Georgios Tsilingaridis

Survival of 534 incisors after intra-alveolar root fracture in patients aged 7-17 years

The purpose of the study was to evaluate and assess the survival rate of 534 root fractured teeth, including factors that may affect the survival rate but were not included in previous long-term studies. Location of fracture was registered as in the cervical, cervical/middle, middle and apical one-third of the root, and root development was categorized into five stages. Altogether, 383 (78%) showed healing of the fracture, with either formation of hard tissue or interposition of soft tissue between the fragments. In these teeth, no significant difference was found between positions in the root or types of healing. In 325 teeth, the healing remained unchanged throughout the control period, while 58 teeth showed a posthealing complication. A new injury occurred in 47 teeth; in 21 of these, the injury healed spontaneously, in four after endodontic treatment. Increased mobility of the coronal fragment was recorded for 32 teeth, and in 11 of these, the looseness of the fragment was so pronounced that the teeth had to be extracted. No healing, i.e. radiolucency in the alveolar bone, adjacent to fracture, took place in 109 teeth (22%). Of these teeth, 34 were extracted during the observation time while 75 (69%) showed healing after endodontic therapy. At the final assessment of survival (including all parameters) of 534 root fractured teeth, 425 (80%) showed survival and 109 (20%) were extracted during the observation period. It was concluded that the survival of root-fractured teeth was high for up to 10 years of observation (mean = 63 months). The highest frequency of tooth loss (70%) was found in 77 teeth with horizontal fractures restricted to the cervical part of the root. When these teeth were excluded, the frequency of survival in remaining teeth rose to 88%.

Intrusive luxation of 60 permanent incisors: a retrospective study of treatment and outcome

BACKGROUND/AIM   Intrusive luxation in the permanent dentition is an uncommon injury but it is considered one of the most severe types of dental trauma because of the risk for damage to the periodontal ligament, pulp and alveolar bone. Management of intrusive luxation in the permanent dentition is controversial. The purpose of this study was to evaluate pulp survival and periodontal healing in intrusive luxated permanent teeth in relation to treatment alternatives, degree of intrusion and root development. MATERIAL AND METHOD   The material consisted of 60 intruded permanent teeth in 48 patients (32 boys and 16 girls) aged 6-16 years (mean 9.4, median 9.0). The observation time was 6-130 months (mean 47.8, median 40.0). The analysed treatments were spontaneous re-eruption (17 teeth), orthodontic extrusion (12 teeth) and surgical reposition (31 teeth). The degree of intrusion was registered as mild (0-3 mm), moderate (4-6 mm) and severe (≥7 mm). Root development was categorized with respect to root formation and development of the apex into four stages; one-quarter to three-quarters root formation, full root formation with open apex, full root formation with half-closed apex and full root formation with apex closed. Ankylosis-related resorption with pulp necrosis was diagnosed in 20 teeth, ingrowth of bone apically in two teeth, pulp necrosis without ankylosis-related resorption in 23 teeth and pulp revitalization occurred in 15 teeth. RESULTS   Significant correlations to the treatment outcome were root development (P = 0.03) and degree of intrusion (P = 0.03). CONCLUSIONS   No firm conclusion could be drawn for the difference in outcome between orthodontic extrusion and surgical reposition. To conclude, evaluation of the prognosis for intruded teeth should be based on the stage of root development and degree of intrusion. In teeth with immature root development, no active treatment appears to result in fewer healing complications.

Root fractures: the influence of type of healing and location of fracture on tooth survival rates - an analysis of 492 cases

AIM The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed. MATERIAL AND METHODS Long-term survival rates were calculated using data from 492 root-fractured teeth in 432 patients. The cause of tooth loss was assessed as being the result of either pulp necrosis (including endodontic failures), new traumas or excessive mobility. The statistics used were Kaplan-Meier and the log rank method. RESULTS AND CONCLUSIONS The location of the root fracture had a strong significant effect on tooth survival (P = 0.0001). The 10-year tooth survival of apical root fractures was 89% [95% confidence interval (CI), 78-99%], of mid-root fractures 78% (CI, 64-92%), of cervical-mid-root fractures 67% (CI, 50-85%), and of cervical fractures 33% (CI, 17-49%). The fracture-healing type offered further prognostic information. No tooth loss was observed in teeth with hard tissue fracture healing regardless of the position of the fracture. For teeth with interposition of connective tissue, the location of the fracture had a significant influence on tooth loss (P = 0.0001). For teeth with connective tissue healing, the estimated 8-year survival of apical, mid-root, and cervical-mid-root fractures were all more than 80%, whereas the estimated 8-year survival of cervical fractures was 25% (CI, 7-43%). For teeth with non-healing with interposition of granulation tissue, the location of the fracture showed a significant influence on tooth loss (P = 0.0001). The cause of tooth loss was found to be very dependent upon the location of the fracture. In conclusion, the long-term tooth survival of root fractures was strongly influenced by the type of healing and the location of the fracture.

Specialist paediatric dentistry in Sweden 2008 - a 25-year perspective.

International Journal of Paediatric Dentistry 2010; 20: 313-321 Background. Paediatric dentistry in Sweden has been surveyed four times over the past 25 years. During this period postgraduate training, dental health, and the organization of child dental care have changed considerably. Aim. To investigate services provided by specialists in paediatric dentistry in Sweden in 2008, and to compare with data from previous surveys. Design. The same questionnaire was sent to all 30 specialist paediatric dental clinics in Sweden that had been used in previous surveys. Comparisons were made with data from 1983, 1989, 1996 and 2003. Results. Despite an unchanged number of specialists (N = 81 in 2008), the number of referrals had increased by 16% since 2003 and by almost 50% since 1983. There was greater variation in reasons for referrals. The main reason was still dental anxiety/behaviour management problems in combination with dental treatment needs (27%), followed by medical conditions/disability (18%), and high caries activity (15%). The use of different techniques for conscious sedation as well as general anaesthesia had also increased. Conclusions. The referrals to paediatric dentistry continue to increase, leading to a heavy work load for the same number of specialists. Thus, the need for more paediatric dentists remains.

Enhanced levels of prostaglandin E2, leukotriene B4, and matrix metalloproteinase-9 in gingival crevicular fluid from patients with Down syndrome.

The aim was to study the levels of prostaglandin E2 (PGE2), leukotriene B4 (LTB4), and matrix metalloproteinase-9 (MMP-9) in gingival crevicular fluid (GCF) from Down syndrome patients exhibiting gingival inflammation. The levels of PGE2, LTB4, and MMP-9 were determined in GCF from 18 Down syndrome patients and from 14 controls matched with respect to age and degree of gingival inflammation. Probing depth (PD) and gingival inflammation, assessed by bleeding on probing (BOP), were determined around all teeth. In each patient, GCF was collected from 6 sites (16m, 26m, 36m, 46m, 41m, 11d) using periopaper, and the volume was determined using Peritron 8000. The PGE2 and LTB4 levels were determined using RIA kits and MMP-9 level using ELISA kits. The degree of gingival inflammation, expressed as mean value of BOP (%) as well as the volume of GCF, was similar between Down syndrome patients and controls. The mean levels of PGE2, LTB4, and MMP-9 were significantly (P < 0.05) higher in GCF from Down syndrome patients compared to controls. When comparing the two groups, the correlation coefficients for LTB4 to BOP and PD, respectively, as well as for MMP-9 to BOP significantly differed between Down syndrome and controls (P < 0.05). The study supports the concept of an altered host response in periodontal tissue in Down syndrome subjects.

Tooth mobility changes subsequent to root fractures: a longitudinal clinical study of 44 permanent teeth

The purpose of this study was to analyze tooth mobility changes in root-fractured permanent teeth and relate this to type of interfragment healing (hard tissue healing (HT), interfragment healing with periodontal ligament (PDL) and nonhealing with interposition of granulation tissue (GT) because of pulp necrosis in the coronal fragment. Furthermore, the effect of age, location of the fracture on the root, and observation period on mobility values was analyzed. Mobility values were measured for 44 of 95 previous reported root-fractured permanent incisors. Mobility changes were measured with a Mühlemanns periodontometer and noninjured incisors served as controls. The mobility values represented the labial-lingual excursion of the root measured in μm when the tooth received a frontal and a palatal impact of 100 g force. In 18 cases of hard tissue healing (HT), a slightly increased mobility was seen after 3 months and 1 year, and a normalization of mobility value was usually found after 5 and 10 years. In 17 cases of PDL healing, generally a higher mobility was found in comparison with root fractures healing with hard tissue, and a consistent decrease in mobility value was found in the course of the 10 year observation period. A tendency for reduced mobility over time was found, a relation that could possibly be explained by the known general decrease in tooth mobility with increasing age. Finally, nine cases of nonhealing with initial interposition of granulation tissue (GT) because of pulp necrosis in the coronal fragment resulted in increasing mobility values possibly related to a lateral breakdown of the PDL in relation to the fracture line. In control teeth, a lowering of mobility was found over the course of a 10-year observation period. In conclusion, mobility changes appeared to reflect the radiographic healing stages and known age effects upon tooth mobility.

Scandinavian multicenter study on the treatment of 168 patients with 230 intruded permanent teeth – a retrospective cohort study

BACKGROUND/AIM The aim of the study was to evaluate the survival of intruded permanent teeth related to treatment in a large number of patients, with special focus on development of pulp necrosis and replacement resorption (ankylosis-related resorption). MATERIALS AND METHODS The material consisted of 168 patients (mean age 9.6 years) with 230 intruded permanent teeth from dental trauma clinics in Copenhagen, Denmark, Stockholm, Sweden, and Oslo, Norway. The degree of intrusion was classified as mild (1-<3 mm), moderate (3-7 mm), and severe (>7 mm). Root development was categorized with respect to root formation and development of the apex into three groups of increasing tooth maturity: very immature, immature, and mature. RESULTS Awaiting re-eruption was the treatment of choice in 107 teeth (47%), orthodontic repositioning in 28 (12%) and surgical repositioning in 95 (41%) teeth. Pulp necrosis was diagnosed in 173 teeth (75%), infection-related root resorption in 57 (25%) and replacement resorption in 50 teeth (22%). Very immature teeth, teeth diagnosed with mild intrusion, and teeth awaiting re-eruption had significantly (P < 0.05) fewer complications. In a stepwise discriminant function analysis, choice of treatment, root development, and degree of intrusion were significantly (P < 0.05) associated with the development of replacement resorption. Root development and degree of intrusion were significantly (P < 0.05) associated with the development of pulp necrosis. CONCLUSION This study indicates that root development and degree of intrusion may be important for the development of pulp necrosis as well as replacement resorption, whereas choice of treatment only seems to influence the development of replacement resorption in intruded permanent teeth. Awaiting re-eruption resulted in the lowest risk for developing replacement resorption.