singleimplant prostheses and adjacent teeth, as well as to provide guidelines to prevent interproximal contact loss (ICL). MATERIALS AND METHODS: This was a retrospective, cross-sectional study. One hundred twenty-eight patients (174 single-implant restorations) from Columbia University College of Dental Medicine and a private faculty clinic with a single-implant restoration in the posterior or anterior region were selected to participate in this study. Patients between the ages of 19 and 91, both male and female, were included in this pilot study. The period of evaluation after implant restoration insertion was between 3 months and 11 years. Participants were seen at random intervals to identify ICL. Interproximal contacts were evaluated with 0.07-mm-thickness dental floss and visual confirmation. Contact was considered open if floss passed without resistance from adjacent teeth. RESULTS: The results of this study revealed a significant percentage of ICL, 52.8%, between single-implant restorations and adjacent teeth; 78.2% were identified on the mesial surfaces and 21.8% on the distal surfaces. ICL was noted in 57.9% of the maxillary implant restorations and 49% of the mandibular implant restorations. Eight implant restorations in women demonstrated mesial and distal openings. Among the patients with ICL, a significant percentage, 40%, were aware of the presence of ICL and food impaction. CONCLUSION: In this study, 52.8% of implant restorations demonstrated ICL. This result dictates that ICL should be included as a prosthetic implant complication. The high prevalence of ICL is justification for proper informed consent, and associated clinical problems need to be addressed. Possible causative factors were presented, but further research is necessary to identify the causative factors for ICL. The authors suggest the use of an Essix retainer to prevent ICL between single-implant restorations and adjacent teeth. Evaluation of interproximal contact between implant restorations and the adjacent teeth should be periodically monitored.

Open contacts adjacent to dental implant restorations: Etiology, incidence, consequences, and correction.

BACKGROUND: The aim of this investigation was to evaluate the potential causes, clinical significance, and treatment of open contacts between dental implant restorations and adjacent natural teeth. TYPES OF STUDIES REVIEWED: The authors searched the dental literature for clinical trials in humans that addressed the incidence of open contacts that develop after implant restorations are placed next to teeth. RESULTS: The authors found 5 studies in which the investigators addressed the incidence of open contacts after implant restorations are inserted next to teeth. Results from these studies indicated that an interproximal gap developed 34% to 66% of the time after an implant restoration was inserted next to a natural tooth. This event occurred as early as 3 months after prosthetic rehabilitation, usually on the mesial aspect of a restoration. CONCLUSIONS: The occurrence of an interproximal separation next to an implant restoration was greater than anticipated. It appears that force vectors cause tooth movement and an implant functions like an ankylosed tooth. PRACTICAL IMPLICATIONS: Clinicians should inform patients of the potential to develop interproximal gaps adjacent to implant restorations, which may require repair or replacement of implant crowns or rehabilitation of adjacent teeth. Furthermore, steps should be taken to check the continuity of the arch periodically. If the clinician detects an open contact, it is prudent to monitor for signs or symptoms of pathosis so that prosthetic repair of the gap can be initiated, if needed. These problems could add to treatment costs and decrease overall patient satisfaction related to implant treatment.

Long-term morbidities of coronectomy on lower third molar.

OBJECTIVE: To monitor the long-term morbidity of retained roots up to 5 years following lower third molars coronectomy with close proximity to the inferior alveolar nerve (IAN). STUDY DESIGN: A prospective study on long-term morbidities after lower third molar coronectomy. RESULTS: This study included 612 lower third molar coronectomies in 458 patients. The prevalence of IAN injury was 0.16% (1/612) and was temporary. Long-term postoperative infection occurred in 1 case at 6 months following surgery and another at 12 months. No infection was found after 12 months. The incidence rates of pain at 6 months, 12 months, 24 months after surgery were 0.50% (3/596), 0.38% (2/529), 0.49% (2/411), respectively. Root exposure was noted in 2.3% of cases (14/612). Reoperation to remove the exposed root did not cause any IAN deficit. CONCLUSIONS: Lower third molar coronectomy is safe in the long term.

Prevalence of temporomandibular joint dysfunction and its signs among the partially edentulous patients in a village of North Gujarat.

UNLABELLED: There is disagreement about the association between missing teeth and the presence of temporomandibular disorder (TMD). AIM: To investigate whether, the span of edentulousness, gender, number of quadrants involved, pathological migration and the type of kennedy's classification are related to the temporomandibular joint (TMJ) dysfunction signs. MATERIALS AND METHODS: Clinical examination of 250 patients (males 99 and females 151) was done among the age group of 35 to 45 years. The patients were partially edentulous for 6 months or more and did not wear any kind of prosthesis. RESULTS: Among 250 subjects, females showed more TMJ dysfunction signs. Clicking sounds were present in 46.5%, mandibular deviation was present in 40% of individuals, TMJ tenderness was observed in 32% and masseter was involved in 32% of individual. Temporomandibular joint dysfunction signs in relation to pathologic migration of teeth show that clicking and mandibular deviation was present in 54.5 and 49.2% and among muscles masseter muscle tenderness 41.9% was more commonly present. Masseter muscle tenderness 64.1% was seen in individuals who were edentulous for more than 5 years. CONCLUSION: Females subjects had a significantly higher prevalence of TMJ dysfunction signs then male subjects. As the span and time of edentulousness, the number of missing teeth and the number of quadrant involved increased, the signs of dysfunction became more prevalent. Among the TMJ dysfunction signs deviation and clicking sound were most frequently observed. The masseter muscle was most commonly affected and demonstrated muscle tenderness.

Transmigration of impacted canines: prevalence, management and implications on tooth structure and pulp vitality of adjacent teeth.

The aim of this study was to estimate the prevalence of transmigrant canines in a sample of panoramic radiographs of a random Greek population, to classify them and evaluate clinically and radiographically all the implications for adjacent teeth. Panoramic radiographs of 3,586 patients retrieved from eight private practices between 1998 and 2009, were examined. Panoramic radiographs with extracted canines were not included in this study. An impacted canine was considered to be transmigrant when at least part of its length had crossed the midline. Six radiographs exhibited transmigrant canines (0.17% of the total sample of panoramic radiographs), of which four were mandibular and two maxillary. Canine transmigration is a rare phenomenon in Greek population. The impact of transmigrant canines on adjacent teeth varied from inclination, calcific metamorphosis and root resorption to no effect. Orthodontic therapy was the treatment of choice for two of the cases, while in the remaining cases the patients were scheduled for periodic recalls. Clinical and radiographic evaluation and early diagnosis are crucial aids in proper treatment planning.

Prevalence and characteristics of supernumerary teeth in a non-syndrome Turkish population: Associated pathologies and proposed treatment

Objective: The objectives of the present study were to investigate the prevalence and characteristics of supernumerary teeth and evaluate the associated pathologies and treatment protocol in a Turkish patient population. Study design: A retrospective study was performed using full-mouth periapical and panoramic radiographs of3491 patients (2146 females and 1345 males) ranging in age from 12 to 25. For each patient with supernumerary teeth we recorded the demographic variables (including age, sex), number, location, position, type, and morphology of supernumerary teeth, associated pathologies or complications, and whether any treatment has been carried out. The Pearson chi-squared test was used to determine potential differences in the distribution of supernumerary teeth when stratified by gender.Results: Supernumerary teeth were detected in 42 subjects (1.2%), of which 27 were males and 15 were females with a 1.8:1 male female ratio (P<.001). The most commonly found supernumerary teeth were mesiodens (31.3%)followed by premolar (25.0%), lateral (22.9%), distomolar (14.5%), paramolar (4.2%), and canine (2.1%). Of the 48 supernumerary teeth examined, 50.0% (n=24) were conical, 81.3% (n=39) were in a vertical position, and 20.8%(n=10) were erupted. Supernumerary teeth caused rotation or displacement of the adjacent teeth in 14 cases, and the impaction of the permanent teeth in 8 cases.Conclusion: The prevalence of supernumerary teeth in our series was found to be 1.2%, the most frequent type being mesiodens. Rotation or displacement of permanent teeth was the most frequent complication caused by supernumerary teeth (AU)

Evaluation of the long-term oral consequences of equine exodontia in 50 horses.

The aims of this study were to objectively evaluate and quantify the process of post-extraction cheek teeth (CT) dental drift in horses, and to report on associated disorders of CT wear and long-term periodontal health. Fifty horses that had CT oral extraction because of apical infection were prospectively re-examined and a full oral examination, including measurements of some dental parameters, was performed. Narrowing of the extraction space was noted in all cases with complete closure occurring in 18% of horses. The rate of dental drift was calculated as 15.7% of extraction space/year (range 4-50%) and was not associated with the age at extraction (P=0.78) or frequency of dental care since extraction (P=0.48). There was a significant negative relationship between the rate of dental drift and the duration of time since extraction (P=0.008). Overgrowths were present on the opposite CT row in 98% of horses, including opposite the extracted CT and on the Triadan 06s and 11s. No significant difference was noted in either the number of diastemata (P=0.9) or periodontal disease score (P=0.8) between the extraction and the contralateral cheek tooth rows.

Transmigrant maxillary canines.

OBJECTIVE: The objective of this study was to investigate the incidence and pattern of transmigrant maxillary canines. PATIENTS AND METHODS: The records of 6000 patients who were presented to our oral and maxillofacial surgery services between January 1998 and January 2007 were reviewed. Observations were made as to the right/left localization and number of transmigrant canines; sex and age of patients; retained deciduous canines; and any other associated pathology. RESULTS: A total of 12 patients presented with transmigrated maxillary canines with 6 females (age 15 to 37) and 6 males (age 17 to 57) in 6000 individuals (0.2%). All transmigrant canines were unilateral. The numbers of left and right transmigrant maxillary canines were equal. Ten individuals in 12 patients had not retained deciduous canines. None of these patients had any pathology associated with impacted canines. CONCLUSION: The canine transmigration can occur not only in the mandible but also the maxilla. Further studies are necessary to examine this rare phenomenon to allow classification of transmigrant canines in the maxillary arch. Thus, the incidence, demographic factors, and etiology of this phenomenon can be clarified. How transmigrant maxillary canines pass on the contralateral side of the mid palatal suture must be completely clarified.

Oral health status of homeless people in Hong Kong.

The authors report on an oral health survey among Hong Kong Chinese homeless people. A total of 140 homeless men underwent clinical examination and were interviewed with a structured questionnaire. More than 90% had evidence of caries experience; most (75%) were related to untreated caries. The mean DMFT score was 9.0 (DT = 3.2, MT = 5.2, FT = 0.6). Periodontal disease was highly prevalent, with 96% having periodontal pockets. The dental problems most frequently reported by the homeless were: bleeding gums or drifting teeth (62%), dental pain (52%) and tooth trauma (38%). More than 70% of the study's participants perceived a need for dental care. The population surveyed had poorer oral health compared to the general population. High levels of dental needs, both normative and perceived, were found. There is a need to provide more accessible and affordable oral health services to this group of people.

Pathologic tooth migration.

Pathologic tooth migration (PTM) is a common complication of moderate to severe periodontitis and is often the motivation for patients to seek periodontal therapy. In this review of the literature, available information concerning prevalence, etiology, treatment, and prevention of pathologic tooth migration is summarized. Prevalence of PTM among periodontal patients has been reported to range from 30.03% to 55.8%. A survey of the literature regarding chief complaints of periodontal patients support these high prevalence findings. The etiology of PTM appears to be multifactorial. Periodontal bone loss appears to be a major factor in the etiology of PTM. Many aspects of occlusion can contribute to abnormal migration of teeth, and more than one of those factors may be present in an individual patient. Soft tissue forces of the tongue, cheeks, and lips are known to cause tooth movement and in some situations can cause PTM. Also considered important in the etiology of PTM is pressure produced from inflammatory tissues within periodontal pockets. Because extrusion is a common form of PTM, clinical observations support the theory that eruption forces sometimes play a role in the etiology of PTM. Many oral habits have been associated with PTM which are often difficult for the therapist to detect. Most cases of severe PTM require a team approach to achieve success. Periodontal, orthodontic, and prosthodontic treatment are often required. Many patient variables enter into the selection of treatment for PTM. In early stages of PTM, spontaneous correction of migrated teeth sometimes occurs after periodontal therapy. Light intrusive forces are used successfully to treat extrusion and flaring forms of PTM. Based on the literature reviewed, it appears that many cases of PTM could be prevented through the early diagnosis and treatment of periodontal disease, occlusal contributing factors, gingival enlargement, and oral habits.

Periodontal conditions of teeth presenting pathologic migration

O objetivo deste estudo foi avaliar as condições clínicas periodontais de dentes anteriores com migração patológica (MDP) em pacientes com periodontite crônica generalizada e comparar a severidade de destruição periodontal entre dentes migrados e não-migrados. Foram selecionados 32 pacientes, de ambos os sexos, apresentando média de idade de 46,0 anos (± 11,6), com perda clínica de inserção em dentes anteriores e presença de algum tipo de MDP, a saber: vestibularização, diastema, inclinação proximal, giroversão ou extrusão. Os parâmetros avaliados foram a perda clínica de inserção (PIC) e o percentual de perda óssea radiográfica (PO). Os resultados mostraram, em média, uma PIC de 5,50 mm (± 2,20 mm) e uma PO de 41,90% (± 15,40%) do comprimento radicular, em 115 dentes selecionados. Os tipos mais freqüentes de migração foram vestibularização (34,80%) e presença de diastemas (27,00%). A extrusão foi a menos freqüente (4,30%). Maiores valores de PO e PIC foram registrados nos dentes com extrusão (59,44% e 8,42 mm) e vestibularização (45,17% e 6,07 mm). Esses valores de PO foram superiores aos observados nos dentes com giroversão ou inclinação proximal (p < 0,05 - Kruskal-Wallis). A PIC não apresentou diferenças significativas entre os diferentes tipos de migração (p = 0,11). Constatou-se que os dentes anteriores com MDP apresentaram maior PIC e PO (5,1 mm e 40%) quando comparados aos não-migrados (4,1 mm e 31%). Pôde-se concluir também que o tipo de MDP mais prevalente foi a vestibularização, que esteve relacionada a maiores níveis de perda óssea.

Jaw and tooth abnormalities detected on panoramic radiographs in New Zealand children aged 10-15 years.

Panoramic radiographs of 1,608 children and adolescents aged 10 to 15 years (797 males and 811 females) were reviewed to determine the prevalence of tooth and jaw abnormalities. Abnormalities were detected on 21 percent of the radiographs (23 percent females and 17.3 percent males); 879 teeth were diagnosed with abnormalities on 331 radiographs. The more common abnormalities were malpositioned teeth, missing teeth, misshaped teeth, and teeth with hypoplastic appearance. Bony abnormalities and growth problems were detected in a few radiographs. This study demonstrates the value of panoramic radiography in detecting or confirming dental abnormalities, and supports recommendations on the use of panoramic radiography to aid in the assessment of dental development.

A study on factors associated with pathologic tooth migration.

The purpose of this cross-sectional epidemiological study was to determine the prevalence of pathologic tooth migration (PTM) among periodontal patients and to investigate the relationship and degree of association between PTM and the following factors: bone loss, tooth loss, gingival inflammation according to the gingival index, age, lingual interposition, parafunctions and oral habits. 852 periodontal patients (36.7% male, 63.3% female) whose ages ranged from 19 to 72 years (mean 42.5 +/- 9.9) were studied. PTM was defined as the presence of a developing diastema in the upper anterior sextant, which was not present in the past or already existed but increased. Statistical analysis was performed using the Wald test and the Mantel-Haenszel test. Estimates odds ratio were also calculated to assess increased PTM probability as a function of a single variable, or a combination of several. PTM prevalence of 55.8% was found, and it was statistically associated with bone loss (p<0.001), tooth loss (p<0.001) and gingival inflammation (p<0.001), while no association was observed with the remaining variables. The odds ratio indicated that PTM probability increased between 2.95 to 7.97 times as bone loss increased. For tooth loss this probability increased 2.76 times when no tooth loss was compared to 4 or more teeth lost. Likewise the probability increased 2.23 times when the gingival index was above 2. According to the single effect as well as the combined effect of these 3 main factors, it was concluded that: (1) no single factor by itself is clearly associated with PTM: (2) the factor mainly related to PTM is bone loss, followed by tooth loss and gingival inflammation: (3) as bone loss increases, the association of additional factors with PTM, such as tooth loss and gingival inflammation, increases.

Oral disease, impairment, and illness: congruence between clinical and questionnaire findings.

In 1992 a questionnaire was sent to 50-year-olds in two Swedish counties. These self-report data were compared with clinical observations with regard to number of teeth, removable dentures, caries, and periodontitis. Complete information from both data sources was obtained for 1041 persons. The relevant questionnaire item explained 71% of the missing tooth variance. An agreement of 0.91 (Cohen's kappa) was obtained for removable dentures. A question about problems in opening the mouth differentiated clearly with regard to measured mouth opening ability. Toothache and tooth sensitivity were reported with 95% probability when having 22 decayed teeth and with 46% when there were no decayed teeth (58% correctly predicted). Two teeth with pockets > or = 6 mm gave 5% probability and 22 such teeth gave 39% probability of reporting migration of front teeth. The main conclusion from this study is that there is good correspondence between subjective self-reports and clinical findings, especially for those conditions that are relatively easy for the patient to observe, such as the number of teeth and the presence of dentures. Thus questionnaire data can be used for information and screening about some well-defined oral conditions.

Dental malocclusion in native children of British Columbia, Canada.

Since 1972, the Medical Services Branch (MSB), Pacific Region of Health Canada, has conducted quadrennial surveys of the dental health status of Native children in British Columbia (B.C.), Canada. This paper will analyze the findings related to dental malocclusion. Data from the most recent survey in 1988 are compared to data from 1980, and also to similar data from the most recent B.C. Children's Dental Health Survey. Prevalences of abnormal and severe malocclusion are also compared to the original 1972 data. Methods used in the surveys were detailed in a previous paper (I). Significant decreases in the percentage of children with drifting due to premature space loss (P < 0.05), as well as a slight decrease in the percentage of children with crowding were observed. A trend towards an increase in Class II molar relationship was demonstrated, but was not consistent for all age groups. In contrast, there was a slight, but consistent, trend towards a decrease in the percentage of children with an anterior openbite. Comparisons between the age groups demonstrated an increased prevalence of abnormal molar relationship, drifting due to space loss, crowding, crossbite, and overjet greater than 4 mm in children older than 7 years. Native children had a significantly greater prevalence of Class III molar relationship, crossbite, crowding, negative overjet, and anterior openbite than other schoolchildren in B.C. (P < 0.05). However, percentage of Native children with a severe malocclusion decreased significantly from 1972 to 1988 for 7, 9, and 11 year old children (P < 0.05), but for 13 and 15-yr-olds. Improvement has occurred over time in some aspects of dental malocclusion in these Native Canadian children, but malocclusion continues to be a frequent problem, especially amongst adolescents.

[Early deciduous tooth loss--the mature or immature eruption of their permanent successors]. / Frühzeitiger Milchzahnverlust--reifer oder unreifer Durchbruch der bleibenden Nachfolger.

On the basis of 147 panoramic radiographs of 49 patients, this study investigated the influence of the premature loss of deciduous teeth on the formation of their permanent successors at the time of their eruption. Furthermore the study investigated the eruptive movement of the successor teeth at the time of eruption. In addition to detecting the accelerated emergence of still immature successor premolars, the study also determined that the extraction ot the deciduous molars before the age of eight years delayed the eruption of the permanent successors given the absence of an infected deciduous tooth with abscess formation. In relation to the eruptive movement of the permanent molars due to the premature loss of the second deciduous molar, the study ascertained a mesial movement of the first permanent molars and an accelerated eruption of the second permanent molars.

Extreme distal migration of the mandibular second bicuspid. A variant of eruption.

A five-year study of 26,264 panoramic radiographs found distal positioning of the mandibular second bicuspid associated with a missing adjoining first molar in one of every 505 patients. Following early removal of the first molar, there is a 5% to 10% chance that the second bicuspid will migrate distally. It usually continues until it contacts the root of the second molar, and then rotates up into occlusion adjacent to the parallel with that tooth. Mesial drift seldom occurs in this circumstance; the resulting space between lower first and second bicuspids remains. Early conservative management can be very important in these cases, making periodic x-ray examination advisable whenever a molar has been lost and the adjoining bicuspid has not yet erupted.

[Incidence of displacement of the front median line after unilateral early extraction of a deciduous cuspid]. / Die Häufigkeit der Frontmittenverschiebung nach einseitiger, frühzeitiger Milcheckzahnextraktion.

600 persons with malocclusion were examinated to clear the hypothesis if one-side untimely extraction of the deciduous canine teeth will cause a displacement of the front median line towards the extraction side. 70 patients had untimely extractions in the maxilla, 53 in the mandibula. These patients showed an increased median displacement of the front median line towards the extraction side. Therefore, it is immportant to point to the demand for symmetric extraction.