Root fractures: epidemiological, clinical and radiographic aspects.

Chronic root fractures are a relative frequent dental condition, occurring both in vital teeth and in teeth with root canal treatment, with a difficult and frustrating diagnosis. Two clinical forms are described: crown-root fractures with crown origin and vertical root fractures with root origin. The aim of the study was to determine the prevalence of the root fractured extracted teeth in two dental clinics with different profile [oral rehabilitation (OR) and endodontics (E)] and to present some particular aspects of the root fractures. A retrospective study over a period of five years was performed to determine the number of extracted teeth and the motives for extraction. For root fractured extracted teeth were noted: fracture type, tooth vitality, restoration type. Although the number of the patients with tooth extractions in the five years period was significantly higher in OR clinic than in E clinic, the number of tooth extractions was almost similar. Most of the teeth (70.6%) were extracted for caries complications. The prevalence of the root fractured extracted teeth was 17.93%. In OR clinic, women had more root fractured extracted teeth compared with E clinic, where the number of root fractured extracted teeth was higher in men. Most extracted teeth for root fracture were teeth with prosthetic restorations followed by teeth with root canal treatment and dental fillings. The most extracted teeth for root fracture were maxillary premolars, almost similar for both sexes, followed by mandibular molars. The teeth with least extractions for root fractures were mandibular incisors and mandibular canine.

Optical coherence tomography applications in tooth wear diagnosis.

Dental wear represents an irreversible loss of dental hard tissue under the action of physical, chemical and mechanical factors, excluding dental caries and acute trauma. Four clinical forms of dental wear are described: erosion, attrition, abfraction, and abrasion. Most experts agree that in each clinical form multiple etiological factors are involved, one being predominant. Optical coherence tomography (OCT) is a non-invasive optical method characterized by a micronic resolution. The applications of this type of investigation are multiple in the medical field in recent years, and OCT is gaining a growing importance in dentistry. The study pointed out through OCT imaging for the erosive tooth wear lesion the existence of chemical aggression, with strong demineralization of enamel and dentin. For attrition lesion, OCT images showed the contribution of excessive force and friction movements specific to bruxism. In abfraction, OCT image revealed the importance of the mechanic factor in producing this form of tooth wear and abrasion damage studied may be considered physiological, according to patient age. OCT examination may reveal existing lesions in hard dental tissues for each clinical form and could bring evidence on the mechanisms involved.

Study on the histopathological modifications of the dental pulp in occlusal trauma.

The diagnosis of occlusion-generated disorders of the dento-maxillary apparatus represents a sensitive stage within the establishment of the therapeutic means for the functional rehabilitation of dental arches. The laborious effort carried out in order to specify the diagnosis resides in the fact that any trauma arising at the level of any component of the stomatognate system may lead to an occlusal dysfunction. The uncured carious processes, besides the pulp and periapical complications, may lead to an occlusal dysfunction through horizontal migrations of teeth resulting in the derangement of the occlusal curvatures as well as through vertical migrations of the teeth opposing a tooth diagnosed with occlusal caries or which largely reduced the coronary height. The dental iatrogenia, besides the eructation anomalies and neuromuscular dysfunction within the oromaxillofacial area also determines the appearance of occlusal dysfunction. The radiological examination through correlation with the clinical manifestations may provide significant data related to the magnitude of the prejudice caused to dento-paradontal units experiencing occlusal trauma. The histopathological study through correlation with the clinical manifestations provides significant data on the tolerance of dento-paradontal units within the occlusal dysfunction. Also, subsequent to the analysis of the possible actions of aggression generated by the occlusal trauma correlations could be determined between the type of the histological lesion of the pulp-dentine complex and the etiopathogenic factors, as well as correlations depending on the damage degree through occlusal trauma of the dental parts involved.

Matrix metalloproteinase 9 levels in gingival crevicular fluid in patients after periodontal microsurgery for orthodontic induced gingival hypertrophy.

INTRODUCTION: In this study, we aim to compare the levels of matrix metalloproteinase 9 (MMP9) in the gingival crevicular fluid (GCF), as indicators for healing, in two groups of patients - operated with a classic periodontal surgical technique and the same technique but using a dental microscope. MATERIALS: We included 14 patients with ages between 12 and 26 years, average 14±6.2 years. Eight patients were women and six men. All patients presented gingival hypertrophy because of the orthodontic treatment on the mandibular arch. We performed gingivectomy on one-half of the mandibular arch by classic periodontal surgery and on the other half of the mandibular arch by a microscope-assisted gingivectomy. METHODS: In the hypertrophied gingiva, the expression of MMP9 was identified using immunohistochemical-staining techniques. For immunological determination of MMP9 in GCF we performed Elisa tests. RESULTS: We found different levels in different moments of the healing process for the two hemiarcades. CONCLUSIONS: We consider that faster healing in case of microscope-assisted gingivectomy may be related to the expression of MMP-9 in the GCF.

Radiological and microscopic aspects of the denticles.

In this paper we have realized a study on 43 patients on which the retro-alveolar radiological exam has shown the existence of a calcareous structure within the pulp chamber having in view a better knowledge of this structure and its etiology, way of forming and pathological implications. For 16 of the patients the radiological exam was supplemented by a microscopic examination. Radiologically, the denticles were noticed more often in the pulp chamber of the molars. The examination of the histological samples has evidenced aspects such as the size, shape and structure of the denticles. The concentric disposition of the tissue elements shows that in the formation of a denticle there is a "center" around which a conjunctive substance avid of calcium salts is deposited. The microscopic aspects noticed on large denticles allowed us to sustain the hypothesis that in a large pulp chamber many denticles form simultaneously and grow up and merge generating a large-sized unique calcareous structure.