Periodontal effects of rapid maxillary expansion with tooth-tissue-borne and tooth-borne expanders: A computed tomography evaluation

Introduction: The force delivered during rapid maxillary expansion (RME) produces areas of compression on the periodontal ligament of the supporting teeth. The resulting alveolar bone resorption can lead to unwanted tooth movement in the same direction. The purpose of this study was to evaluate periodontal changes by means of computed tomography after RME with tooth-tissue-borne and tooth-borne expanders. Methods: The sample comprised 8 girls, 11 to 14 years old, with Class I or II malocclusions with unilateral or bilateral posterior crossbites Four girls were treated with tooth-tissue-borne Haas-type expanders, and 4 were treated with tooth-borne Hyrax expanders. The appliances were activated up to the full 7-mm capacity of the expansion screw. Spiral CT scans were taken before expansion and after the 3-month retention period when the expander was removed. One-millimeter thick axial sections were exposed parallel to the palatal plane, comprising the dentoalveolar area and the base of the maxilla up to the inferior third of the nasal cavity. Multiplanar reconstruction was used to measure buccal and lingual bone plate thickness and buccal alveolar bone crest level by means of the computerized method. Results and Conclusions: RME reduced the buccal bone plate thickness of supporting teeth 0.6 to 0.9 mm and increased the lingual bone plate thickness 0.8 to 1.3 mm. The increase in lingual bone plate thickness of the maxillary posterior teeth was greater in the tooth-borne expansion group than in the tooth-tissue-borne group. RME induced bone dehiscences on the anchorage teeth's buccal aspect (7.1 ± 4.6 mm at the first premolars and 3.8 ± 4.4 mm at the mesiobuccal area of the first molars), especially in subjects with thinner buccal bone plates. The tooth-borne expander produced greater reduction of first premolar buccal alveolar bone crest level than did the tooth-tissue-borne expander. © 2006 American Association of Orthodontists.

Effects of tissucol™ and epsilon aminocaproic acid in the healing process following dental extraction in dehydrated rats

A histological study was conducted of the alveolar bone healing process following tooth extraction of dehydrated rats after the implantation of fibrin adhesive (TISSUCOL™) associated to previous irrigation of the wound with a 5% epsilon aminocaproic acid solution (EACA). Seventy two rats were used, divided into three groups receiving different treatments after the surgical procedure. In group I, the gingival mucosa was sutured after extraction of the right upper incisor. In groups II and III, chronic dehydration was produced by water deprivation for 9 days (3 days in the preoperative period and 6 days in the postoperative period). In the animals of Group II, after tooth extraction, the gingival mucosa was sutured in the same way as performed in group I. In group III, after extraction, the dental socket was irrigated with 5% EACA, followed by implantation of the fibrin adhesive (TISSUCOL™). The mucosa was sutured in the same way as performed in the other groups. At 3, 7, 15 and 21 postoperative days, the animals were sacrificed in number of 6 for each group. Specimens containing the dental socket were removed and fixed in 10% formalin and decalcified in an equal part formic acid and sodium citrate solution. After routine processing, the specimens were embedded in paraffin for microtomy. We obtained 6 μm semi-serial slices that were stained with hematoxylin and eosin for histological evaluation. The results showed that the water deprivation in the pre- and postoperative periods caused a delay in the alveolar bone healing process. The use of the fibrin adhesive (TISSUCOL™) produced an improvement in the fibrinolytic picture caused by dehydration.

Clinical evaluation of an ointment with 10% metronidazole and 2% lidocaine in the treatment of alveolitis.

AIM: In this study, the authors evaluate the use of a 10% metronidazole and 2% lidocaine ointment, using a lanolin base and mint as flavoring, to treat alveolitis in humans. METHODS: Twenty-five patients, with a diagnosis of alveolitis, were treated in the following way: locoregional anesthesia; surgical cleaning of the socket with alveolar curettes; saline solution irrigation with a 20 ml disposable syringe; and complete filling of the socket with the ointment. RESULTS: The analysis of the results showed that the painful symptoms were severe before and on the day of the treatment in 17 (68%) of the 25 patients treated. Post-treatment analysis presented 2 patients (18%) with severe painful symptoms after 24 h of the treatment and complete remission of painful symptoms after 48 h of the treatment with the ointment. CONCLUSIONS: Based on the results, it is possible to conclude that the 10% metronidazole and 2% lidocaine ointment, with mint flavoring and lanolin as a base, can be used to treat alveolitis.

A new device in immediately loaded implant treatment in the edentulous mandible

Purpose: This article reports preliminary clinical results of the Speed Master system, a method for immediate loading of implants for the treatment of mandibular edentulism. Materials and Methods: Fifteen patients with edentulous mandibles were consecutively included in the study. Each received 4 implants between the mental foramina placed using the system's surgical guides. Permanent fixed prostheses fabricated over premanufactured titanium bars were attached to the implants on the day of implant placement. The patients were followed for 15 to 27 months (mean, 19 months). Peri-implant tissues were periodically evaluated. Marginal bone loss was monitored with periapical radiographs using a computerized technique. Satisfaction was assessed by means of a questionnaire. Results: The overall implant and prosthetic survival rates were 100%. At the time of the final follow-up visit, mean marginal bone loss was 1.11 mm, and bleeding on probing was not observed. Only 6.7% of the patients reported any discomfort during treatment, and all patients would recommend the procedure to others. Discussion: The immediate loading of implants placed in the edentulous mandible with the Speed Master surgical and prosthetic protocol reduces treatment time and number of surgical procedures in comparison to classic delayed loading protocols. Conclusion: The rehabilitation of the mandible with an immediately delivered occlusally loaded hybrid prosthesis supported by 4 implants does not appear to jeopardize the success of the osseointegration and represents a viable treatment option.

Delayed tooth replantation after root surface treatment with sodium hypochlorite and sodium fluoride: Histomorphometric analysis in rats

In cases of delayed tooth replantation, non-vital periodontal ligament remnants have been removed with sodium hypochlorite in an attempt to control root resorption. Nevertheless, reports of its irritating potential in contact with the alveolar connective tissue have been described. Therefore, this study evaluated the healing process on delayed replantation of rat teeth, after periodontal ligament removal by different treatment modalities. Twenty-four rats, assigned to 3 groups (n=8), had their upper right incisor extracted and left on the workbench for desiccation during 60 min. Afterwards, the teeth in group I were immersed in saline for 2 min. In group II, root surfaces were scrubbed with gauze soaked in saline for 2 min; and in group III, scrubbing was done with gauze soaked in 1% sodium hypochlorite solution. Thereafter, root surfaces were etched with 37% phosphoric acid and immersed in 2% acidulate-phosphate sodium fluoride solution, at pH 5.5. Root canals were filled with a calcium hydroxide-based paste and the teeth were replanted. The animals were sacrificed 60 days postoperatively and the pieces containing the replanted teeth were processed and paraffin- embedded. Semi-serial transversally sections were obtained from the middle third of the root and stained with hematoxylin and eosin for histomorphometric analysis. Data were analyzed statistically using Kruskal-Wallis and Dunn's tests. The results showed that root structure and cementum extension were more affected by resorption in group III (p<0.05). All groups were affected by root resorption but the treatment performed in group III was the least effective for its control. The treatment accomplished in groups I and II yielded similar results to each other.

Prosthetic rehabilitation of a bone defect with a teeth-implant supported, removable partial denture

The use of teeth-implant, mucosa-supported removable dentures for rehabilitation of partially edentulous patients involves highly complex biomechanical aspects. This type of prosthesis associates 3 kinds of support that react differently to the functional and parafunctional forces developed in the oral cavity. Although the construction of removable partial dentures may seem paradoxical when osseointegrated implants are placed, in some cases, this option is an excellent alternative to solve difficulties related to the anatomic, biologic, psychomotor, and financial conditions of the patient. This article reports on a case in which a teeth-implant, mucosa-supported removable partial denture was the option of choice for a patient with financial and anatomic limitations, having a large structural loss of the residual alveolar ridge caused by trauma by a gunshot injury at the mandible. The 5-year follow-up did not reveal any type of biomechanical or functional problem. Copyright © 2006 by Lippincott Williams and Wilkins.

The effect of alcohol consumption on periodontal bone support in experimental periodontitis in rats

Objective: The aim of this study was to evaluate the effect of the alcohol consumption on the periodontal bone support (PBS) in experimental periodontitis in rats. Materials and Methods: Sixty-three male rats were divided into seven groups: G1 (control); G2 (10% ethanol); G3 (nutritional control of G2); G4 (20% ethanol); G5 (nutritional control of G4); G6 (30% ethanol) and G7 (nutritional control of G6). The groups G3, G5 and G7 received controlled diets with equivalent caloric amounts to those consumed in G2, G4 and G6 respectively, with the ethanol replaced by sucrose. After anesthesia, ligatures were installed around the mandibular first molar, leaving the contralateral teeth unligated. After 8 weeks, the rats were killed and their mandibles were radiographed to measure the percentage of PBS on the distal aspect. Results: The intragroup analyses showed that presence of ligatures induced periodontitis (p<0.05). Unligated groups did not show significant differences among the percentages of PBS (p=0.1969). However, in ligated groups the rats that received alcohol (G2:48.71%±3.88; G4:47.66%±2.54; G6:47.32%±3.24) and the nutritional control group associated with a high concentration of ethanol (G7:47.40%±3.24) presented a significantly lower percentage of PBS than the other groups (G1:52.40%±2.75; G3:52.83%±2.41; G5:50.85%±4.14). Conclusions: These results demonstrated that alcohol consumption in rats may result in a direct effect on alveolar bone loss and increased development of periodontitis. In addition, they suggest that heavy caloric consumption of ethanol may also present an indirect effect on periodontal tissue as a consequence of malnutrition.

Histological investigation of a 10% metronidazole and 2% lidocaine dressing on wound healing in rats.

AIM: Alveolitis is considered a disturbance of the alveolar healing process that is characterized by blood clot disintegration, alveolar wall infection and extreme pain. Several substances have been investigated to improve healing and guarantee postoperative comfort to patients. The aim of this study was to evaluate, microscopically, in rats, the healing process in non-infected tooth sockets, after application of a 10% metronidazole and 2% lidocaine dressing, using lanolin as vehicle and mint as flavoring. METHODS: Forty-five rats (Rattus norvegicus albinus, Wistar) had their right incisor extracted and were randomly assigned to 3 groups (n=15): Group I (control): the sockets were filled with blood clot; Group II: application of adrenaline solution at 1:1 000 with an absorbent paper point during 1 min plus filling of the socket with a 10% metronidazole and 2% lidocaine dressing, with lanolin as vehicle, and mint as flavoring; Group III: filling of the socket with the 10% metronidazole and 2% lidocaine dressing, with lanolin as vehicle and mint as flavoring. After 6, 15 and 28 days postoperatively, 5 animals per group were euthanized with an injectable anesthetic overdose. Histological and statistical analyses were performed. RESULTS: The results showed that the 10% metronidazole and 2% lidocaine dressing with lanolin as vehicle and mint as flavoring yielded similar response as that of the normal repair group and may be used to prevent the onset of alveolitis in those cases in which any predisposing factor is present. CONCLUSIONS: The use of this dressing has shown a good postoperative patient's comfort and does not cause a significant delay in the alveolar healing process.

Intraosseous schwannoma mimicking a periapical lesion on the adjacent tooth: Case report

Aim: To present an additional case of intraosseous schawannoma involving the apical area in the mandibular alveolar bone mimicking an inflammatory periapical lesion. Summary: This article describes a case of schwannoma periapically located mimicking an inflammatory periapical lesion in the mandible of a 34-year-old female. Diagnostic and therapeutic problems can occur when this lesion is misinterpreted as being endodontic in origin. The diagnosis, radiograph, immunohistochemical aspects and treatment are also discussed. Key learning points: • Intraosseous schwannoma is a rare unilocular radiolucency that when located periapically could be misdiagnosed as an endodontic lesion and result in unnecessary root canal treatment. • The vitality of the pulp is an important test to exclude lesions of inflammatory origin. • Histological examination is important to establish the diagnosis of lesions in the periradicular region. © 2007 International Endodontic Journal.

Sobredentadura inmediata y con carga tardía: Revisión de la literatura

The oral rehabilitation of the patients toothless totals presents large difficulties, because diverse factors act limiting the treatment with complete dentures conventional, as severe reabsorption of the alveolar process, generating for the phonetic patient difficulties and of mastication, annoyance, retention lack and stability of the prosthesis. With the emergence of you implant them osseointegratin idealized by Prof o Branemark, these aspects were improved by means of the possibility of new treatment options, as the overdentures tissue-implant-supported. However, the protocol of Branemark demanded a period of scaring from three to six months, owing the patients to await this time for the placement of the final prosthesis. This way, the surgical technique of immediate load was proposed to abbreviate this period, improving the transition phase, at the same time that it reduces the problems psychological associates. This way, the objective of the present study is to carry out a literature revision about the works that used overdentures comparing immediate and late load, the best alternative and factors wrapped in the success of the procedure discussing. © 2008 1995, Editorial Ciencias médicas.

Comparative Analysis of 2 Techniques of Double-Gloving Protection During Arch Bar Placement for Intermaxillary Fixation

Purpose: This study was conducted to comparatively evaluate, in a prospective and randomized manner, 2 techniques for providing double-gloving protection during arch bar placement for intermaxillary fixation. Materials and Methods: A total of 42 consecutive patients in whom application of an Erich bar was indicated for intermaxillary fixation were equally divided into 2 groups. In group 1, 2 sterile surgical gloves were used; in group 2, a nonsterile disposable inner glove was used under a sterile surgical glove. Wilcoxon, Mann-Whitney, Kruskal-Wallis, and binomial statistical tests were used to analyze the findings. Results: A total of 103 perforations were found in the outer gloves (47 in group 1 and 56 in group 2), along with 5 perforations in inner gloves in both groups (α = .01). No significant statistical difference was found between groups in terms of inner glove perforations (α = .05). The nondominant hand presented with 70.9% of the perforations, statistically significant to 1%. Conclusions: Both double-gloving techniques were found to provide effective clinician protection. The use of a nonsterile disposable glove under the surgical glove is possible for less-invasive procedures, offering the same safety as using 2 sterile surgical gloves while decreasing operational costs. This method does not eliminate the need to change gloves when a perforation is suspected or noted during the surgery, however. © 2007 American Association of Oral and Maxillofacial Surgeons.

Information for the diagnosis and treatment of root resorption due to tooth replantation.

A favorable prognosis after tooth avulsion depends on some variables, such as the extra-alveolar period and storage medium. Vitality of the periodontal ligament cells is considered a critical factor for a successful outcome without root resorption. The dental surgeon is provided with clinical information and radiographic findings to establish a diagnosis and may rely on current available guidelines. Once trauma has occurred, treatment must be quick and effective, and periodic follow-up must be performed. Clinical, radiographic, and histologic characteristics for each type of root resorption due to tooth replantation are presented, with the aim to provide information for the diagnosis and treatment of healing complications.

Immunohistochemical, tomographic and histological study on onlay iliac grafts remodeling

The information concerning the molecular events taking place in onlay bone grafts are still incipient. The objective of the present study is to correlate the effects of perforation of resident bone bed on (1) the timing of onlay autogenous graft revascularization; (2) the maintenance of volume/density of the graft (assessed through tomography); and (3) the occurrence of bone remodeling proteins (using immunohistochemistry technique) delivered in the graft. Thirty-six New Zealand White rabbits were subjected to iliac crest onlay bone grafting on both sides of the mandible. The bone bed was drill-perforated on one side aiming at accelerating revascularization, whereas on the other side it was kept intact. After grafts fixation and flaps suture all animals were submitted to tomography on both mandible sites. Six animals were sacrificed, respectively, at 3, 5, 7, 10, 20 and 60 days after surgery. A second tomography was taken just before sacrifice. Histological slides were prepared from each grafted site for both immunohistochemistry analysis [osteopontin, osteocalcin, type I collagen and vascular endothelial growth factor (VEGF) anti-bodies] and histometric analysis. The values on bone volume measured on tomography showed no statistic significance (P≥0.05) between perforated and intact sites. Grafts placed on perforated beds showed higher bone density values compared with non-perforated ones at 3 days (P≤0.05). This correlation was inverted at 60 days postoperatively. The findings from VEGF labeling revealed a tendency for earlier revascularization in the perforated group. The early revascularization of bone grafts accelerated the bone remodeling process (osteocalcin, type I collagen and osteopontin) that led to an increased bone deposition at 10 days. The extended osteoblast differentiation process at intermediate stages in the perforated group cooperated for a denser bone at 60 days. © 2008 Blackwell Munksgaard.

Smoking enhances bone loss in anterior teeth in a Brazilian population: A retrospective cross-sectional study

The aim of the present study was to radiographically evaluate the effect of smoking on bone loss resulting from chronic periodontitis. Periapical radiographs were analyzed of 80 patients with chronic periodontitis (40 current or former smokers and 40 never-smokers) that attended a private periodontal practice. The smokers or former-smokers with a minimum consumption of 10 cigarettes/day for a period of over 10 years were selected. Interproximal radiographic bone loss was considered as the distance between the cementum-enamel junction and the alveolar bone crest. Bone loss for smokers was higher than that observed in never-smokers (p < 0.05) (3.33 ± 1.09 mm and 2.24 ± 0.76 mm; mean ± standard deviation for smokers and non-smokers, respectively). When each region of the mouth was comparatively evaluated, it was observed that the smokers' incisors presented the highest bone loss when compared with the other groups of teeth (p < 0.01). Within the limits of the present investigation it can be concluded that smoking enhances the bone loss resulting from periodontitis and that the incisors are the teeth most affected.

Bone spreading technique a case report

Bone spreading technique (BST) is a horizontal augmentation with minimal trauma for simultaneous implant placement and an alternative to Summer's osteotome technique both for its clinical use and for the armamentarium. The foremost advantage of the crest dilation technique is a substantially less invasive method; the buccal wall expands after the medullary bone is compressed against the cortical bone. The lateral dilation and compaction of medullary bone improved primary stability. The vital difference is that the BST used in this case report avoided discomfort of the patient, thus eliminating the need for malleting.