Validation of the cone beam computed tomography-based stereolithographic surgical guide aiding autotransplantation of teeth: clinical case-control study.

OBJECTIVE: To compare the outcome of cone beam computed tomography (CBCT)-based surgical planning and transfer technique for tooth autotransplantation versus conventional autotransplantation. STUDY DESIGN: The study material comprised 40 pediatric subjects in whom 48 teeth were transplanted following a case-control design. While the study group (mean age 11 years) underwent CBCT imaging for surgical planning and transfer via stereolithographic tooth replica fabrication, the historical control group (mean age 12 years) was subjected to conventional autotransplantation. RESULTS: The CBCT-based preoperative planning and the use of a tooth replica decreased the extra-alveolar time and reduced the number of positioning trials with the donor tooth. In the control group, 6 patients showed 1 or more complications, while this was noticed for only 2 study patients. CONCLUSION: CBCT-based surgical planning of tooth autotransplantation may benefit from a shorter surgical time, while being a less invasive technique, causing fewer failures than a conventional approach.

Importance of root development in autotransplantations: a retrospective study of 137 teeth with a follow-up period varying from 1 week to 14 years.

The aim of the present study was to perform a retrospective study of autotransplanted teeth with a variable but individually maximized follow-up period in order to provide information on the long-term clinical outcome. The sample was obtained from patients who were treated at the University Hospitals KU-Leuven, Belgium, during the period 1996-2010. Of the total of 109 subjects (137 teeth), 98 patients were invited for recall, of whom 68 patients (87 teeth) responded positively. Eleven out of the 109 patients were excluded due to loss of the transplanted tooth. Although 41 patients had no re-examination visit, clinical and radiological data from all 109 subjects were included in the sample. The follow-up period varied from 1 week of 14.8 years, with a mean of 4.9 years. Transplanted teeth receiving orthodontic treatment had a lower risk of ankylosis and were less likely to fail. The risk of root resorption was lower for teeth with stages one-half to three-quarters of root length at the time of transplantation. Molars were more susceptible to ankylosis. Almost all teeth showed partial or full obliteration of the pulp. Absence of further root development was higher in donor teeth with root length stage less than one-half. Trans-alveolar transplantation was less successful. Autotransplantation can be a valid alternative method in young adolescents for replacing missing teeth because of agenesis or trauma. The optimal time to transplant is when the root has reached two-thirds to three-quarters of the final root length.

Bisphosphonate-Related Osteonecrosis of the Jaw Bone: Radiological Pattern and the Potential Role of CBCT in Early Diagnosis.

OBJECTIVES: To systematize the clinico-radiological symptoms and course of bisphosphonate-related osteonecrosis of jaw bone and toevaluate the diagnostic potential of various radiological techniques to detect mild osteonecrosis in each stage of the disease. MATERIAL AND METHODS: The sample consisted of 22 patients previously diagnosed with extraoral malignant disease. Diagnosis was based on a clinical examination in conjunction to digital panoramic radiography and cone beam computed tomography (CBCT). Two dentomaxillofacial radiologists reviewed all images. RESULTS: Twenty patients showed mandibular involvement clinically, while two others had a maxillary involvement. Four stages of the disease were proposed based on the clinico-radiological findings. Subclinical cortical and lamina dura thickening was detected with only three-dimensional CBCT and periapical images, while ulceration and cortical bone thickening was detected only by three-dimensional CBCT. Mixed sclerotic, lytic bone destruction involving alveolar and basal bone with or without encroachment on the mandibular canal, pathological mandibular fractures were detected by two-dimensional panoramic and three-dimensional CBCT images. Other findings are non healing extraction sockets, periapical radiolucencies, osteolysis, sequestra, oroantral fistula, and periosteal new bone formation. CONCLUSIONS: The present study showed that bisphosphonate-related osteonecrosis of jaw bone occurs in four distinct clinico-radiological stages. For mild cases, panoramic image diagnosis was much less obvious, whereas cone beam computed tomography was able to fully characterise the bony lesions and describe their extent and involvement of neighbouring structures in all cases. Thus cone beam computed tomography might better contribute to the prevention of bisphosphonate-related osteonecrosis of jaw bone as well to the disease management.

The genetic basis of inherited anomalies of the teeth. Part 2: syndromes with significant dental involvement.

Teeth are specialized structural components of the craniofacial skeleton. Developmental defects occur either alone or in combination with other birth defects. In this paper, we review the dental anomalies in several multiple congenital anomaly (MCA) syndromes, in which the dental component is pivotal in the recognition of the phenotype and/or the molecular basis of the disorder is known. We will consider successively syndromic forms of amelogenesis imperfecta or enamel defects, dentinogenesis imperfecta (i.e. osteogenesis imperfecta) and other dentine anomalies. Focusing on dental aspects, we will review a selection of MCA syndromes associated with teeth number and/or shape anomalies. A better knowledge of the dental phenotype may contribute to an earlier diagnosis of some MCA syndromes involving teeth anomalies. They may serve as a diagnostic indicator or help confirm a syndrome diagnosis.

The oro-dental phenotype in Prader-Willi syndrome: a survey of 15 patients.

BACKGROUND: Prader-Willi syndrome (PWS) is a rare disorder caused by genetic defects in certain regions of chromosome 15q11-13. It is characterized by severe neonatal hypotonia and feeding problems, childhood-onset hyperphagia and obesity, short stature, facial dysmorphy, hypogonadism, learning and behavioural difficulties, and dental abnormalities. AIM: To describe the oro-dental phenotypic spectrum of patients with PWS. DESIGN: Fifteen PWS patients (3-35 years of age) being followed at the Centre for Human Genetics of the University Hospital of Leuven were examined at the dental clinic of the same institution. Medical information collected included age at diagnosis, body mass index (BMI) and level of cognitive functioning. Oral, clinical and radiological evaluations were performed. Caries experience (cavitation level), dental erosion and salivary flow rates were assessed. RESULTS: The 15 patients had dmft/DMFT scores ranging from 0 to 28, while nine were cavity-free. Those with severe caries experience also presented advanced dental erosion. BMI ranged from 16 to 42.6. There was no association between BMI and caries experience or erosive tooth wear. The PWS patients in our survey presented with a more favourable oral health status than those in previous studies. This might be due to early diet management or better oral hygiene during childhood or both.

[A strategy for treating the anxious patient]. / Stratégie de traitement chez le patient anxieux.

The article describes the different ways of dealing with dental fear. First the importance of preventive dentistry is pointed out. Subsequently the potential of behaviour therapy for both children and adults is discussed. Relaxation therapy and hypnosis are considered next. From the pharmacological point of view the indications and use of oral and intravenous sedation are explained. One more option to achieve sedation is nitrous oxide inhalation. As a last resort we have general anaesthesia. Indications and procedures are outlined.

[Medical history in relation to dental anxiety in children]. / L'intérêt d'une liste anamnestique relative à l'angoisse chez l'enfant.

Fear in children is of clearly exogenous origin. Negative experiences will cause fear by direct conditioning. The influence of an important other person can be the root of fear by indirect conditioning. Antecedent factors and intermediary variables associated with fear are described. Usefulness and indications of the different questionnaires for children are specified.

[Medical history in relation to dental anxiety in adults]. / L'intérêt d'une liste anamnestique relative à l'angoisse chez l'adulte.

Fear in adults has a clearly endogenous component. Specific fear anamnesis questionnaires are available to gauge the fear of dental treatment. On the basis of a literature review the different questionnaires and their usefulness are being discussed.