Use of a Modified Matrix Band Technique to Restore Subgingival Root Caries.

Given the increasing incidence of root caries in the elderly population, clinicians frequently must isolate and restore subgingival preparations. This article demonstrates a technique utilizing a modified Tofflemire matrix band that creates a preparation free of crevicular fluid and blood for restoration with resin-modified glass ionomer cement.

The mesially impacted mandibular third molar: The incidence and consequences of distal cervical caries in the mandibular second molar.

AIMS: Distal Cervical Caries (DCC) of the mandibular second molar (Md2M) is primarily related to retained mesially impacted third molars (Md3M). Treatment of this condition indicates the removal of the Md3M and the restoration of the Md2M and, on occasions, the loss of the Md2M. The aim of this study was to determine the incidence, treatment outcomes for patients, and calculate costs related to Md2M DCC. METHODS: A review of 121 patients who had Md3M removed due to Md2M DCC was undertaken to determine the treatment outcomes for patients. The number of patients affected by DCC of Md2M was calculated from the incidence of DCC (15%) in a cohort of patients requiring Md3M removal (1100) and the annual number of patients undergoing third molar surgery in England. Direct costs were calculated using NHS and independent treatment tariffs and indirect costs from Office of National Statistics (ONS). RESULTS: It is estimated that 152,000 patients in England undergo third molar removal on an annual basis. Approximately 27,000 Md3M are removed annually due to DCC of the Md2M; costing £27 m to treat with additional costs of £28 m if dental implant replacement of the Md2M is included. Total cost for treating Md2M DCC: £55 m/annum. CONCLUSIONS: Treating Md2M DCC and its consequences is expensive for healthcare funders such as the NHS and for patients. Md2M DCC is avoidable if patients who are at risk have prophylactic Md3M removal. This would offer potential and substantial savings in the financial cost of treating an otherwise avoidable disease.

Rehabilitación oral mediante implantes dentales en paciente con síndrome de Sjõgren / Oral rehabilitation with dental implants in patients with Sjõgren's syndrome

El Síndrome de Sjögren (SS) es una patología autoinmune caracterizada por un proceso crónico inflamatorio de las glándulas exocrinas, cuya manifestación fenotípica es la queratoconjuntivitis seca y la xerostomía, lo que trae consigo el desarrollo de caries, enfermedad periodontal e infecciones bacterianas y fúngicas. Estos pacientes presentan alto riesgo cariogénico, siendo de gran interés y preocupación en la práctica odontológica, donde el tratamiento es principalmente sintomático. El caso a presentar es de una paciente de 65 años de edad diagnosticada con SS hace 8 años; la cual presenta múltiples caries y restos radiculares en dientes mandibulares y maxilares, a la cual se indican exámenes radiográficos y médicos, se realizan exodoncias múltiples en sector inferior y en el mismo acto quirúrgico se instalan cinco implantes, se esperan tres meses para permitir la oseointegración para posteriormente rehabilitar con una prótesis sobre implantes tipo ad-modum en palafito y en el sector superior se rehabilitará con resinas compuestas previo encerado diagnóstico y prueba de Mock-up para llegar al plano oclusal y así recuperar funcionalidad y estética

Sjõgren's syndrome (SS) is an autoimmune disease characterized by a chronic inflammatory process of the exocrine glands, whose phenotypic expression is keratoconjunctivitis sicca and xerostomia, which entails the development of caries, periodontal disease and bacterial and fungal infections. These patients are at high risk cariogenic, being of great interest and concern in dental practice, where treatment is mainly symptomatic. The present case is a patient of 65 years of age diagnosed with SS 8 years; which has multiple cavities and root fragments in mandibular teeth and jaws, which radiographic examinations anddoctors indicated, multiple extractions are performed in lower sector and in the same operation five implants are installed, three months are expected to allow osseointegration to further rehabilitate a prosthesis implantsad modum type on stilts and in the upper section will be rehabilitated with wax composites prior diagnosisand test mock up to reach the occlusal plane and recover functionality and aesthetics...

Advanced restorative dentistry - a problem for the elderly? An ethical dilemma.

The type of dental restorations taken into old age may have an adverse effect on the quality of life of the elderly. Root caries and dry mouth increase in prevalence with age and may precipitate the breakdown of remaining natural and restored teeth. At present the availability of dental personnel and facilities in residential aged care facilities (RACFs) is limited, often non-existent, and the elderly living at home may be unable to easily gain access to dental care. Thus, the provision of appropriate and timely dental treatment may not occur, resulting in prolonged pain and suffering. It is important that, as our elderly population increasingly retain natural teeth into advanced old age, appropriate funds are made available to ensure their dental health is maintained. A lack of early intervention to arrest dental disease may result in life-threatening medical consequences in the elderly, such as ventilator assisted pneumonia or the need for a general anaesthetic and possible associated medical risks. Significant local disease, such as osteonecrosis, may also result from a lack of appropriate dental intervention. The necessity to remove questionable teeth prior to irradiation for neoplastic disease or bisphosphonate prescription for neoplastic disease or severe osteoporosis emphasizes the need for regular dental care. In contrast, extensive dental restorative treatment for younger people may have benefits, such as optimal dental aesthetics and oral function, but in older individuals careful consideration should be given to select the most appropriate treatment modality so that adverse situations can be avoided or their resolution simplified should they occur later when the individual is compromised or in a RACF. This may mean the use of conservative dental restorative materials and an avoidance of complex restorative options which may be difficult for the individual or RACF staff to maintain. Some years after receipt of their complex restorations they may be unable to cope with the operative demands and financial burden of resolving their deteriorating dental situation and so complex implant-born structures and precision removable prostheses should probably be avoided for those individuals contemplating entering a care situation. Therefore, the timing of the provision of complex dentistry poses an ethical dilemma.

Autotransplantation combined with orthodontic treatment to restore an adult's posttraumatic dentition.

This case report describes the successful treatment of an adult with a skeletal Class II Division 2 posttraumatic dentition with consequential restorations. The extracted maxillary premolar was autotransplanted to replace the hopeless mandibular first molar. The endodontically treated maxillary right canine was extracted instead of the premolar. A multidisciplinary approach including autotransplantation and orthodontic treatment provided a satisfactory outcome.

Fresh-socket implants in periapical infected sites in humans.

BACKGROUND: The aim of the present study is to compare the outcome of the immediate placement of implants when used in the replacement of teeth with and without chronic periapical lesions. METHODS: Thirty patients requiring a single-tooth extraction of a monoradicular or premolar tooth were selected. The control group (CG) included 15 patients without periapical lesions but with root caries and root fractures. The test group (TG) included 15 patients with periapical lesions, periapical radiolucencies, and no signs of pain, fistulas, or suppuration. Thirty teeth were extracted, and implants were immediately positioned in fresh sockets and loaded after 3 months in both groups. Clinical parameters (probing depth [PD], modified plaque index, modified bleeding index [mBI], marginal gingiva level [MGL], and keratinized mucosa [KM]) and marginal bone levels were evaluated at baseline and 12 and 24 months after implant placement. Comparisons between CG and TG values over time were performed by the Student two-tailed t test. RESULTS: At the 24-month follow-up, a survival rate of 100% was reported for all implants. The mean bone loss was 0.82 +/- 0.52 mm for the CG and 0.86 +/- 0.54 for the TG. Plaque accumulation was 0.74 +/- 0.29 for the CG and 0.69 +/- 0.29 for the TG. The mBI was 0.77 +/- 0.33 for the CG and 0.72 +/- 0.36 for the TG. The soft tissue profile MGL and KM remained stable for up to 24 months for the CG and TG. The mean PD was 2.05 +/- 0.66 mm for the CG and 1.99 +/- 0.57 mm for the TG. Differences that were not statistically significant were reported between the CG and TG over time and between time points. CONCLUSION: At the 24-month follow-up, endosseous implants placed immediately in extraction sites affected by periapical infection rendered an equally favorable soft and hard tissue integration of the implants, revealing a predictable outcome.

Immediate, non-submerged, root-analogue zirconia implant in single tooth replacement.

This report demonstrates the successful clinical use of a modified root-analogue zirconia implant for immediate single tooth replacement. A right maxillary premolar was removed and a custom-made, root-analogue, roughened zirconia implant with macro-retentions in the interdental space was fabricated and placed into the extraction socket 4 days later. Four months after root implantation a composite crown was cemented. No complications occurred during the healing period. An excellent esthetic and functional result was achieved with the composite crown. No clinically noticeable bone resorption or soft-tissue recession was observed at 26 months follow up. Significant modifications such as macro-retentions seem to indicate that primary stability and excellent osseointegration of immediate root-analogue zirconia implants can be achieved, while preventing unesthetic bone resorption. The macro-retentions must be limited to the interdental space to avoid fracture of the thin buccal cortex. This successful case warrants further clinical research in well controlled trials.

A new approach using the surgical extrusion procedure as an alternative for the reestablishment of biologic width.

A modification of the surgical extrusion technique to treat fractured teeth was realized as an alternative periodontal therapy to avoid ostectomy following orthodontic extrusion of teeth with their biologic widths compromised by different etiologic involvements. After delicate luxation and arrested avulsion, the teeth were coronally positioned to allow room for a new biologic width. Clinical and radiographic monitoring showed the ability of the periodontium to adapt function and esthetic recovery. The advantages and disadvantages of this therapeutic procedure for resolution of a periodontal involvement are presented.

Periodontal attachment level of extractions presumably performed for periodontal reasons.

BACKGROUND/AIMS: The aim of this study was to analyse the residual periodontal attachment in teeth extracted by East German dentists in order to determine a possible 'forceps level'. METHODS: Out of about 8000 extracted teeth collected from a dental waste disposal company, 500 teeth were randomly selected. After exclusion of wisdom teeth and premolars extracted for orthodontic reasons (intact teeth with attachment > 90%), coronal and root caries, fillings, pulp exposure and incomplete root fillings (based on X-rays) were registered. The periodontal ligament was stained with 1% Fuchsin Red and measured with a light microscope. RESULTS: For intact teeth (DF = 0, periodontal disease definition I), the mean periodontal attachment (50.5% +/- 16.0) was significantly lower than for teeth with carious defects or fillings (64.7% +/- 18.8. unpaired t-test: p < 0. 00 1). There was a marked increase in frequency of extractions in intact teeth below 70% periodontal attachment and 37% were extracted at attachment levels between 50 and 69%. Teeth with pulpal involvement showed significantly different frequency distributions and mean attachment values (77.9% +/- 17.8) than the remaining teeth (periodontal disease definition II; 55,2% +/- 15.5). CONCLUSIONS: A considerable number of teeth with no or minor coronal destruction were extracted at an attachment level of 50-70%, regardless of the tooth type. The threshold for 'periodontal' extractions seem to be too low and undifferentiated, which calls for an improvement in knowledge of periodontal diagnosis and treatment.

Coverage of previously carious roots is as predictable a procedure as coverage of intact roots.

BACKGROUND: Coverage of roots exposed by gingival recession is one of the main objectives of periodontal reconstructive surgery. A variety of highly predictable and esthetically acceptable mucogingival grafting procedures are available for treating intact root surfaces. One of the indications for root coverage procedures is prevention of root caries. However, little is known about the ability to treat previously carious roots by mucogingival grafting, and even less is known about the outcome of such treatment. METHODS: Sixty patients with gingival recession were treated with subepithelial connective tissue grafts. During initial examination, 33 intact teeth with longstanding gingival recessions of 4.09 +/- 0.16 mm (mean +/- SEM) and 27 teeth with carious roots (restored and unrestored) and longstanding gingival recessions of 3.44 +/- 0.22 mm (mean +/- SEM) were found. Prior to grafting, any carious dentin and plastic restorations were removed. The exposed roots were thoroughly planed and covered by a subepithelial connective tissue graft without any further root treatment or conditioning. Patients were evaluated periodically between 1 and 6 years. Residual recession, defect coverage, and caries incidence were assessed. RESULTS: Recession was reduced to a similar extent on all teeth whether root caries was present (0.31 +/- 0.11 mm) or not (0.15 +/- 0.04 mm). This resulted in comparable defect coverages of 92.41 +/- 2.38% for previously carious roots and 97.46 +/- 0.79% for intact roots. In 44 cases, complete coverage of the recession was achieved. The results were stable, and no further recessions or recurrent caries were found during the periodic evaluations. CONCLUSIONS: These results indicate that coverage of previously carious roots with subepithelial connective tissue grafts is a very predictable procedure with results similar to those found on intact roots. This procedure may provide a definitive biological alternative for conventional restorative treatment modalities for root caries. Moreover, the results are more esthetic, biologically acceptable, and maintainable.

Soft tissue root coverage as treatment for cervical abrasion and caries.

Root exposure caused by gingival recession may result in cervical abrasion, root caries, root sensitivity, and compromised esthetics. Although cervical root lesions can be treated with Class V restorations, there may be advantages in treating them with soft tissue grafts for root coverage since they restore the dento-gingival unit to its prerecession condition. The rationale for root coverage with soft tissue grafts is reviewed and two cases are presented of successful root coverage procedures in which gingival recession associated with cervical abrasion and caries was present.

Simultaneous team approach of a crown-lengthening procedure and an operative restoration: technique and long-term effect.

Traditionally, crown-lengthening procedures to expose subgingival caries for operative restorative work are carried out in a two-stage approach. A disadvantage of this procedure is that the gingival margin associated with the treated tooth moves apically; this may create an esthetic problem. Resin-modified glass-ionomer cement has been demonstrated to have good biocompatibility with dental hard and soft tissues. Surgical and restorative procedures were combined at the same appointment in an effort to achieve a restoration with minimal change in the gingival margin. Four patients have been treated with this one-stage team approach and followed for 8 to 13 months. The clinical results demonstrated this team approach procedure is excellent for the dentition when esthetics is a consideration.

Extraoral apical elongation of deeply damaged roots with titanium posts. A comparison of 2 methods.

42 very deeply fractured or otherwise damaged single roots which could not be saved by intra-alveolar transplantation only were replanted to a supragingival level after extraoral transapical elongation by either an ordinary titanium root screw (method 1) or a specially designed titanium post (TransApex, Dentatus) (method 2). After observation periods of x = 73 months (method 1) and x = 34 months (method 2), 61% and 85% of the cases-respectively, were considered successful, fulfilling all 5 predefined success criteria. No other resorptions than slight surface resorptions were seen and all teeth showed very shallow pocket depths and physiological mobility, indicating that the long extraoral treatment had not caused lasting traumatic injury to the PDL cells. The most frequent complication in method 1 was periapical osteitis, indicating that the elongation system had become insufficient. On the other hand, the method showed the capacity to heal many of the pre-existing osteitis cases. Both root elongation techniques described in this report are comparatively inexpensive and safe, since the apical elongation is never extended beyond the lamina dura structure of the alveolus. Method 2 is to be preferred, however, as the specially designed through-and-through post-system which simultaneously provides apical closure, transapical elongation and coronal retention, allows treatment of even very short roots and seems to give better results.

Surgical correction of gingival recessions associated with radicular carious lesions.

In this clinical report, six cases are presented in which radicular carious lesions and gingival recessions were treated concurrently. The combined treatment included the removal of caries, radicular planing, and various surgical techniques for root coverage. Traditional procedures, as well as newer procedures, such as guided tissue regeneration, showed successful results.

Intra-alveolar transplantation. I. A 10-year follow-up of a method for surgical extrusion of root fractured teeth.

A group of 19 patients where traumatic root fractures were treated with surgical extrusion procedure has been clinically and radiographically followed up for 10 years. Except for one out of 21 intraalveolar transplanted roots all functioned with different kinds of crown restorations and without pathological complications. The surgical extrusion method should thus be a useful tool in the treatment of teeth with cervical root-fractures and also teeth with deep cervical root caries which are difficult to treat conservatively.

[Decision to extract for periodontal reasons]. / Décisions d'extraction pour raisons parodontales.

The decisions to extract that are discussed here mainly relate to severe periodontal bone losses and plain interradicular attacks. Extractions for periodontal reasons appear at several treatment stages: immediate extraction in terminal stages, e.g. for teeth without any strategic importance, or deferred extraction if one chooses to wait for treatment response. The elements of the decision are various: function and strategic importance of the tooth, extension of the lesion, level of the interradicular attack, any endoperiodontal lesions, fractures and luxations, radicular proximity, implication of wisdom teeth, evolution after treatment. All these factors are discussed.