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Primary Dental Journal Dec 2023This paper aims to aid clinicians in the assessment and immediate management of dental trauma displacement injuries to permanent teeth. Long term sequelae, the impact of...
This paper aims to aid clinicians in the assessment and immediate management of dental trauma displacement injuries to permanent teeth. Long term sequelae, the impact of such injuries, and the evidence-base for managing these are discussed.Clinical cases are provided to illustrate management challenges and highlight where further evidence-based guidance is needed. The role of the general dental practitioner in the immediate management and follow-up of traumatic dental injuries is outlined and sequelae, worthy of potential referral, described.
Topics: Humans; Tooth Fractures; Dentists; Professional Role; Dentition, Permanent; Tooth Injuries
PubMed: 38018680
DOI: 10.1177/20501684231213770 -
International Endodontic Journal Dec 2023The mechanism of action of root resorption in a permanent tooth can be classified as infection-related (e.g., microbial infection) or non-infection-related (e.g.,... (Review)
Review
BACKGROUND
The mechanism of action of root resorption in a permanent tooth can be classified as infection-related (e.g., microbial infection) or non-infection-related (e.g., sterile damage). Infection induced root resorption occurs due to bacterial invasion. Non-infection-related root resorption stimulates the immune system through a different mechanism.
OBJECTIVES
The aim of this narrative review is to describe the pathophysiologic process of non-infection-related inflammatory processes involved in root resorption of permanent teeth.
METHODS
A literature search on root resorption was conducted using Scopus (PubMed and Medline) and Google Scholar databases to highlight the pathophysiology of bone and root resorption in non-infection-related situations. The search included key words covering the relevant category. It included in vitro and in vivo studies, systematic reviews, case series, reviews, and textbooks in English. Conference proceedings, lectures and letters to the editor were excluded.
RESULTS
Three types of root resorption are related to the non-infection mechanism of action, which includes surface resorption due to either trauma or excessive orthodontic forces, external replacement resorption and external cervical resorption. The triggers are usually damage associated molecular patterns and hypoxia conditions. During this phase macrophages and clastic cells act to eliminate the damaged tissue and bone, eventually enabling root resorption and bone repair as part of wound healing.
DISCUSSION
The resorption of the root occurs during the inflammatory phase of wound healing. In this phase, damaged tissues are recognized by macrophages and neutrophiles that secrete interlaukines such as TNF-α, IL-1, IL-6, IL-8. Together with the hypoxia condition that accelarates the secretion of growth factors, the repair of the damaged perioduntiom, including damaged bone, is initiated. If the precementum and cementoblast are injured, root resorption can occur.
CONCLUSIONS
Wound healing exhibits different patterns of action that involves immune stimulation in a bio-physiological activity, that occurs in the proper sequence, with overlapping phases. Two pathologic conditions, DAMPs and hypoxia, can activate the immune cells including clastic cells, eliminating damaged tissue and bone. Under certain conditions, root resorption occurs as a side effect.
Topics: Humans; Root Resorption; Dentition, Permanent; Hypoxia
PubMed: 37712904
DOI: 10.1111/iej.13976 -
European Journal of Orthodontics Jul 2023To investigate the effect of three interceptive measures (slow maxillary expansion (SME) with removable plates (1), extraction of both upper deciduous canines (DC) (2)... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To investigate the effect of three interceptive measures (slow maxillary expansion (SME) with removable plates (1), extraction of both upper deciduous canines (DC) (2) and no intervention (3)) on maxillary canine (MC) position in patients with early mixed dentition (EMD) and lack of upper arch space. These three groups were additionally compared to a control group (4) with adequate upper arch space.
NULL HYPOTHESIS
None of the studied strategies outperforms the others regarding improvement of MC position.
TRIAL DESIGN
Four-arm parallel group prospective randomized controlled trial.
PARTICIPANTS
Patients in EMD with at least one impacted MC, non-resorbed DC, and no crossbite.
INTERVENTIONS
Patients with a lack of space were randomly distributed to protocols (1), (2), and (3).
PRIMARY OBJECTIVE
To assess the change in MC position after 18 months follow up.
SECONDARY OBJECTIVES
To assess canine eruption and need for orthodontic intervention within 18-60 month follow up.
OUTCOME ASSESSMENT
Five variables defined canine position: sector, canine-to-midline angle, canine-to-first-premolar angle, canine-cusp-to-midline distance, and canine-cusp-to-occlusal-plane distance on two panoramic radiographs at 0 (T1) and 18 months (T2). Mean differences between groups were compared with linear mixed models, corrected for age and sex.
RANDOMIZATION
The patient allocation sequence was generated by an electronic randomization list.
BLINDING
The operator taking the measurements was blinded to the groups.
RESULTS
Seventy-six patients were included (142 canines, mean age 9.2 years, 60.5 per cent male, mean follow up 1.9 years), 19, 17, 14, and 26 patients in groups 1-4, respectively. In absence of dental crossbite in patients with lack of space and impacted MC, SME improved the canine sector (P = 0.040), compared to no intervention (P = 0.028). Canine-to-midline angle and canine-to-occlusal-plane distance significantly decreased in all groups at T2. Extraction improved the canine-to-first-premolar angle at T2 more than other strategies in EMD (P = 0.015-0.000).
CONCLUSIONS
Early SME improves the canine sector and reduces the need for major orthodontic intervention in the long term. Taking a first panoramic radiograph in EMD allows timely intervention in case of MC impaction.
TRIAL REGISTRATION NUMBER
NCT05629312 (Clinical Trials.org). Trial status: follow up ongoing.
Topics: Humans; Male; Child; Tooth Eruption, Ectopic; Treatment Outcome; Prospective Studies; Tooth Extraction; Tooth, Deciduous; Malocclusion; Cuspid; Maxilla; Tooth, Impacted
PubMed: 37266982
DOI: 10.1093/ejo/cjad014 -
Australian Endodontic Journal : the... Dec 2023This review investigated whether any therapeutic options influenced the outcome of treatment for teeth with external cervical resorption. Out of 870 articles identified... (Review)
Review
This review investigated whether any therapeutic options influenced the outcome of treatment for teeth with external cervical resorption. Out of 870 articles identified by an electronic search, 60 clinical case reports and six case series were included. No randomised clinical trials were found. Risk of bias was assessed using Joanna Briggs Institute's tools. External surgical intervention was the preferred method of accessing the lesions. Removal of resorptive tissue was most often achieved mechanically. Bioactive endodontic cements were the preferred materials for restoring teeth. The outcome measures were based on clinical and radiographic parameters. Of the cases included in the review, no specific treatment approach had a superior outcome in relation to Heithersay's classification. Furthermore, due to the absence of randomised clinical trials, and the low level of evidence associated with case reports/case series, it was not possible to define the optimum clinical treatment for external cervical resorption.
Topics: Humans; Dental Cementum; Tooth Cervix; Neck; Root Resorption
PubMed: 37702252
DOI: 10.1111/aej.12794 -
European Archives of Paediatric... Dec 2023Molar incisor hypomineralization (MIH) is playing an increasingly important role in dental practice. MIH is defined as hypomineralization of systemic origin of one to...
PURPOSE
Molar incisor hypomineralization (MIH) is playing an increasingly important role in dental practice. MIH is defined as hypomineralization of systemic origin of one to four permanent first molars, often associated with affected incisors. Affected teeth are more susceptible to caries and post-eruptive enamel loss and should be diagnosed and treated as early as possible. In 2016, the Würzburg concept was developed for German-speaking countries including a classification index-the MIH Treatment Need Index (MIH-TNI)-and a treatment plan based on it for the use in daily practice. In the meantime, the concept has also gained international recognition. The aim of this paper is to update part 2 of the Würzburg concept, the treatment plan, as knowledge about MIH has increased and the disease has been studied more extensively in the last years. Other treatment approaches are now available and therefore need to be included in the concept. Although, the evidence of the different treatment options is still weak, practitioners need guidance in their daily practice.
METHODS
The authors reviewed the available literature, including clinical and laboratory studies and published guidelines.
RESULTS
The updated version of the Würzburg concept includes additional non-invasive strategies and temporary therapy options, as well as treatment approaches for incisors. It therefore covers currently available treatment modalities for MIH-affected teeth, ranging from prophylaxis, non-invasive treatment to restorative approaches and possibly even extraction.
CONCLUSIONS
This is intended to help guide the practitioner and will need to be further validated by clinical trials.
Topics: Humans; Dental Enamel Hypoplasia; Molar Hypomineralization; Dental Enamel; Incisor; Molar; Prevalence
PubMed: 37856065
DOI: 10.1007/s40368-023-00848-5 -
Human Cell Sep 2023Teeth are a kind of masticatory organs of special histological origin, unique to vertebrates, playing an important role in chewing, esthetics, and auxiliary... (Review)
Review
Teeth are a kind of masticatory organs of special histological origin, unique to vertebrates, playing an important role in chewing, esthetics, and auxiliary pronunciation. In the past decades, with the development of tissue engineering and regenerative medicine, the studies of mesenchymal stem cells (MSCs) gradually attracted the interest of researchers. Accordingly, several types of MSCs have been successively isolated in teeth or teeth-related tissues, including dental pulp stem cells, periodontal ligament stem cells, stem cells from human exfoliated deciduous teeth, dental follicle stem cells, stem cells from apical papilla and gingival mesenchymal stem cells. These dental stem cells (DSCs) are easily accessible, possess excellent stem cell characteristics, such as high proliferation rates and profound immunomodulatory properties. Small-molecule drugs are widely used and show great advantages in clinical practice. As research progressed, small-molecule drugs are found to have various complex effects on the characteristics of DSCs, especially the enhancement of biological characteristics of DSCs, which has gradually become a hot issue in the field of DSCs research. This review summarizes the background, current status, existing problems, future research directions, and prospects of the combination of DSCs with three common small-molecule drugs: aspirin, metformin, and berberine.
Topics: Animals; Humans; Regenerative Medicine; Tooth; Periodontal Ligament; Tissue Engineering; Mesenchymal Stem Cells; Dental Pulp
PubMed: 37358734
DOI: 10.1007/s13577-023-00943-1 -
Evidence-based Dentistry Mar 2024Searches were carried out using PubMed/MEDLINE and Web of Science databases between January 2008 and January 2023. Only articles in English language were included....
DATA SOURCES
Searches were carried out using PubMed/MEDLINE and Web of Science databases between January 2008 and January 2023. Only articles in English language were included. Boolean operators were used to search: "permanent teeth" OR "permanent tooth" OR "permanent dentition" AND "deep caries" OR "stepwise" AND "partial caries removal OR "stepwise caries removal" OR "pulp vitality" OR "healing rate".
STUDY SELECTION
Inclusion criteria were randomised controlled trials, which compared the total removal of carious tissue with either a selective or stepwise removal in permanent teeth with deep carious lesions. Criteria also required a follow up of at least 6 months and publications in English. Exclusion criteria were articles in other languages, articles not comparing different types of total or selective caries removal and articles published before January 2008.
DATA EXTRACTION AND SYNTHESIS
Data extraction followed PRISMA guidelines. Two reviewers independently screened articles, analysing titles and abstracts using Rayyan's Intelligent Systematic Review Platform. They also collected data and risk of bias assessed using the Cochrane Risk of Bias Tool for Randomised Trials, dividing articles into high risk of bias, few concerns and low risk of bias. A third researcher resolved conflict or doubt in case of divided opinions.
RESULTS
In total, 105 articles were identified, and 10 duplicates removed. 95 articles were reviewed by title and abstract and 75 of these did not meet the inclusion criteria. 20 articles were then read, excluding a further 15 due to comparing only partial removal or non-selective caries removal or absence of numerical data. This left 5 articles which met eligibility criteria. These were randomised controlled trials between 2010 and 2021. Follow up ranged from 1 month to 5 years. The inclusion and exclusion criteria in all studies had similar clinical parameters. 3 studies performed management only on permanent molars, whilst the rest also included management on permanent incisors/canines/premolars and molars. Management of caries was divided into non-selective caries removal vs partial caries removal (either selective or stepwise). All but 2 studies included specific information about the materials used. Liners were calcium hydroxide or Dycal, provisional restorations were glass ionomer cements or Ketax Molar and definitive restorations were Herculite Tetric N-Ceram resin, Ivolclar Vivadent or amalgam. Clinical success or failure was measured using pulp vitality, absence of periapical lesions, radiographic analysis and lack of symptoms. Clinical follow up was evaluated by external examiners, although 2 studies did not specify this clearly. There were a variety of tools used for statistical analysis in each study.
CONCLUSIONS
When comparing non-selective caries removal with either selective or stepwise, 3 studies proposed statistically significant differences in terms of longevity, marginal integrity and success rate of restorations. 1 study stated inexistence of statistically relevant divergences between procedures. Non-selective caries removal is not highly recommended for deep carious lesions and may be considered invasive and risks pulpal exposure. Both selective and stepwise removal are considered conservative approaches. Selective removal is considered the best management option in the short term (with 1.5 years follow up), predominantly related to a lower risk of pulpal exposure. At 5 years, however, the results of selective were similar to those of non-selective, accepting the null hypothesis. There were also no differences in success rates for materials used for definitive restorations.
Topics: Humans; Dental Caries Susceptibility; Dental Caries; Dentition, Permanent; Molar; Dental Amalgam
PubMed: 38253747
DOI: 10.1038/s41432-024-00973-0 -
Progress in Orthodontics Sep 2023Clear aligner therapy has become increasingly popular in recent years, although it has encountered several difficulties in premolar extraction treatment. These...
INTRODUCTION
Clear aligner therapy has become increasingly popular in recent years, although it has encountered several difficulties in premolar extraction treatment. These difficulties include anterior dentition, lingual tipping and extrusion. The design of the present clinical scheme usually set a tiny space between the anterior teeth before retraction in order to obtain an ideal outcome. The objective of our research was to analyze the effect of the existing spaces during retraction.
METHODS
Models including maxillary dentition without first premolars, maxilla, periodontal ligaments, gingiva, or aligners were constructed and imported to an ANSYS workbench. Five groups of models were created: without spaces and with 0.25, 0.50, 0.75 and 1.00 mm spaces between the anterior dentition. A 0.20 mm retraction step was applied to all the groups.
RESULTS
As the spaces between the anterior dentition increased, the bowing effect of the aligner caused by the passive forces decreased gradually. Accordingly, the degree of extrusion of the anterior dentition was alleviated significantly, while sagittal movement was reduced. However, the overall movement tended to be a bodily displacement rather than tipping. Meanwhile, maximum Von Mises stress of the periodontal ligaments (PDLs) was markedly decreased.
CONCLUSION
These analyses indicate that spaces between the anterior dentition during anterior retraction are beneficial for decreasing the tendency for extrusion of the anterior dentition and require provision of anchorage. Appropriate spaces can be designed to lest the lingual tipping and extrusion effect of the anterior teeth while simultaneously reducing the maximum stresses on PDLs.
Topics: Humans; Bicuspid; Incisor; Finite Element Analysis; Tooth Movement Techniques; Malocclusion; Orthodontic Appliances, Removable
PubMed: 37747552
DOI: 10.1186/s40510-023-00484-1 -
BMC Oral Health Nov 2023The treatment of young permanent first molars with extensive carious tissue loss may often require restoration with preformed crowns. This study compared the clinical... (Randomized Controlled Trial)
Randomized Controlled Trial
Clinical and radiographic performance of preformed zirconia crowns and stainless-steel crowns in permanent first molars: 18-month results of a prospective, randomized trial.
BACKGROUND
The treatment of young permanent first molars with extensive carious tissue loss may often require restoration with preformed crowns. This study compared the clinical and radiographic performance of stainless-steel crowns (SSCs) and preformed zirconia crowns (ZCs).
METHODS
Forty-eight molar incisor hypomineralisation (MIH)- or caries-affected permanent molars in 20 healthy patients between 6-13-year-old were randomly divided into ZC and SSC groups (n = 24 teeth/group) in a split-mouth design. The oral hygiene levels of patients were assessed using Greene and Vermillion simplified oral hygiene index (OHI-S). Plaque accumulation and gingival health were evaluated using the Silness&Löe plaque index (PI) and Löe&Silness gingival index (GI), respectively. Clinical retention, marginal extension level, marginal adaptation of crowns and wear of the antagonist teeth were assessed at baseline, 1, 6, 12 and 18 months. The radiological assessments for evaluating the marginal adaptation of crowns and periapical pathology of crowned teeth were performed at 6 and 12 months. The data were analyzed using Kaplan-Meier analysis, Mann-Whitney U test, and two-way ANOVA.
RESULTS
A total of forty teeth in 17 children were evaluated for 18 months. ZCs had significantly lower gingival and plaque index values than teeth restored with SSCs during all evaluation periods (p < 0.05). Neither crown type resulted in clinically-detectable wear on opposing dentition or periapical pathology. One ZC was lost at 13 months, while all SSCs survived in function clinically. The cumulative survival rates of ZCs and SSCs were 95.2% and 100% respectively.
CONCLUSIONS
Both ZCs and SSCs showed high clinical retention rates in young permanent molars. ZCs had lower plaque accumulation and better gingival health than SSCs, which were consistently associated with mild gingival inflammation.
CLINICAL TRIAL REGISTRATION NUMBER
NCT05049694.
Topics: Child; Humans; Adolescent; Tooth, Deciduous; Prospective Studies; Dental Restoration, Permanent; Stainless Steel; Dental Restoration Failure; Molar; Dental Plaque; Crowns
PubMed: 37924021
DOI: 10.1186/s12903-023-03501-1 -
Progress in Orthodontics Nov 2023To investigate the displacement of dentition and stress distribution on periodontal ligament (PDL) during retraction and intrusion of anterior teeth under different...
The displacement of teeth and stress distribution on periodontal ligament under different upper incisors proclination with clear aligner in cases of extraction: a finite element study.
OBJECTIVES
To investigate the displacement of dentition and stress distribution on periodontal ligament (PDL) during retraction and intrusion of anterior teeth under different proclination of incisors using clear aligner (CA) in cases involving extraction of the first premolars.
METHODS
Models were constructed, consisting of the maxilla, PDLs, CA and maxillary dentition without first premolars. These models were then imported to finite element analysis (FEA) software. The incisor proclination determined the division of the models into three groups: Small torque (ST) with U1-SN = 100°, Middle torque (MT) with U1-SN = 110°, and High torque (HT) with U1-SN = 120°. Following space closure, a 200 g intrusion force was applied at angles of 60°, 70°, 80°, and 90° to the occlusal plane, respectively.
RESULTS
CA therapy caused lingual tipping and extrusion of incisors, mesial tipping and intrusion of canines, and mesial tipping of posterior teeth in each group. As the proclination of incisors increased, the incisors presented more extrusion and minor retraction, and the teeth from the canine to the second molar displayed an increased tendency of intrusion. The peak Von Mises equivalent stress (VMES) value successively decreased from the central incisor to the canine and from the second premolar to the second molar, and the VMES of the second molar was the lowest among the three groups. When the angle between the intrusion force and occlusal plane got larger, the incisors exhibited greater intrusion but minor retraction.
CONCLUSIONS
The "roller coaster effect" usually occurred in cases involving premolar extraction with CA, especially in patients with protruded incisors. The force closer to the vertical direction were more effective in achieving incisor intrusion. The stress on PDLs mainly concentrated on the cervix and apex of incisors during the retraction process, indicating a possibility of root resorption.
Topics: Female; Humans; Periodontal Ligament; Incisor; Finite Element Analysis; Molar; Orthodontic Appliances, Removable
PubMed: 37981597
DOI: 10.1186/s40510-023-00491-2