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.

Guided Tissue Regeneration Using a Barrier Membrane in Endodontic Surgery

Endodontic surgery aims at the resolution of a periapical inflammatory process by surgical access followed by enucleation of the lesion and root-end filling to curb any potentially noxious agent within the physical confines of the affected root. Guided bone regeneration could be associated to endodontic surgery aiming to enhance periradicular tissue regeneration. The objective of this paper was to review the scientific literature about guided bone regeneration in endodontic surgery, evaluating the effects on periapical lesion healing process. The included articles are classified considering the anatomical characteristics of the lesion. Fourteen articles were included in the review after abstract and title selection. Eight articles were on studies on lesions affecting only the periapical region (three about through-and-through lesions) while six were about the treatment of apico-marginal lesions. On the basis of the currently available literature, there is a low scientific evidence of a benefit related. to the use of guided bone regeneration procedure in endodontic surgery.

[Control of generalized chronic periodontitis combined with calcium-antagonist-related gingival overgrowth by a complex periodontal-endodontic-prosthodontic treatment. Case report]

To day a relatively high percentage of elderly population of the industrialized world suffers with different cardiovascular diseases and are on permanent antihypertensive therapy. One of the most frequently used drugs is the calcium channel blockers prescribed against high blood pressure. The most common oral side effect of these drugs is the gingival enlargement that might develop even on otherwise healthy gingiva. The incidence of chronic periodontitis in this age group is also high and the Ca antagonist medication in those individuals might substantially modify the clinical course of periodontal inflammation leading to gingival enlargement and hypertrophic pocket wall. The case presented here is a 52 years old hypertonic woman with a long history of Ca-antagonist therapy and generalized chronic periodontitis combined with gingival hyperplasia. After the change of medication the 1,5 years comprehensive periodontal endodontic and prosthodontic therapy restored patient's periodontal health and provided complex dental rehabilitation. Nevertheless, only regular periodontal supportive therapy could ensure predictable outcome and guarantee long lasting periodontal health.

[Our experience with Denti root form implants in clinical practice]

In the past 40 years, dental implantology has developed significantly in Hungary just like all over the world. This development refers to the implant materials, the diagnostics, the surgical techniques and the implantation prosthetics equally. According to the available statistics, approximately 66,000 implants are used annually in Hungary, which are provided by 32 implant systems. DenTi System founded in 1989, takes a prominent place among the 32 systems developing and preparing the implants in cooperation with the German Hager & Meisinger Company since 2003. The author of this paper has been using the system since 1995 and summarizes the experience gained in the past 5 years with the most ecently developed Denti implants: the one-stage root form implants, the one-stage Denti zirconium root form implants, the two-stage Denti root form implants and the two-stage Denti root form zirconium implants. Based on the findings, the author concludes that Denti implants belong to the best implants both in Hungary and worldwide.

Endodontic surgery with and without inserts of bioactive glass PerioGlas--a clinical and radiographic follow-up

OBJECTIVE

This study evaluated the use of bioactive glass, PerioGlas, after retrograde filling with Super EBA cement in the treatment of periapical bone destruction.

STUDY DESIGN

Healing outcomes were followed up after endodontic surgery in 186 teeth. Outcomes were divided into two groups according to follow-up time: short- and long-term. The EBA group (n = 110) underwent endodontic surgery and retrograde filling with EBA cement. In the EBA + PerioGlas group (n = 76), PerioGlas was embedded in the bone cavity after retrograde filling.

RESULTS

The success rate in the EBA + PerioGlas group was 72% compared with 56% in the Super EBA group at the short-term follow-up and 74% and 84%, respectively, at the long-term follow-up. Healing of periapical bone destruction classified as uncertain at the short-term follow-up was considered successful in two out of three cases at the long-term follow-up.

CONCLUSION

This study found that PerioGlas as bone substitute did not significantly improve endodontic healing outcome.

Surgical endodontic retrograde root-end filling materials

The treatment of diseased and necrotic pulpal tissue in teeth spans has been well known throughout history. Root canal treatment in the twentieth century has included complete removal of pulpal remnants to remove the failing tissue and then obturating the canal space with biocompatible material. This treatment preserves individual teeth to further function as part of a whole dentition for the patient's well-being. Failed root canal treatment, however, sometimes requires surgical intervention to treat the teeth from the root end. This article reviews the materials placed in intimate contact with tissues in this surgical procedure. The implications of these various materials within the tissues are discussed, along with clinical signs and symptoms a healthcare provider might encounter when examining these patients. There is no clear-cut "best" material for root-end surgical obturation at this time. Therefore, major materials that might be used are included in this discussion.

[New technologies and ways of endodontic-endoossal implantation improving]

There were developed, tested and used in practice new transdental implants (TDI) considerably widening the indications to endodontic-endoossal implantation. Universal TDI has a number of advantages over the known analogs and meant for osseointegration and fibro-osseointegration. The implant provides full tooth fixation in small bone volume, on maxilla including.

Mineral trioxide aggregate in endodontic treatment for immature teeth

The aim of the present study was to test the hypothesis that the fracture strength of calcium hydroxide and mineral trioxide aggregate (MTA) filled immature teeth decrease over time. Immature mandibular incisors from sheep were extracted and the pulps were extirpated using an apical approach with a barbed broach, and the teeth were divided into three experimental groups. Group 1: Untreated teeth. Group 2: The root canal was filled with calcium hydroxide paste (Ultradent-UltraCal XS). Group 3: The root canal was filled with ProRoot MTA system (Dentsply, USA). All specimens were kept in saline with 1% antibiotics at 4 degres C for certain periods of time: two weeks, two months and one year. All teeth were tested for fracture strength in an Instron testing machine at the indicated observation periods. The results were subjected to statistical analysis by a one-way analysis of variance and with the t-test at a 5% level of significance. One tooth from each group was selected randomly for the histological study. The mean fracture strengths decreased over time for all the three groups. The fracture strengths were not found significantly different from the untreated, calcium hydroxide-treated or MTA-treated teeth at two-week or two-month (p>0.05). However, the results for MTA-treated teeth were significantly higher than the other two groups at one year (p=0.0137). The teeth with root treatment with MTA showed the highest fracture resistance at one year (p<0.05), since only MTA induced the expression of TIMP-2 in the dentin matrix and possibly prevents rapid destruction of collagen.

Stress and deformation analysis induced by dental implants in mandible

The paper presents the human implanted mandible behavior under the action of muscle forces creating different stress distributions depending on the kind of motion performed. The mandible is treated in accordance to the classical mechanics methods. The model is based on the mandible actual shape, taking into account the correct geometric parameters. By imposing the motion conditions during mastication and by considering the real forces developed by muscles during this motion, the reaction forces acting in the temporal-mandible joint and on each tooth have been computed. The aim of the paper is to establish a connection between the implant number and the jaw mechanical behavior.

"Hypnopuncture"--a dental-emergency treatment concept for patients with a distinctive gag reflex

The present case report describes a newly developed dental treatment concept for patients with a distinctive gag reflex. "Hypnopuncture" is a combination therapy of hypnosis and acupuncture. Its simple, fast, and effective application autonomous of the cause makes it a valuable tool for dental-emergency treatment procedures. Physiologic and psychological aspects of gagging are influenced at the same time. The protocol is illustrated in the case of a 76-year-old patient with a severe gag reflex who was successfully treated by this combination approach. Necessary and effective therapeutic measures from both acupuncture and hypnosis are portrayed.

Evidence-based approach for treatment planning options for the extensively damaged dentition

Restoring the extensively damaged dentition has always been a difficult decision-making process for the dental practitioner. Decisions to restore these teeth were primarily based on the fact that "fixed" teeth are typically better functionally than "removable" teeth and better esthetically than "no" teeth. Prior to dental implants, restoring missing teeth and extensively damaged teeth utilizing traditional therapy such as crown lengthening, root hemisection/amputation, endodontic therapy, apical surgery, post and cores and splinting were the options available to our patients. These teeth typically required the expertise of additional specialist, however their prognosis and success rates were typically guarded at best. Presently, dental implant success rates have been clearly identified and documented in the literature which now questions the survivability and success rates of the traditional mode of therapy for extensively damaged teeth. This paper will attempt to review the dental literature for various traditional modes of therapy for restoring the extensively damaged to provide a consensus of their survivability to help the practitioner to present options and prognosis for their patients.

Engine driven rotary instrumentation for endodontic therapy in a cat

A 10-year-old, male/neutered Himalayan cat was presented for evaluation following diagnosis of a fractured maxillary right canine tooth (104) during an annual physical examination 1-week before presentation. The cat had received a professional teeth cleaning procedure 2-years previously at which time 104 had appeared normal during oral examination.

Endodontic instruments for root canal therapy

This article on endodontic instrumentation includes endodontic instruments and techniques of root-canal preparation of teeth in veterinary patients. Familiarity with instruments covered in this article and with advances in veterinary endodontics has become necessary for the veterinary dental practitioner who wishes to practice dentistry using current techniques. Veterinary endodontic techniques that help to retain the teeth longer are increasing in demand as an option to extracting damaged teeth. Endodontic treatment involves removal of the irreversibly damaged pulp, followed by cleaning and shaping of the root canal space using endodontic instruments and subsequent filling, or obturation, with a semisolid material and a sealer.

Restorative procedures after root canal therapy

One of the most common indications for veterinary dental restoration involves replacing tooth structure after a root canal procedure. Special considerations are necessary due to the interaction of the restorative material with materials used to obturate the root canal. The restoration must provide a hermetic seal of the pulp chamber, as well as restore function. Combining several different restorative materials provides the best overall performance. In certain instances, full crown coverage is required to restore functional length or cervical anatomy.

Periodontal healing after intentional auto-alloplastic reimplantation of injured immature upper front teeth

BACKGROUND/AIMS

Conventional endodontic treatment results in high complication quota when performed in immature teeth. Intentional reimplantation with extraoral insertion of an endodontic implant (auto-alloplastic reimplantation) is an alternative.

METHOD

In a retrospective study, the healing of 40 teeth reimplanted intentionally according to this method in patients aged 7 to 15 years was evaluated. Clinical tests (palpation, percussion sound, periotest values) and radiographical examinations were used to determine the type of periodontal healing (inflammatory resorption/periodontitis apicalis; replacement resorption/ankylosis; normal healing).

RESULTS

Mean lifetime of the replanted teeth was 59.2+/-42.5 months, estimated survival time on the basis of the Kaplan-Meier analysis was 99.5 months. 17 teeth (42.5%) were classified as failures, mostly due to inflammatory resorption or periodontitis apicalis. Further investigations demonstrated that success rate and retention period of intentionally replanted teeth depend on the preoperative condition of the pulp. Teeth with preoperative infection suffered frequently from inflammatory resorption or periodontitis apicalis after being replanted (14 of 28 teeth). Estimated survival time according to Kaplan-Meier was 75.5 months. In contrast, inflammations or progressive resorptions were not observed in teeth without preoperative infection of the pulp. All these 12 teeth showed normal periodontal healing and regular tooth mobility. In the absence of any pathology in clinical or radiological findings after an average functional period of 72.3 months, the prognosis can be presumed excellent. Estimated survival time of 148.3 months according to Kaplan-Meier differs significantly from survival time of teeth infected preoperatively.

CONCLUSIONS

From the results of this investigation, it may be concluded that an infection of the pulp - due to delay of treatment or attempts at endodontic therapy - should be avoided before intentional replantation of immature front teeth with pulp necrosis. Periodontal healing of the autologous root is not impaired by the insertion of posts made of Al2O3-ceramics or titanium. The inserted posts do not ankylose. Orthodontic movement of auto-alloplastically replanted teeth is possible.

Application of titanium-alloy endodontic implants in conjunction with periradicular surgery

OBJECTIVE

To evaluate the outcome of placement of titanium-alloy endodontic implants in conjunction with periradicular surgery.

STUDY DESIGN

Twenty-four teeth were treated with endodontic implants with corresponding periradicular surgery by using SuperEBA cement (Harry J Bosworth Co, Skokie, Ill) as a sealer. The results of the endodontic implant surgery were evaluated clinically and radiographically from 2 to 4 years after treatment.

RESULTS

Twenty-two teeth were treated successfully, whereas 2 teeth were treated unsuccessfully, for a success rate of 92%.

CONCLUSIONS

Titanium-alloy endodontic implants in conjunction with periradicular surgery may provide good short-term results. Sealing between the endodontic implant and the dentin is likely an important factor for success.

Indirect sinus augmentation procedures using one-stage anatomically shaped root-form implants

Sinus augmentation procedures are a standard part of implant dentistry. Indirect sinus augmentation procedures reduce the magnitude of the surgery when sinus lift procedures are necessary. This article describes a variation of the indirect augmentation of maxillary sinuses. The surgery is performed through small diameter surgical access openings. This modified indirect sinus augmentation procedure is combined with the immediate placement of one-stage dental implants that effectively seal the surgical access openings and have an anatomical exit profile for easier restoration.

The use of magnets in the comprehensive treatment of congenital partial anodontia: a case report

This case report describes the treatment of an adult patient with a combination of fixed and removable prosthodontics. The treatment involved increasing the patient's vertical dimension of occlusion, placing two osseointegrated implants, making six surveyed crowns, fabricating a maxillary partial denture, and using magnets to help retain the mandibular partial denture. The clinical steps for using a type of intraoral magnet are described.

[The enhanced efficacy of endodontic endosseous and endosseous implantation using Hydroxyapol]

Hydroxyapol was used for intercanal-interosseous and intraosseous implantation. Operations were carried out in 62 patients with good results, this permitting the authors to recommend Hydroxyapol for practical implantations.

An alternative treatment for the severely resorped maxillary lateral incisor: a sequela of ectopic eruption

At times dental crowding, maxillary arch inadequacy, or an abnormal lingual or horizontal position restricts the eruption of the maxillary cuspid. This ectopic eruption can cause the canine to compress the blood supply to the periodontal tissues of the adjacent lateral incisor. If undiagnosed and untreated, physiological and chemical changes are induced, and the lateral root undergoes resorption. When the resorption is severe enough to endanger the retention of the lateral, an endeosseous stabilizer can be placed through the root and extended into the bone to stabilize the tooth artificially. Two cases demonstrate the technique and success of such treatment.

Extraoral root lengthening with titanium screws

The aim of the present study was to experimentally evaluate marginal and periapical healing in extracted and subsequently replanted teeth following extraoral cementing of apically exposed titanium root screws in the root canal. In 5 out of 6 replanted teeth, the periodontal tissues had healed with a normal periodontal membrane or healed surface resorptions indicating that only minor trauma had been inflicted during the extraoral procedure. In 3 out of 6 teeth, total or partial osseointegration of the titanium screws was seen, while a connective tissue capsule had formed around the remaining 3 screws. It was concluded that both of the healing results described in the present study, osseointegration and connective capsule formation, may be regarded as acceptable as long as inflammation is prevented, although it remains to be shown which one represents the end-point.

Endodontic stabilizers

With the recent influx of osseointegrated endosseous implants in dentistry, attention has been drawn away from using endodontic stabilizers as a means of stabilizing and retaining teeth. It is our opinion that endodontic stabilizers should be considered in the treatment planning of seemingly nonretainable teeth. They are biocompatible and have the additional advantage of maintaining the periodontal membrane attachment of the remaining tooth. Extraction and subsequent replacement with osseointegrated implants should only be considered after all other means of retaining the natural tooth have been fully explored. Selective case studies from various areas of the dentition demonstrate the broad applicability of stabilizers. A technique is presented for the use of endodontic stabilizers.

Autotransplantation using endosseous implants as stabilizers

The surgical transfer of a tooth from one site to another in the same individual is known as autotransplantation. Usually the tooth transferred is an unerupted or partially erupted third molar which is placed into a first molar position with some external fixation. In this case report, the first molar was already missing and the second molar was hopeless. An erupted third molar was autotransplanted into the second molar site and endosseous implants were used to stabilize the tooth. A fixed bridge was placed 6 months later and the progress followed for 4 yr.

Clinical observations of a titanium-alloy prefabricated post

Clinical observations led to the development of this article in order that the dental profession may become cognizant of the ethereal radiographic appearance of titanium-alloy posts.

Evaluation of the retention of endodontic implants

The study investigated the retentive strength of endodontic implants measured by forced removal (pull-out or push-out tests) as a function of implant design and cement type. Smooth-tapered, threaded, and an innovative porous-surfaced implant were evaluated. Specimens were cemented in single-rooted human teeth with five different cements: zinc phosphate, polycarboxylate, glass ionomer, silicophosphate, or AH-26. The results indicated superior retention for the threaded and porous-surfaced implants, and stronger retention with glass-ionomer and AH-26 cements.