Efficacy of flapless intentional replantation with enamel matrix derivative in the treatment of hopeless teeth associated with endodontic-periodontal lesions: A 2-year prospective case series.

OBJECTIVE: In this prospective case series, the effects of flapless intentional replantation (IR) with root surface conditioning with enamel matrix derivative (EMD) was evaluated for the treatment of periodontally-endodontally involved hopeless teeth. METHOD AND MATERIALS: A total of 17 teeth (17 patients, aged 40 to 73) with ≥ 10 mm attachment loss and radiographic bone loss to the apex were included in the study. The affected teeth were atraumatically extracted using a flapless approach, then granulation tissues, calculus, and necrotic cementum on the root surfaces were removed. EMD was applied for 5 minutes to the root surfaces. The teeth were reinserted to the socket without any bone grafts and splinted. RESULTS: After 2 years, clinical healing was uneventful in 16 cases and the radiographs revealed no root resorption or ankylosis. IR with EMD treatment provided statistically significant reduction in probing depth (6.4 ± 2.6 mm), gain in clinical attachment level (5.9 ± 2.5 mm), and gain in radiographic bone level (48.2 ± 26.1%) compared to baseline values (P < .01). CONCLUSION: Within the limitations of the study, flapless IR with EMD treatment appeared to act as an alternative strategy to extraction of severely compromised teeth with endodontic-periodontal lesions beyond the root apex.

Valor pronóstico de la densidad ósea y de la movilidad en el éxito implantológico / Prognostic value of bone density and mobility in implant success

Objetivos. Evaluar el valor pronóstico de la movilidad primaria (momento de inserción del implante) y secundaria (fase protésica), así como el de la densidad ósea en el resultado de éxito o fracaso del implante durante un seguimiento continuado al año, a los 5 años y a los 10 años. Material y métodos. Se realizó un estudio longitudinal prospectivo con un seguimiento a 10 años en el que se incluyeron 151 implantes colocados en 71 pacientes, no fumadores, durante los años 2005 y 2006. A cada uno de los implantes se les midió las estabilidades primaria y secundaria a través de un valor Periotest® (VPT) y se anotó la densidad ósea presente en el momento de la implantación. De los 151 implantes colocados inicialmente, completaron el estudio 109. Resultados. No se observaron diferencias estadísticamente significativas respecto a la movilidad del implante en el momento de inserción o en la fase protésica y el éxito o fracaso del mismo al año, a los 5 años, o transcurridos 10 años desde su inserción. Sí encontramos diferencias estadísticamente significativas con relación al tipo de densidad ósea donde se colocó el implante a los 5 y 10 años (p<0,05). Conclusiones. La movilidad primaria o secundaria del implante carece de valor pronóstico significativo sobre el éxito del mismo transcurridos 10 años desde su inserción. Por el contrario, la densidad de hueso inicial tiene una clara influencia en el éxito del implante a los 10 años, siendo más proclives al fracaso los huesos de alta densidad ósea (AU)

Purposes. To prospectively analyze the prognosis value of the primary mobility (at the moment of implant insertion) and secondary (prosthetic phase), as well as bone density, in the implant success or failure after one year, five years and ten years. Materials and methods. Between 2005 and 2006, 151 implants were placed in 71 non-smoking patients. Primary (at the moment of surgery) and secondary (once osseointegrated) stabilities were measured in each implant through a Periotest® value (PTV) and the bone density was scored at the moment of implantation. One hundred nine of 151 implants placed initially completed the study. Results. There were no statistically significant differences regarding implant mobility at the moment of its insertion or once osseointegrated and the implant success or failure after 10 years. However, statistically significant differences were found respect to the bone density where the implant was placed after 5 and 10 years (P<.05). Conclusions. Primary or secondary mobility of the implant has no significant prognosis value on the implant success after 10 years. On the other hand, bone density has a clear influence on long time implant success. High density bones are more predictable to fail than low density bones after a long time (AU)

Effect of Causative Tooth Extraction on Clinical and Biological Parameters of Odontogenic Infection: A Prospective Clinical Trial.

PURPOSE: To prospectively compare changes of body temperature, white blood cell count, fibrinogen, and C-reactive protein between odontogenic infections in which the responsible tooth was removed and odontogenic infections in which the treatment included no extraction. MATERIALS AND METHODS: The sample was composed of patients admitted to the authors' maxillofacial unit for odontogenic infection from 2010 through 2013. One hundred seventy-nine patients were categorized into an extraction or a non-extraction group based on whether the causative tooth was non-restorable or restorable, respectively. Non-restorable teeth were extracted at admission of the patient. Otherwise, the treatment protocol, including incision of the involved space in conjunction with intravenous antibiotics, was the same for the 2 groups. The parameters were measured and recorded at admission and 2 days later. Data records were statistically analyzed by comparing the change of the parameters studied between the extraction and non-extraction groups. P values less than .05 were regarded as statistically significant. RESULTS: One hundred seventy-nine patients fulfilled the inclusion criteria and were enrolled in the study. The mean age of the patients was 39.1 years (minimum, 14 yr; maximum, 81 yr; standard deviation, 15.4 yr). One hundred nine patients (60.9%) were male, and 70 (39.1%) were female. Differences in the mean decrease of axillary temperature, white blood cell count, fibrinogven, and C-reactive protein between the 2 groups were 0.178, 2,300, 1.01, and 0.64, respectively. All these differences were statistically significant (P =.02, .001, .001, and .001, respectively). Also, the mean hospital stay in the extraction group was 1.05 days shorter than in the non-extraction group, with the difference being statistically significant (P = .006). CONCLUSIONS: In odontogenic maxillofacial infections, extraction of the causative tooth is associated with a faster clinical and biological resolution of the infection.

Soft-tissue re-growth following fibre retention osseous resective surgery or osseous resective surgery: a multilevel analysis.

BACKGROUND: The aim of this study was to assess soft-tissue re-growth following Fibre Retention Osseous Resective Surgery (FibReORS) or Osseous Resective Surgery (ORS) over a 12-month healing period. MATERIAL AND METHODS: Thirty patients with chronic periodontitis showing persistent periodontal pockets at posterior natural teeth after cause-related therapy were enroled. Periodontal pockets were associated with infrabony defect ≤3 mm; 15 patients were randomly assigned to FibReORS (test group) and 15 to ORS (control group). Measurements were performed by a blind and calibrated examiner. Soft-tissue rebound after flap suture was monitored by changes in gingival recession at 1-, 3-, 6-, and 12- month follow-up. Multilevel analysis considering patient, site, and time levels was performed. RESULTS: Greater osseous resection during surgery and higher post surgical gingival recession was observed in the ORS group. The mean amount of soft-tissue rebound following surgery was 2.5 mm for ORS-treated sites and 2.2 mm for FibReORS-treated sites. Approximately 90% of the coronal re-growth was detectable after 6 months for both procedures. The interaction between ORS and time of observation showed a higher soft-tissue rebound after 12 months (p = 0.0233) for ORS-treated sites. CONCLUSIONS: Both procedures showed a similar coronal soft-tissue re-growth with a significant higher recession reduction for ORS-treated sites. Significant clinical stability of the gingival margin is obtained 6 months after surgery for both procedures.

Bone grafts using autogenous tooth blocks: a case series.

OBJECTIVE: A case study was conducted to examine the clinical results and histologic healing of bone grafts performed using an autogenous tooth block (AutoBT block), which was developed recently and proprietary. STUDY DESIGN: Guided bone regeneration, extraction socket graft, sinus bone graft, and ridge augmentation were performed using autogenous tooth block graft material in 12 patients from March 2009 to June 2010. The clinical outcomes of each case were examined, and tissue specimens were collected from 1 case 2.5 months after the bone graft for histopathological analysis. RESULTS: All of the cases had successful bone graft results. One patient developed wound dehiscence after surgery, although favorable secondary healing was achieved. One implant resulted in osseointegration failure. A histopathologic examination was performed after 2.5 months and showed excellent bone healing due to osteoconduction. The AutoBT block was incorporated into the upper soft tissue, aponeurosis, and lower recipient bone. CONCLUSION: There were no notable complications associated with the bone transplant materials. The AutoBT block is clinically useful for a variety of bone grafts.

The anatomical evaluation of the dental arches using cone beam computed tomography--an investigation of the availability of bone for placement of mini-screws.

OBJECTIVE: To assess the amount of maxillary and mandibular inter-radicular bone mass and determine the most reliable mini-screw placement sites. MATERIALS AND METHODS: Retrospective Cone Beam Computed Tomography (CBCT) images of 40 Angle Class I subjects (20 females, 20 males, aged 16 to 32) were obtained. Measurements on the buccal (BI), medial (MI) and lingual (LI) sides of the inter-radicular spaces were taken at 0, 1, 2, 3, 4, 5 mm from the cemento-enamel junction (CEJ) in an apical direction. RESULTS: The male and female BI scores ranged from 2.99±0.73 mm to 6.18±1.03 mm and 2.69±0.84 mm to 6.21±1.22 mm respectively. The male and female MI scores ranged from 1.36±0.38 mm to 4.50±0.99 and 1.53±0.66 to 4.77±1.99 mm respectively. LI scores ranged from 2.37±0.70 to 6.47±1.0 mm and 2.45±0.56 mm and 6.66±1.33 mm respectively. In both maxillary and mandibular arch, the inter-radicular space increased in the apical direction except for the buccal and medial inter-radicular spaces between the maxillary first and second molars. CONCLUSION: The medial inter-radicular spaces are the decisive parameter for mini-screw placement. In the maxillary arch, regions between central and lateral incisors, lateral incisor and canine, first and second molars are not viable for mini-screw insertion. The residual inter-radicular regions are proper for implantation at 3 mm above the CEJ. In the mandible, the regions between incisors and canines are too narrow for mini-screw insertion and the reliable sites for mini-screws are regions between premolars, molars or first molar and second premolar at 2 mm below the CEJ.

Procedimiento de estética inmediata en región anterior inferior. Presentación de un caso clínico / Immediate aesthetic procedure in the anterior inferior region. Presentation of a clinical case

Introducción: En la actualidad los pacientes demandan no sólo resultados funcionales, sino que también requieren resultados estéticos y una disminución del tiempo transcurrido desde la extracción dentaria hasta su rehabilitación protética sobreimplantes. Esta mayor demanda de resultados estéticos y disminución de los tiempos de tratamiento ha contribuido en la aparición un procedimiento denominado "reposición inmediata" que combina la colocación de implantes postextracción y estética inmediata. Objetivo: Presentar como alternativa terapéutica el procedimiento de reposición inmediata en el sector anteroinferior, describiendo la técnica y sus resultados estéticos. Caso clínico: Paciente mujer de 53 años que acude a nuestra consulta por movilidad en incisivos inferiores, en la exploración clínica se observó movilidad tipo 2-3 y ausencia de signos de infección, mientras que la exploración radiológica evidenció una extensa pérdida ósea horizontal alrededor de los incisivos inferiores. Ante esta situación clínica se decidió la extracción de los mismos y su rehabilitación mediante procedimiento de "reposición inmediata". Conclusiones: un buen diagnóstico, una cuidadosa técnica quirúrgica y un correcto tratamiento protético favorecen un pronóstico favorable en este procedimiento terapéutico denominado reposición inmediata, si bien la evolución y mantenimiento de los resultados depende de la higiene oralque mantenga el paciente y que acuda con regularidad a los controles clínicos (AU)

Introduction: At present, patients demand not only functional results, but they also require aesthetic results and a decrease of the time transpiring from the dental extraction until their prosthetic rehabilitation with implants. This greater demand of aesthetic results and decrease in the treatment time has contributed to the appearance of a procedure called "immediate replacement" which combines the placement of post extraction implants and immediate aesthetics. Objective: To present as a therapeutic alternative the procedure of immediate replacement in the anterior inferior sector, describing the technique and the aesthetic results. Clinical case: Female patient of 53 years of age comes to the office for mobility in inferior incisors; in the clinical examination type 2-3mobility and absence of signs of infection were observed, while the radiological examination showed extensive horizontal bone loss around the lower incisors. In view of this clinical situation it was decided to extract them and perform their rehabilitation by means of the "immediate replacement" procedure. Conclusions: a good diagnosis, a careful surgical technique and correct prosthetic treatment support a favourable prognosis in this therapeutic procedure called immediate replacement, although the evolution and the maintenance of the results depend on the oral hygiene that the patient maintains and that she comes regularly to the clinical checks (AU)

[Bone tissue restoration after tooth removal by means of tissue-engineering construction based on multipotent stromal adipose cells].

The paper contains clinical examples of tissue-engineering construction based on multipotent stromal adipose cells application for tooth socket healing. The method do not only prevents the bone tissue resorption but allows recreating its volume.

Tooth separation: a risk-free procedure?

This article reports the case of a 12-year-old patient with tooth extrusion, pain, gingival bleeding, and localized periodontitis near the maxillary second premolar. Despite probing and radiographic examination, it was not possible to establish the etiology. Tooth extraction was indicated because of the severe tooth mobility and extrusion. Curettage of the tooth socket revealed a rubber separator. Preventive approaches are suggested to avoid iatrogenesis and legal problems.

Effectiveness of two flavored topical anesthetic agents in reducing injection pain in children: a comparative study.

UNLABELLED: Topical anesthesia is widely advocated in pediatric dentistry practice to reduce pain and anxiety produced by administration of local anesthesia. There are different combinations of topical anesthetic agents that are marketed worldwide. However, sparse literature reports exist regarding clinical efficacy of these agents. AIM: To compare the clinical effectiveness of two strawberry flavored topical anesthetics viz. Precaine (8% Lidocaine + 0.8% Dibucaine) and Precaine B (20% Benzocaine) in children before intra oral local anesthetic injections and for extraction of mobile primary teeth. STUDY DESIGN: This triple blind clinical study included sixty children divided equally under three techniques--palatal injections, inferior alveolar nerve block and extraction of mobile primary teeth. Both the products were used alternately using split mouth design in two visits and the child's pain response was assessed using VAS and SEM pain scale. The scores obtained were subjected to statistical analysis. RESULTS: Precaine has shown lower mean scores in all the techniques under both the pain scales, but were statistically insignificant. Gender wise comparison has also shown lower mean scores for Precaine for both males and females, however these were statistically insignificant. On visit wise comparison, Precaine B reported significant lower scores (p < 0.05) in visit 2 compared to visit 1 for inferior alveolar nerve block and extraction of mobile primary teeth under SEM pain scale. CONCLUSION: Precaine (8% Lidocaine + 0.8% Dibucaine) can be used as effectively as Precaine B (20% Benzocaine).

Simple diagnostic method to assess the available bone for immediate implant placement in an extracted socket.

The success rate of immediate tooth replacement has been well documented in the literature. To achieve long-term success of dental implants, evaluation of the dimensions of the resorbing alveolar process must be accurate because an implant should be surrounded by at least 1 mm of bone. To minimize facial gingival recession, an intact labial bony plate along with an osseous-gingival relationship of 3 mm on the facial aspect of the failing tooth has been suggested. This article mentions a technique wherein the amount of available labial and palatal bone of an extracted socket can be assessed by using the extracted tooth that is to be replaced with an endosseous implant and a ridge mapping procedure without reflecting the flap.

Selection of instruments for the successful extraction of molar teeth: a pilot study.

We report the result of a pilot study that was designed to test the effectiveness of a chart that gives advice about the choice of extraction instruments and the techniques necessary to remove molar teeth successfully. It was designed from experience gained from the extraction of several molar teeth under local anaesthesia, and includes 20 blocks that cover a combination of five clinical presentations of tooth decay with four clinical presentations of tooth mobility. Recent graduates who used the chart were able to extract more molar teeth successfully than those who did not, and its use can also reduce the amount of supervision time necessary without compromising the guidance required.

Treatment of intrabony periodontal defects with enamel matrix derivative in private practice: a long-term retrospective study.

The present study describes treatment of intrabony periodontal defects with enamel matrix derivative (EMD) in private practice. Ten patients with clinical diagnosis of chronic periodontitis were subjected to data analysis. A total of 18 teeth with various osseous defects received regenerative therapy with EMD, and were followed for a minimum of 2 years. Treatment of the intrabony defects with EMD led to a statistically significant improvement in the mean value of probing depth at 1-year when compared with at the baseline (p<0.01). Reduction in probing depth was achieved with minimal recession of the gingival margin, and was maintained over the 2-year observation period with no significant change. Mean values of attachment gain at 1 and 2 years were of clinical significance: 3.39+/-1.46 mm and 3.22+/-1.40 mm, respectively. Although one tooth was extracted because of subsequent loss of attachment and bone, most teeth treated have been successfully maintained for 2 to 7 years with no significant signs of disease progression. In conclusion, EMD treatment of intrabony osseous defects yielded clinically favorable responses. The gain in clinical attachment can be longitudinally maintained in a private practice setting. Further controlled studies are needed to elucidate the clinical significance of EMD treatment.

Use of pedicled buccal fat pad in root coverage of severe gingival recession defect.

BACKGROUND: Gingival recession in its localized or generalized form is an undesirable condition resulting in root exposure. Sites exhibiting Miller Class IV gingival recession are not suitable for treatment with surgical root coverage techniques, and their prognoses are very poor with current techniques. The aim of this case report is to establish a new technique for the root coverage of severe gingival recession defects (Miller Class IV) by providing a new source of enough tissue with good blood supply using the pedicled buccal fat pad (PBFP). METHODS: The PBFP was mobilized through an incision in the base of the buccal flap at the level of the upper second molar; the vascularized flap was secured to the buccal surface of the upper first molar tooth and premolar teeth and sutured with the wound margins. RESULTS: A clinically significant amount of keratinized gingiva that covered the root recession defect was obtained. Epithelialization of the buccal fat pad was completed after 6 weeks, with formation of healthy-looking keratinized mucosa in the anatomic site of the keratinized gingiva. CONCLUSIONS: The PBFP technique is simple and easy to handle. It may also be considered a novel application with promising results for the root coverage of severe gingival recession defects (Miller Class IV) that may provide a considerable amount of keratinized tissue used for root coverage of the upper posterior molar teeth.

Intraoral findings of Papillon-LeFevre syndrome.

Papillon-Lefevre syndrome (PLS) is a rare autosomal, recessive condition characterized by hyperkeratosis of palms and soles of the feet and elbows and by rapid formation of periodontitis and hypermobility, migration and exfoliation of the teeth of primary and permanent dentition. The purpose of this report was to describe the case of an 8-year-old boy who presented to the Department of Oral Diagnosis and Radiology of Faculty of Dentistry of Ondokuz Mayis University with a chief complaint of mobility and rapid loss of teeth. Hyperkeratosis of palms and soles were realized. His gingivae were hyperemic and edematous, and the teeth were mobile. Histopathological examination of the specimen taken from the thickened skin was reported to be consistent with PLS. All teeth with poor prognosis were extracted and extensive periodontal therapy was administered, and a special denture was constructed.

Bisphosphonate-related osteonecrosis of the jaws: a report of three cases demonstrating variability in outcomes and morbidity.

BACKGROUND: Bisphosphonates are used widely to manage skeletal disorders resulting from malignancies that destroy bone and from some metabolic bone diseases. A strong association between bisphosphonate treatment and the appearance of painful exposed nonvital bone in the mandible and maxilla after oral surgery has been reported in the last decade. Extensive reviews have appeared in the dental literature regarding bisphosphonate-related osteonecrosis of the jaws (BRONJ), including protocols for diagnosis, management and diagnostic imaging for early detection; feature definition; and determination of extent of the disease. CASE DESCRIPTION: The authors provide three case reports to show the contrast in treatment outcomes and morbidity in patients with BRONJ. The cases involved diagnostic imaging modalities commonly used in the practice of dentistry: panoramic radiography and cone-beam volumetric computed tomography. CLINICAL IMPLICATIONS: These case reports demonstrate the usefulness of dental diagnostic imaging in the detection and management of BRONJ, corroborate the increasing number of reports regarding high levels of morbidity associated with various BRONJ treatments, and underscore the danger of performing invasive dental procedures for patients receiving bisphosphonate therapy.

Implant-supported reconstruction in a patient with generalized aggressive periodontitis.

BACKGROUND: A 31-year-old female was diagnosed with generalized aggressive periodontitis based on clinical and radiographic findings. Dental implants were used to restore her dentition. The long-term success of osseointegrated implants in periodontally healthy patients has been documented well in the literature. However, only a few cases of full-mouth rehabilitation, using dental implants, have been reported in periodontally compromised patients, especially those who exhibited generalized aggressive periodontitis. METHODS: Following extraction of all teeth except #6 through #11 in the maxilla, oral rehabilitation was accomplished with the use of implant-supported restorations; detailed treatment planning and sequence are presented. RESULTS: Eight implants were loaded immediately in the mandible. Six implants were placed in the posterior maxilla with a conventional two-stage approach. The maxillary implants were loaded after a 4-month healing period. The patient was followed for 18 months postloading in the maxilla and 24 months postloading in the mandible. CONCLUSION: Successful oral rehabilitation was accomplished using osseointegrated implants in a patient with generalized aggressive periodontitis.

Tratamiento de los defectos óseos mediante implante con apafill-g / Bone defect treatment with apafil-g graft

Se realiza un estudio para valorar la eficiencia del tratamiento de los defectos óseos mediante implante con Apafill-G en la Clínica Estomatológica Docente Asistencial Lidia Doce, en el período comprendido de noviembre de 2000 a marzo de 2002. Se encuentra que es eficaz como material de implante en el tratamiento de los defectos óseos provocados por la enfermedad periodontal destructiva crónica. Predomina, después del tratamiento, la ausencia de bolsa periodontal. La biocompatibilidad se logró excelentemente en todos los pacientes. Se emiten conclusiones y recomendaciones. Se anexan tablas estadísticas (AU)