Tooth morphology following root resection procedures in maxillary first molars

Maxillary root amputation: Case report with a 14-year-follow-up and updated mini review

Root resection is performed to create a maintainable furcation area in teeth with advanced periodontitis. However, the long-term feasibility of this treatment remains controversial. We present a case in which distal root resection in a maxillary molar successfully preserved the form and function of the dentition for approximately 14 years.

A new bone substitute in the definitive management of furcation involvement: a case report

Bone xenografts are used for reconstructive surgery in medicine and dentistry. The grafts are osteoconductive, serving as a matrix in bone regeneration. Furcation involvements are one of the most challenging clinical problems in periodontics. Unilab Surgibone is a bone xenograft and has been investigated in many clinical and experimental studies. In this case report, a 50-year old male patient was diagnosed with a Class III furcation problem in his upper right first molar. The tooth was surgically treated by resection of the distobuccal root after the flap elevation. The extraction defect was grafted with the Unilab Surgibone. After nine months, the patient was evaluated clinically and radiographically. The healing was uneventful. The clinical and radiographic data suggest that Unilab Surgibone supports bone regeneration.

Estimation of radiographic angles and distances in coronal part of mandibular molars: A study of panoramic radiographs using EMAGO software

Objective:

This study was designed to investigate radiographically the effects of age and external irritating stimuli on the morphology and thickness of the pulp chamber ceiling and floor in mandibular molars.

Materials and Methods:

A total of 234 panoramic radiographs were recruited and 494 mandibular molars were examined in this study. The sample was divided into six age groups: Group 1, <20 years; Group 2, 20-29 years; Group 3, 30-39 years; Group 4, 40-49 years; Group 5, 50-59 years and Group 6, >60 years. Each group was subdivided into two subgroups with regard to the tooth condition (intact or non-intact teeth). Four distances, two angles and two ratios were measured, in order to estimate the dimensions of the pulp chamber and the thickness of the pulp chamber ceiling and floor.

Results:

The thickness of the pulp chamber ceiling and floor increased significantly from Group 1 to 6. The pulp chamber floor angle presented progressive sharpness from Group 1 to 6 whereas the pulp chamber ceiling angle presented progressive bluntness from Group 1 to 5 and sharpness from Group 5 to 6. Significant differences were identified in the thickness of the pulp chamber ceiling, the thickness of the pulp chamber floor and the ceiling-floor distance between intact and non-intact teeth.

Conclusion:

Based on those results, there are differences in the location of secondary dentin formation between the two pulp chamber walls. Age is related to diminished pulp chamber size. The increase rate of the pulp chamber ceiling thickness is similar to that of the pulp chamber floor thickness. Furthermore, external irritating stimuli have an effect on the pulp chamber dimensional changes.

Root resection under the surgical field employed for extraction of impacted tooth and management of external resorption

This case report illustrates determination of prognosis and immediate resection carried out, before completing the endodontic therapy, during the surgery employed for managing a nonperiodontal problem. This case showed external pressure resorption in the distobuccal root of maxillary second molar caused by the impingement of impacted third molar. Extraction of third molar was decided when healing was not seen, despite initiating endodontic therapy in second molar. Following elevation of flap and extraction of third molar, the poor prognosis due to severe bone loss around the resorbed root was evident. But due to strategic value of second molar, it was found beneficial to employ resection. Therefore, immediate resection was carried out in the same surgical field before the completion of endodontic therapy. This prevented the need for another surgical entry with its associated trauma to carry out resection separately later. Resection followed by the completion of endodontic therapy and full crown assisted in salvaging the remaining functional portion of the tooth and prevented the occurrence of distal extension with its potential drawbacks.

Biometric analysis of the maxillary permanent molar teeth and its relation to furcation involvement

A high rate of root exposure and consequently the exposure of the furcation area is usually observed in multirooted teeth. In maxillary molar teeth, this fact may endanger the three existent furcations (buccal, mesial and distal), causing serious problems. In this research, distance measures from the buccal furcation to the mesial (F1M) and distal (F1D) surfaces of the mesio-buccal and disto-buccal roots; from the mesial furcation to the buccal (F2B) and palatal (F2P) surfaces of the mesio-buccal and palatal roots and from the distal furcation to the buccal (F3B) and palatal (F3P) surfaces of the disto-buccal and palatal roots, respectively were established. One hundred maxillary first molar teeth were used, 50 of the right and 50 of the left side. Reference marks and demarcations were determined on the furcations and also on the root surfaces involved in the measures. We concluded that these measurements are important because they may effectivelly contribute to diagnosis, prevention and treatment of periodontal problems.

Morphological Measurements of Anatomic Landmarks in Human Maxillary and Mandibular Molar Pulp Chambers

The aim of this in vitro study was to measure critical morphology of molar pulp chambers. One hundred random human maxillary and mandibular molars (200 teeth in total) were used. Each molar was radiographed mesiodistally on a millimeter grid. Using a stereomicroscope, the measurements were read to the nearest 0.5 mm. Results were as follows (mean, mm): pulp chamber floor to furcation, maxillary = 3.05 +/- 0.79, mandibular = 2.96 +/- 0.78; pulp chamber ceiling to furcation, maxillary = 4.91 +/- 1.06, mandibular = 4.55 +/- 0.91; buccal cusp to furcation, maxillary = 11.15 +/- 1.21, mandibular = 10.90 +/- 1.21; buccal cusp to pulp chamber floor, maxillary = 8.08 +/- 0.88, mandibular = 7.95 +/- 0.79; buccal cusp to pulp chamber ceiling, maxillary = 6.24 +/- 0.88, mandibular = 6.36 +/- 0.93; and pulp chamber height, maxillary = 1.88 +/- 0.69, mandibular = 1.57 +/- 0.68. The pulp chamber ceiling was at the level of the cementoenamel junction in maxillary, 98%, and mandibular, 97% of the specimens. The measurements showing the lowest percentage variance were buccal cusp to furcation (approximately 11%) and buccal cusp to pulp chamber ceiling (approximately 14%). The measurements were similar for both maxillary and mandibular molars.

Treatment of molar furcation involvement using root separation and a crown and sleeve-coping telescopic denture. A longitudinal study

Because of the inconsistent results of periodontal and prosthetic therapy, periodontists may choose to treat maxillary molar furcation involvements (FI) with poor root morphology utilizing a root resection technique (RRT). In addition, poor root morphology of the remaining root following RRT is usually considered a high risk factor for long-term periodontal and prosthetic success. The purpose of this retrospective study was to investigate the differences in the clinical periodontal parameters between molar abutments with and without molar root separation and/or resection (RSR) before and after periodontal and prosthetic therapy, using a crown and sleeve-coping telescopic denture (CSCTD). A total of 85 molars (47 maxillary and 38 mandibular) were treated in 25 subjects. There were 33 abutments without root separation/resection and 52 abutments with RSR. Forty-three CSCTD were placed, 23 in the maxillary arch and 20 in the mandibular arch. The mean observation period was 6.7+/-1.9 years (range, 5 to 13 years). The plaque index, gingival index, probing depth, clinical attachment level, and alveolar bone change were recorded. The differences in these parameters before and after periodontal and prosthetic therapy between the advanced furcation-involved molars with and without RSR were evaluated. The results revealed a remarkable improvement in the periodontal parameters in advanced Class II and Class III FI in molars with RSR as compared to those without RSR. It was, therefore, concluded that molar abutments with RSR in conjunction with a specifically designed telescopic device provide a modified approach for treating molars with advanced Class II and III FI.

Pulp remains viable following vital amputation of the mesio-buccal root of the maxillary fourth premolar in dogs

Vital amputation of the mesio-buccal root of the maxillary fourth premolar (P4) was performed bilaterally in 8 dogs. Histopathologic evaluation of the tooth structure revealed normal pulp in the remaining mesio-buccal, mesio-palatal, and distal roots and crown during a mean follow-up period of 3.5 +/- 1.9 months. Amputation site healing was characterized by a reparative dentin bridge produced by odontoid cells. Tunnel defects were observed in 13 of 16 (81%) dentin bridges. It is concluded that the pulp of a tri-rooted, periodontal disease-free tooth remains viable during a 6-month period following vital root amputation. These results point to the intriguing possibility that this may also occur in humans, however, this needs to be directly tested in man.

A review of root resective therapy as a treatment option for maxillary molars

Restorative treatment planning is often confounded when periodontal attachment loss, caries or tooth fracture involves the furcation area of the tri-rooted maxillary molars. Although such involvement invariably diminishes the long-term prognosis of the affected teeth, extraction is not always an option. Root resective therapy, which removes the involved root plus its associated crown portion (trisection), is one of several treatment modalities that can be used in such cases. This article reviews the indications and contraindications for root resective therapy, describes the techniques of surgical trisection and presents a case in which combined resective, endodontic and prosthetic management resulted in a successful outcome.

Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The annual review of selected dental literature this year cites 384 published papers and reports. This year's review contains more editorial comment than reviews of years passed. New data on the biological responses to materials is emphasized in several sections. Observations on new compounds able to prevent plaque formation are presented. Clinically relevant advances in knowledge concerning the etching of different tooth structures are reported along with the effect of etching procedures on the dental pulp. Evaluation of periodontal diseases in all age groups is a topic. Limitations of current diagnostic techniques in periodontal disease, temporomandibular disorders, and implant therapy are included. There are new views on the use of dental amalgam. The future use of dental mercury is predicted. Interest in new ceramic systems is indicated as the demand for esthetics continues. Clinical information is emphasized over scientific information throughout this year's review.