Socket seal surgery: Clinical uses in implant dentistry and guided bone regeneration procedures for single tooth replacement in the esthetic zone

Restoring failing anterior teeth with a dental implant is considered a complex treatment even with thorough biologic knowledge of the situation. The goal is to produce a result in which the labial soft tissues and the papillae remain stable over time. Treatment of the fresh extraction socket in the alveolar ridge presents a challenge in everyday clinical practice. Regardless of the subsequent treatment, maintenance of the ridge contour will frequently facilitate all further therapeutic steps. Socket seal surgery and socket preservation in combination with immediate, early, or delayed implant placement can be valuable procedures for single tooth replacement. However, their potential as ridge preservation techniques in these different situations still needs to be demonstrated. The use of these procedures is illustrated in three consecutive cases.

The face of conflict: Significant sharp force trauma to the mid-facial skeleton in an individual of probable 16th-17th century date excavated from Byczyna, Poland

A variety of injuries have always been associated with violence, consequences of which people had to deal with. In this paper we present a complex of craniofacial and dental injuries resulted from sharp force trauma. The basis of our study was historical skeletal material excavated from archeological site in Byczyna (11th-17th century), Poland. An individual whose skeleton was exhumed from the grave No. 610 exhibited healed, oblique trauma of the left maxilla, damage to the crowns of right central and lateral incisors and concomitant luxation of the right maxillary central incisor. We describe the mechanism of this trauma and complications that resulted from damage to the masticatory apparatus.

Multidisciplinary approach for replacement root resorption following severe intrusive luxation: A case report of decoronation

Intrusive luxation is a severe trauma-related event with a high frequency of pulp necrosis and root resorption. A common complication following intrusion is tooth ankylosis, which can extend to progressive replacement root resorption. An increasing infraposition in growing individuals can also occur. Decoronation is a new conservative treatment for cases of tooth ankylosis in young patients who have not finished growing. In this surgical technique, the tooth crown is removed and the root with replacement resorption process remains inside the alveolus. This treatment allows the alveolar bone to continue to develop, thus preserving bone dimensions. The purpose of this article is to report a multidisciplinary case of a young patient with anterior open bite, dental ankylosis, and tooth infraposition affected by intrusive luxation. Decoronation was the treatment of choice for this patient. The patient was then referred to orthodontic treatment to maintain the space of the maxillary right central incisor and open bite correction. After 5 years of follow-up, good clinical and radiologic results were obtained.

Rare sequelae in the permanent successor due to trauma in the primary incisor: a case report

Severe dental trauma-such as intrusion or avulsion-to the primary dentition in infants and toddlers may cause developmental disturbances in the permanent successor. In this case, a 9-year-old boy was referred for treatment due to the absence of his permanent maxillary right central incisor. The mother reported avulsion of the corresponding primary tooth when the patient was 2 years old. The radiographic examination revealed impaction and root dilaceration of the permanent tooth; therefore, the treatment plan was tooth extraction. The extracted tooth presented multiple abnormalities, including enamel discoloration, enamel hypoplasia, root dilaceration, and root duplication. Several factors need to be considered when treatment of traumatic sequelae to a permanent successor is planned, including the age of the patient, the developmental stage of the permanent successor at the time of trauma, and the type of trauma to the primary tooth.

Intrusive luxation of an immature permanent incisor: a 10-year follow-up

Intrusive luxation in the permanent dentition is rare and considered the most severe form of dental trauma. Intrusion is characterized by the axial displacement of the tooth into the alveolar bone. It normally affects pulpal vitality and the periodontal ligament. The most common forms of treatment are waiting for spontaneous reeruption, repositioning with orthodontic procedures, or immediate surgical repositioning. A well-planned approach to the treatment of an intrusive luxation is necessary to obtain a successful result. This case report describes treatment of an 8-year-old boy who suffered intrusive luxation of his permanent maxillary right central incisor while root formation was incomplete. The patient was followed clinically and radiographically for 10 years.

Direct Resin Composite Restoration of Maxillary Central Incisors with Fractured Tooth Fragment Reattachment: Case Report

This article presents a clinical protocol to reconstruct two accidentally damaged maxillary central incisors using composite resin material and a fractured tooth component. A patient was referred to the clinic with fracture of the two maxillary central incisors. Clinical examination revealed that both teeth were fractured in the middle third of the crown and that the fractures involved enamel and dentin with no pulp exposure. The patient had also suffered a lower lip laceration. When the lip was evaluated, a fractured fragment of the maxillary right central incisor was found inside the wound. The missing part of the tooth was replaced via adhesive attachment. Due to the damage of the fractured part of the maxillary left central incisor, direct composite restoration of this tooth was performed. With the advent of adhesive dentistry, the process of fragment reattachment has become simplified and more reliable. This procedure provides improved function, is faster to perform, and provides long-lasting effects, indicating that reattachment of a coronal fragment is a realistic alternative to placement of conventional resin composite restorations.

A Step-by-Step Description of PDL-Mediated Ridge Preservation for Immediate Implant Rehabilitation in the Esthetic Region

The aim of this study was to present in detail the clinical steps of the root-membrane technique. This technique combines the benefits of conventional root submergence via intentional maintenance of a root fragment for ridge preservation with those of immediate implant placement for functional rehabilitation of the treated site. A case study of a tooth diagnosed with a horizontal root fracture is used to illustrate this technique step by step. The clinical application of the root-membrane technique not only allowed for immediate placement in a site with compromised buccal plate but also facilitated excellent clinical stability of soft tissue contours during the 3 years of follow-up.

Surgical resolution of an aggressive iatrogenic root perforation in a maxillary central incisor: a case report with a 4-year follow-up

The prognosis of teeth with root perforations depends on several factors, including size, location, and time since occurrence. Root perforations are clinical situations that can be solved by either nonsurgical or surgical approaches. The purpose of this article is to present a case of an aggressive iatrogenic root perforation in a maxillary right central incisor solved surgically using mineral trioxide aggregate (MTA). Even in an unfavorable situation, MTA was able to induce new bone formation and reestablish gingival and periodontal health, as confirmed in follow-up examinations at 2 and 4 years.

Noninvasive bilaminar CAD/CAM composite resin veneers: a semi-(in)direct approach

Direct composite resin restorations have been recognized for their valuable clinical service and respect of intact hard tissue. The cost-effectiveness and inherent minimally invasive approach of resin-based materials means that they are also gaining popularity for use in computer-aided design/computer-aided manufacture (CAD/CAM) procedures. Several cases from the student clinics at the Herman Ostrow School of Dentistry of USC are presented that could have been resolved either with direct composite resin restorations or with indirect porcelain veneers. A novel semi-indirect CAD/CAM approach, characterized by its absolute noninvasiveness and simplicity, was chosen instead. The bilaminar restoration consists of a customized histoanatomical CAD/CAM dentin base (incisoproximal cutback), and a generic enamel skin. The patients can be treated either in one clinical session (semi-directly) or in two clinical sessions (semi-indirectly). The purpose of this article is to present another tool from the anterior restorative armamentarium to bridge the gap between direct and indirect techniques.

Papilla Reformation at Single-Tooth Implant Sites Adjacent to Teeth with Severely Compromised Periodontal Support

Reformation of the lost interdental papilla remains one of the most challenging goals for clinicians. When a single tooth is replaced with an implant, the papilla between the tooth and the implant can often be maintained or predictably reformed as long as the adjacent tooth's periodontal attachment and bone are preserved. However, if the periodontal support is compromised on the neighboring natural tooth, the papilla will often be deficient or missing. The cases presented herein demonstrate long-term follow-up of successful reformation of periodontal/peri-implant tissue contours, including reconstruction of lost interproximal bone and papilla at periodontally compromised sites using a combined hard and soft tissue surgical approach.

Cross-sectional Study of Dental Trauma and Associated Factors Among 9- to 14-year-old Schoolchildren in Isfahan, Iran

PURPOSE

To assess the prevalence of dental trauma (DT) and its associated factors in 9- to 14-year-olds.

SUBJECTS AND METHODS

A cross-sectional survey was carried out through clinical examination of the permanent incisors and canines of 907 schoolchildren (9 to 14 years old, average age = 11 ± 0.5 [SD] years, 55% female and 45% male) enrolled in 20 public schools in Isfahan, Iran. The demographic data, history and cause of trauma were recorded during patient interviews and with a structured questionnaire filled in by their parents. The overjet, lip coverage, and visible signs of DT (permanent incisors only, similar to the classification used by the US National Health and Nutrition Examination Survey 1988-1994, NHANES III) were recorded. DT in permanent canines were also recorded.

RESULTS

Approximately 36% (n = 325) recalled the occurrence of dental trauma, but only 23.8% (n = 216) of children had visible signs of dental trauma to the permanent incisors (girls [18.8%], boys [29.9%], OR = 0.54; 95% CI 0.40- 0.74; p = 0.000). The maxillary central incisors were commonly injured (69.5%). The most frequent types of injuries were the enamel fracture (59.0%), craze lines (16.3%), and enamel and dentin fracture (13.4%). Tooth avulsion was seen in 0.7%. No significant association was found between dental trauma and increased overjet of > 3 mm (p = 0.328), but a tendency was identified for overjet > 5 mm (OR = 1.51; 95% CI 0.89-2.58; p = 0.060). The relationship between DT and lip coverage was statistically significant (OR = 1.63; 95% CI 1.18-2.25; p = 0.003). Violence (30%) and fall (22.7%) were the main causes of DT.

CONCLUSION

The prevalence of DT in permanent incisors was high (23.8%) and significantly lower in girls. The association between DT and lip coverage was significant. There was no association between DT and increased overjet of > 3 mm.

Management of Cervical Root Fracture in Mandibular Central Incisor: A Case Report

Root fractures are relatively uncommon injuries, but they represent a complex healing pattern due to concomitant injury to the pulp, periodontal ligament, dentin and cementum. This report presents a case of successful treatment of cervical root fracture in a mandibular central incisor with the help of guttapercha and MTA Filapex sealer.

Provisional Replacement of Anterior Teeth: A Review of Clinical Techniques and Case Report in a Dental School Training Experience

Upon the premature loss of permanent anterior teeth from unanticipated trauma or by ongoing patient neglect requiring surgery, patient requisites of functional and esthetic considerations must be addressed. Interim management can be achieved through the use of several diverse fixed and/or removable treatment modalities. The purposes of this report are to provide a review of traditional and unconventional techniques for interim replacement of missing anterior teeth and to present a clinical report demonstrating the fabrication of a removable, thermoplastic (vacuum-formed) EssixTM prosthesis, utilizing composite resin as the surrogate material of choice for the absent teeth. This measure proved to be an immediate, esthetic, and transitional treatment solution prior to a permanent resolution for the patient's long-term dental requirements.

A Case Series: The Orthodontic Management of Central Incisors with Horizontal Root Fractures

This case series illustrates the successful orthodontic management of previously root-fractured central incisors. Orthodontic treatment was carried out to correct the underlying malocclusion, remove traumatic occlusal forces and to provide a suitable occlusion for future restorative treatment should the root-fractured teeth be lost in the future. Clinical relevance: Dental trauma occurs commonly; having affected 10% of orthodontic patients. All practitioners should be able to discuss the possibility of orthodontic treatment with patients who have had previous trauma to their front teeth.

Management of progressive apical root resorption 13 years after dental trauma and primary endodontic treatment

Many studies have focused on the search for a restorative material with good sealing properties and biocompatibility for treatment of teeth with open apices and necrotic pulps, which can result from periradicular disease and root resorption. Mineral trioxide aggregate (MTA) has exhibited promising clinical results in retrograde fillings and pulpotomies as well as for treatment of root perforations, root resorptions, incomplete root formations, and pulpal necrosis. This case report describes the management of a progressive apical root resorption in a previously traumatized tooth that had been endodontically treated. Five years of clinical and radiographic follow-up demonstrated the clinical efficacy of MTA in limiting the inflammatory resorptive process and promoting apexification and regeneration of periradicular tissue.

Primary incisor intruded through the nasal cavity: a case report

Intrusive luxation may cause complications for the primary tooth and generate adverse sequelae in the permanent successor. Although intrusion is prevalent in the primary dentition, full intrusion is a rare event that requires specialized treatment and a multidisciplinary approach. This article describes the case of a 1-year-old girl who presented with traumatic displacement of the maxillary left central incisor into the nasal cavity. The parents sought treatment 1 month after the child sustained the injury, and the impacted tooth was removed through her left nostril under general anesthesia. Four-year clinical and radiographic follow-up revealed no adverse sequelae.

Apical Closure in Apexification: A Review and Case Report of Apexification Treatment of an Immature Permanent Tooth with Biodentine

Materials such as calcium hydroxide paste and mineral trioxide aggregate are used in apexification treatment of immature permanent teeth, but the search for improved materials with higher characteristics of biocompatibility results in different materials. Biodentine is a tricalcium silicate cement that possesses adequate handling characteristics and acceptable mechanical and bioactivity properties. This report describes the case of a 9-year-old boy who was referred to the Department of Dental Clinic of Querétaro Autonomous University of Mexico. One month prior the patient had suffered a dental trauma of his upper left central incisor and had been treated by another dentist. The clinical diagnosis was previously initiated therapy and symptomatic apical periodontitis. The treatment was apexification with Biodentine. At follow-ups performed at 3, 6, and 18 months after treatment the tooth was asymptomatic. The cone-beam computed tomography scan at 18-month postoperative follow-up revealed continuity of periodontal ligament space, absence of periapical rarefactions, and a thin layer of calcified tissue formed apical to the Biodentine barrier. On the basis of sealing ability and biocompatibility, apexification treatment with Biodentine was applied in the present case report. The favorable clinical and radiographic outcome in this case demonstrated that Biodentine may be an efficient alternative to the conventional apexification materials.

CBCT-Aided Multidisciplinary Approach to Salvaging an Intruded Tooth

Among the most severe types of traumatic dental injuries is intrusive luxation, which displaces the affected tooth deeper into the alveolus, causing significant damage to the pulp and all of the supporting structures. This article describes a unique case of intrusive luxation of the mature left maxillary central incisor in an 18-year-old male patient. The diagnosis was confirmed using cone-beam computed tomography (CBCT), after which the intruded tooth was successfully repositioned by endodontic and orthodontic management. This was followed by prosthodontic rehabilitation. This case report also discusses the role of CBCT in effectively diagnosing this type of injury.

Endodontic treatment of trauma-induced necrotic immature teeth using a tricalcium silicate-based bioactive cement. A report of 3 cases with 24-month follow-up

BACKGROUND

Pulp necrosis is the second most common complication after traumatic dental injuries and occurs mostly within the first 6-24 months of follow-up period, depending on the type of dental trauma.

CASE REPORT

Three cases with endodontic treatment scenarios of trauma-induced necrosis in immature permanent anterior teeth. All cases were treated by full canal obturation with Biodentine (Septodont, Saint Maur des Fosses, France) and documented for a follow-up period of 24 months.

CONCLUSION

Copious irrigation of the root canal, minimal mechanical preparation, use of calcium hydroxide for a short period of time and complete obturation of these immature teeth with a bioactive cement with superior mechanical properties such as Biodentine were the prominent reasons attributed to the success of these three cases.

Idiopathic Radiographic Apical Root Resorption in Wind Instrument Players

Root resorption of the permanent teeth involves an elaborate interaction among inflammatory cells resulting in loss of dental hard tissues. This report describes three clinical cases where idiopathic root resorption occurred in wind instrument playing patients. These patients produce adequate non-orthodontic forces, while playing their instruments, to expose their teeth to root resorbing force. Careful clinical monitoring of patients' teeth should be undertaken, as the additive effects of orthodontic treatment and musical habits are unknown. CPD/Clinical Relevance: This paper advises that questioning about wind instrument playing during case history-taking would be beneficial to clinicians. Furthermore, careful clinical monitoring of these patients' teeth during orthodontic treatment should be undertaken.

Effect of fiber posts on the fracture resistance of endodontically treated anterior teeth with cervical cavities: An in vitro study

STATEMENT OF PROBLEM

How the placement of fiber posts affects the fracture resistance of endodontically treated maxillary central incisors with cervical cavities is not well documented.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of fiber posts on the fracture resistance of endodontically treated maxillary central incisors with cervical cavities.

MATERIAL AND METHODS

Fifty extracted human maxillary central incisors were selected and divided into 5 test groups (n=10) according to the restoration strategy: GHT, control group; endodontically treated teeth (ETT) without endodontic posts; GCV, ETT with cervical cavities simulating coronal destruction; GCF, ETT with cervical cavities and carbon fiber posts; GGF, ETT with cervical cavities and glass fiber posts; and GCP, ETT with cervical cavities and composite resin posts. After the fiber posts had been cemented with a resin cement and the foundations had been placed, all specimens were quasi statically loaded at 45 degrees in a universal testing machine until fracture. All specimens were evaluated for fracture modes. The data were then analyzed by 1-way ANOVA, followed by multiple comparisons with the Tukey HSD test (α=.05). The mode of failure was determined by visual inspection.

RESULTS

The mean ±SD failure loads for the groups ranged from 718.2 ±89.8 N to 943.8 ±93.1 N. In a 1-way ANOVA followed by post hoc testing, GGFs had a higher fracture strength than all other groups (P≤.05). However, GCPs had a lower fracture strength than all other groups. Statistically significant differences were observed among groups (P≤.05), except between the GHT group and the GCF and GGF groups (P=.075, P=.226). All groups except GHT showed complete favorable fracture mode within the cervical third of the roots.

CONCLUSIONS

Within the limitations of this in vitro study, placement of glass fiber posts significantly improved the fracture resistance of endodontically treated maxillary central incisors with cervical cavities.