Factors affecting root migration after coronectomy of the mandibular third molar.

ABSTRACT: Nerve injury especially inferior alveolar nerve (IAN) is the one of the complications that occur when the mandibular third molar (M3) is extracted and in case of high risk patients, coronectomy might be an alternative to tooth extraction. The purpose of this retrospective study was to analyze root migration and its influencing factors at 6 months after coronectomy in both 2- and 3-dimensions using periapical view and cone-beam computed tomography (CBCT). We analyzed 33 cases of root remnant after coronectomy and measured the amount of migration in CBCT. The following factors that could possibly affect root migration were also analyzed: age, gender, number of M3 roots, shape of M3s, Pell, and Gregory classification, mesiodistal (MD) angulation, buccolingual (BL) angulation, contact point with the second molar, root curvature, and complete removal of the coronal portion. Migration of greater than 2 mm was found in 64% of the roots in the 2-dimensional (2D) analysis, and the average root migration was 4.11 mm in the 3-dimensional (3D) analysis. The factors affecting migration were the root morphology, complete removal of the coronal portion, impaction depth, and MD angulation in the 2D analysis, and MD and BL angulation in the 3D analysis. Ensuring sufficient space for root migration especially considering angulation, depth and complete removal of the coronal portion might be important factors after coronectomy of the M3. Root remnant after coronectomy of M3 may migrate in young patients who has sufficient empty coronal space and this may reduce the nerve damage by the separation of IAN and M3.

Anchorage loss assessment of the indirect anchor tooth during adjunctive orthodontic treatment.

INTRODUCTION: This study quantitatively assessed movement of anchor teeth connected to a miniscrew (indirect anchor tooth) and investigated factors affecting movement during adjunctive orthodontic treatment. METHODS: Dental plaster models of 28 patients whose treatment included an indirect anchor tooth on one side were collected before and after treatment. The casts were digitally scanned, and 2 groups were constituted: the indirect anchor teeth (experimental group; n = 52) and the untreated teeth (control group; the first and second premolars opposing the indirect anchor tooth to which no orthodontic force was applied; n = 55). Pretreatment and posttreatment models were superimposed and the amount and direction of indirect anchor tooth movement were evaluated with the use of a univariate linear mixed model. Possible factors affecting movement of the indirect anchor tooth and its significance were also evaluated with the use of a multiple linear mixed model. RESULTS: The indirect anchor tooth moved 0.91 ± 0.50 mm and did not exhibit significant differences in the transverse, vertical, or sagittal directions. The location of the indirect anchor tooth affected movement and the tooth moved significantly more in the mandible than in the maxilla. CONCLUSIONS: The indirect anchor tooth can move during adjunctive orthodontic treatment and thus requires careful monitoring for occlusal changes.

Repositioning of a pathologically migrated tooth using autologous platelet-rich plasma: a case report with 3-year follow-up.

An intricate balance between the periodontal tissues and the forces of occlusion, tongue, and lips helps to maintain a tooth in its physiologic position within the dental arch. Disturbances in the equilibrium can cause a tooth to migrate pathologically, often requiring multidisciplinary treatment approaches. The present case demonstrates, for the first time, the use of autologous platelet-rich plasma to aid in tooth repositioning after pathologic tooth migration. A 25-year-old woman presented with extrusion and labial migration of the maxillary left central incisor, a diastema of 3 mm, and grade II mobility. Radiographic evaluation showed a deep, angular bone defect, extending to the apical third of the root, on both the mesial and distal aspects of the maxillary left central incisor. Comprehensive treatment consisted of nonsurgical and surgical periodontal therapy with autologous platelet-rich plasma. Without orthodontic intervention, the unesthetic diastema had completely closed by the end of 3 months postoperatively, and the results were stable at a 3-year follow-up examination. This successful, novel approach can be adopted as a conservative and time-efficient modality for management of unesthetic spaces caused by pathologic tooth migration.

Quantified diagnostic work-up casts: applications for interdisciplinary treatment planning.

Diagnostic casts that accurately replicate a patient's occlusion are essential for planning comprehensive care and interdisciplinary treatment. These casts can reveal the actual problem in the spatial relationship between the maxilla and the mandible, which may not be apparent on intraoral examination. Duplicate casts can be altered and measured to quantify the extent of the correction necessary for a predictable result. Treatment planning for interdisciplinary cases requires thorough evaluation of the entire problem and solution set as well as coordination of all procedures. Severe problems and invasive treatments require precise treatment planning. This case report illustrates these principles through multiple applications of quantified diagnostic work-up casts for a patient requiring orthognathic surgery, orthodontics, and occlusal adjustment after a mandibular subcondylar fracture.

Unusual cases of transmigrated mandibular canines.

Transmigration, an extremely rare anomaly that happens almost exclusively with mandibular canines, is defined as a pre-eruptive migration across the midline. It can lead to various restorative, surgical, orthodontic, and interceptive problems. This condition usually is not related to any painful symptoms and cannot be detected on clinical examination. This article presents 3 cases of transmigration. In 1 case, the right canine was involved, which is considered to be especially rare. This case series also highlights the importance of early diagnosis for the interceptive treatment of transmigration.

Migración de caninos inferiores: reporte de un caso y reseña de la literatura / Transmigrant impacted mandibular canines: report of a case and review of the literature

Objetivo: el objetivo de este trabajo es presentar la exodoncia de un canino inferior izquierdo transpuesto y evaluar las alternativas terapéuticas frente a casos similares. Caso clínico: se desarrolla el caso de una mujer de 30 años de edad con migración del canino inferior izquierdo. Conclusión: se destaca la importancia de otener un diagnóstico clínico y radiográfico temprano para poder realizar tratamientos precoces, a fin de evitar la migración y sus posibles complicaciones. Se enfatiza también la necesidad del estudio anatomopatológico de los tejidos blandos obtenidos con la pieza quirúrgica.

Migración de caninos inferiores: reporte de un caso y reseña de la literatura / Transmigrant impacted mandibular canines: report of a case and review of the literature

Objetivo: el objetivo de este trabajo es presentar la exodoncia de un canino inferior izquierdo transpuesto y evaluar las alternativas terapéuticas frente a casos similares. Caso clínico: se desarrolla el caso de una mujer de 30 años de edad con migración del canino inferior izquierdo. Conclusión: se destaca la importancia de otener un diagnóstico clínico y radiográfico temprano para poder realizar tratamientos precoces, a fin de evitar la migración y sus posibles complicaciones. Se enfatiza también la necesidad del estudio anatomopatológico de los tejidos blandos obtenidos con la pieza quirúrgica.(AU)

[Cystic lesion with a displaced tooth in the maxillary sinus]. / Zystischer Kieferhöhlenprozess mit verlagertem Zahn.

Ameloblastomas are epithelial odontogenic tumors in the mandibula or maxilla with potential local infiltrating growth; therefore, relapses can occur after incomplete resection. Among the different histological subtypes, the following are of clinical importance: The so-called unicystic ameloblastoma, radiologically presenting as a common dentigerous cyst, and the so-called extraosseous ameloblastoma. This case report describes the rare combination of a unicystic ameloblastoma with extraosseous localization in the maxillary sinus and association with a displaced tooth. This unusual constellation can cause major diagnostic problems.

An atypical form of necrotizing periodontitis.

BACKGROUND: Necrotizing ulcerative gingivitis/periodontitis are considered necrotizing periodontal diseases. This case report presents an atypical form of necrotizing periodontitis, which does not fit into this classification. METHODS: A 12-year-old child was referred to our clinic for gingival inflammation, extensive alveolar bone loss, and tooth mobility. Clinical and microbiologic examinations were carried out, and radiographs were taken. Clinical examination revealed soft and hard tissue destruction up to the mucogingival junction at the right maxillary premolar and mandibular incisors. Unusual infections or abnormalities in systemic functions were not detected through clinical and laboratory evaluations made at the Pediatrics Department, Istanbul University. Although an intensive established treatment protocol for necrotizing periodontitis was completed, management of long-standing health conditions could not be achieved because of recurrence of the disease, which caused us to repeat this treatment protocol at short intervals. RESULTS: Investigation led to a diagnosis of an atypical form of necrotizing periodontitis because the disease had a recurrent acute phase even under a standard treatment protocol. CONCLUSIONS: Our patient exhibits an unusual, necrotizing form of periodontal disease. The reason for the rapid rate of periodontal disease progression remains unclear.

Differential diagnosis and management of flared maxillary anterior teeth.

BACKGROUND: Flaring of maxillary anterior teeth can be caused by primary or secondary occlusal trauma. A differential diagnosis needs to be made with regard to the etiology of the problem to establish a proper treatment plan. TYPES OF STUDIES REVIEWED: The authors reviewed relevant articles in the literature addressing migration of maxillary anterior teeth to ascertain the proper diagnosis and methods of therapy pertaining to migrated maxillary anterior teeth. RESULTS: The authors identify critical questions that clinicians must answer to ascertain which forces cause flaring of maxillary anterior teeth. They describe treatment methods relevant to flaring of teeth associated with primary and secondary occlusal trauma. The authors provide diagnostic and treatment flowcharts to guide clinicians in making therapeutic decisions. CLINICAL IMPLICATIONS: Failure to treat maxillary flared anterior teeth can result in an unappealing esthetic appearance. Furthermore, if these problems are not treated in a timely manner, they can become worse and result in loss of teeth. Initiation of proper therapy may include occlusal equilibration, periodontal therapy, orthodontic retraction--alone or in combination with each other--and, in certain types of cases, splinting of teeth.

Spontaneous repositioning of pathologically migrated teeth.

BACKGROUND: There is limited clinical evidence that pathologically migrated teeth may reposition themselves after conventional periodontal treatment. The current research was carried out to determine the frequency of spontaneous repositioning of pathologically migrated teeth after routine periodontal therapy, and to study the relation between the severity of migration and the degree of repositioning following treatment. METHODS: Sixteen patients with moderate to severe periodontal disease and presenting 33 diastema sites secondary to pathologic migration participated in this study. After conventional periodontal treatment had been performed, reactive repositioning was assessed by measuring the space between pathologically migrated teeth and adjacent teeth on study models obtained at baseline, re-evaluation at 6 weeks after scaling and root planing, and 4 months after surgery. RESULTS: After scaling and root planing only, 48.5% of all sites exhibited some degree of repositioning with 36.4% of all sites closing completely. After surgery (6 months after baseline observations), 69.7% of all sites exhibited some degree of repositioning with 51.5% of all sites closing completely. When only small to moderate diastemata were considered (<1 mm), 77.8% of sites closed completely. CONCLUSIONS: The findings of this study support the hypothesis that spontaneous repositioning after conventional periodontal treatment is likely, particularly when only light to moderate degrees of pathologic migration are considered. We hypothesize that this spontaneous movement is due to wound contraction during healing.

Hyperkeratosis palmoplantaris (Papillon-Lefèvre syndrome). A case report.

A 16-year-old female presented with a severe chronic periodontitis and with associated hyperkeratotic lesions of her palms and soles. Investigations revealed it as a case of hyperkeratosis palmoplantaris (Papillon-Lefèvre syndrome), which is a rare form of an ectodermal dysplasia. Previously it was speculated that this disease entity is not all that uncommon in Nigeria especially amongst the rural population. However, recent investigations revealed that this is not correct.

[Periodontal disease index]. / Parodontopathie-Indizes.

Periodontal disease indices are a must in epidemiologic studies, analytical epidemiology making special demands. The indices hitherto commonly used do not meet all demands; consequently, they can be applied only in certain studies, especially in the sense of descriptive epidemiology. For 15 years, the periodontal disease index according to Kötzschke has proved to be useful for large-scale correlation calculations, being well suited for making evident the effects of the most different factors. At the beginning of any experiment and investigation, exact considerations must be given to the aim and special objectives of an index.

The use of laser beams for measuring tooth mobility and tooth movements.

The laser reflexion method, a direct contactless measuring technique with a high accuracy, has been applied for clinical purposes. A prototype has been tested using a laser beam to illuminate a patient's tooth fixed to the equipment by an impression plate. The reflected patterns were thrown onto a screen with a coordinate system and photographically recorded, and the movement of the tooth has been geometrically calculated. The relapse tendency after orthodontic treatment of a patient with periodontal disease and parafunctions was studied by repeated measurements of the left medial upper incisor. By use of the method, it was possible to observe that the velocity of the studied tooth was highest during the 1st day and, besides the horizontal movement, a rotation of the tooth began at the end of the measuring period.