The effect of tooth loss on the temporomandibular joint space: A CBCT study

OBJECTIVE

The tooth loss has a significant impact on the positioning of the condyle in the glenoid fossa and joint spaces of the temporomandibular joint (TMJ). The aim of this study was to assess the association between tooth loss and TMJ spaces using cone beam computed tomography (CBCT) images.

MATERIALS AND METHODS

This retrospective investigation involved the evaluation of CBCT images of the bilateral TMJs in a cohort of 111 individuals, comprising 68 males and 43 women. The dentition of the patients was categorized into three categories, including A (65.4%), B (19.1%), and C (16.4%), based on the Eichner index. Anterior, superior, and posterior joint spaces were then measured in sagittal views. The Kruskal-Wallis test and Mann-Whitney test were employed to identify significant differences among the three Eichner groups.

RESULTS

The findings of the present study suggested that there was no statistically significant variation in the anterior joint space among different Eichner groups within the general population (p = .781). Nevertheless, the superior and posterior joint spaces exhibited statistically significant alterations, as indicated by p-values of .039 and .010, respectively. It was detected that condyles were positioned inferiorly and posteriorly in group C when compared to groups A and B.

CONCLUSION

The present study indicated that greater loss of tooth-supporting zones is associated with posterior and inferior displacement of condyles. Understanding these relationships helps emphasize how crucial it is to replace missing teeth to enhance occlusion support and, in turn, stop the progression and further deterioration of temporomandibular disorders.

Association of Tooth Loss with Alzheimer's Disease Tau Pathologies Assessed by Positron Emission Tomography

BACKGROUND

Deterioration of the oral environment is one of the risk factors for dementia. A previous study of an Alzheimer's disease (AD) model mouse suggests that tooth loss induces denervation of the mesencephalic trigeminal nucleus and neuroinflammation, possibly leading to accelerated tau dissemination from the nearby locus coeruleus (LC).

OBJECTIVE

To elucidate the relevance of oral conditions and amyloid-β (Aβ) and tau pathologies in human participants.

METHODS

We examined the number of remaining teeth and the biofilm-gingival interface index in 24 AD-spectrum patients and 19 age-matched healthy controls (HCs). They also underwent positron emission tomography (PET) imaging of Aβ and tau with specific radiotracers, 11C-PiB and 18F-PM-PBB3, respectively. All AD-spectrum patients were Aβ-positive, and all HCs were Aβ-negative. We analyzed the correlation between the oral parameters and radiotracer retention.

RESULTS

No differences were found in oral conditions between the AD and HC groups. 11C-PiB retentions did not correlate with the oral indices in either group. In AD-spectrum patients, brain-wide, voxel-based image analysis highlighted several regions, including the LC and associated brainstem substructures, as areas where 18F-PM-PBB3 retentions negatively correlated with the remaining teeth and revealed the correlation of tau deposits in the LC (r = -0.479, p = 0.018) primarily with the hippocampal and neighboring areas. The tau deposition in none of the brain regions was associated with the periodontal status.

CONCLUSIONS

Our findings with previous preclinical evidence imply that tooth loss may enhance AD tau pathogenesis, promoting tau spreading from LC to the hippocampal formation.

The prospective association between periodontal disease and brain imaging outcomes: The Atherosclerosis Risk in Communities study

AIM

We investigate if periodontal disease is prospectively associated with cerebrovascular and neurodegenerative markers of dementia and Alzheimer's pathology.

MATERIALS AND METHODS

N = 1306 participants (Visit 5 mean age = 76.5 [standard deviation = 5.4] years) in the Atherosclerosis Risk in Communities study with completed dental exams at Visit 4 underwent brain magnetic resonance imaging scans at Visit 5 while N = 248 underwent positron emission tomography scans. Participants were classified as edentulous or, among the dentate, by the modified Periodontal Profile Class. Brain volumes were regressed on periodontal status in linear regressions. Cerebrovascular measures and β-amyloid positivity were regressed on periodontal status in logistic regressions.

RESULTS

Periodontal disease was not associated with brain volumes, microhaemorrhages, or elevated β-amyloid. Compared with periodontally healthy individuals, odds ratios [95% confidence interval] for all-type infarcts were 0.37 [0.20, 0.65] for severe tooth loss and 0.56 [0.31, 0.99] for edentulous participants.

CONCLUSIONS

Within the limitations of this study, periodontal disease was not associated with altered brain volumes, microhaemorrhages, or β-amyloid positivity. Tooth loss was associated with lower odds of cerebral infarcts.

Effects of unilateral posterior missing-teeth on the temporomandibular joint and the alignment of cervical atlas

Cervical atlas alignment changes are associated with craniofacial development. Disturbance of craniofacial development may be associated with temporal mandibular joint function. Therefore, we examined the possibility of a correlation between unilateral missing teeth and morphologic changes of the spine and posture. We collected eighty-nine patients (38 men and 51 women) with unilateral posterior missing teeth and twenty patients without previous orthodontic treatment or missing posterior teeth by tracing and analyzing their panoramic and cephalometric film. We measured the angulations of articular eminence, cranio-cervical angle, and the percentage of the occlusal plane passing through the first and second cervical vertebrae with other morphologic geometric data. The angle of articular eminence inclination was higher in the non-missing teeth group than the missing teeth group (46.66° and 42.28°, respectively). The cranio-cervical angle was smaller in the missing posterior teeth group than the non-missing posterior teeth group (99.81° and 103.27°, respectively). The missing teeth group also showed fewer occlusal planes passing through the intersection of the first and second cervical vertebrae compared to the non-missing teeth group (28.9% and 65%, respectively). Individuals with unilateral missing teeth had lower articular eminence inclination, smaller cranio-cervical angle, and a lower percentage of the occlusal plane passing through the intersection of the first and second cervical vertebrae.

Undesirable course of an oral implant rehabilitation in a patient with a long history of bulimia nervosa: case report and review of the literature

BACKGROUND

Bulimia nervosa is an eating disorder resulting in an intended weight loss due to decreased food intake, induced vomiting, or hyperactivity, and is observed frequently between 12 and 25 years of age. One of the complications is early tooth loss. Moreover, since bulimia nervosa patients suffer from increased atrophy of the alveolar processes, oral rehabilitation even with short dental implants may be impossible. In these cases, lateralization or transposition of the inferior alveolar nerve (IAN) followed by implant placement can be useful.

CASE PRESENTATION

A 40-year-old woman with a long-lasting history of bulimia nervosa requested a fixed rehabilitation of her partially edentulous mandible. In 2012, a bilateral IAN transposition approach was performed using piezosurgery, and without any postoperative neurosensory alterations. Two years later, bilateral insertion of each two implants was followed by an inflammatory destabilization of the lower left mandible; subsequent to the implant removal, a fracture occurred, and the latter was stabilized by osteosynthesis plates. In 2017, three additional implants were placed, finally providing the patient with a fixed restoration on five implants.

CONCLUSION

Eating disorders may have a tremendous impact on both physical condition and oral health, resulting in early tooth loss and severe bone atrophy. IAN transposition is a viable treatment option to enable installing fixed prostheses via dental implants, but the latter will clearly increase the risk of inflammation and interruption of mandibular continuity. Close clinical and radiologic monitoring is mandatory to adequately respond to complications such as peri-implant mucositis, peri-implantitis, osteomyelitis, or concomitant fractures.

Prosthetically Driven Computer-Guided Implant Placement and Restoration Using CEREC: A Case Report

Developments in 3-dimentional (3D) diagnostic technology and advanced digital optical imaging have improved the predictability, safety, and efficiency of restoratively driven implant dentistry. Surgical procedures may now be performed in a single visit utilizing chairside, computer-aided design/computer-aided manufacturing technology and in situations when a two-stage implant protocol is indicated as demonstrated in this case. The CEREC® GALILEOS® integration workflow system was used to prosthetically plan and place an implant in the lower right mandibular first molar site, No. 30, which had been previously grafted following tooth extraction. Preoperative planning was performed, taking into consideration all anatomic landmarks, current tissue status, and restorative needs while incorporating cone-beam computed tomography data to design and mill a stable, tooth-supported surgical guide (CEREC Guide 2.0). After placement and subsequent osseointegration, the implant was restored chairside in a pre-doctoral treatment center. The Sirona TiBase system and VITA ENAMIC® IS block were used to produce an esthetically pleasing and clinically excellent screw-retained implant crown.

Radiographic Assessment of Dental Health in Middle-aged Men Following Sudden Cardiac Death

Poor oral health has been suggested to be a risk factor for myocardial infarction. To study if dental pathology might predispose to pre-hospital sudden cardiac death, and using a sum index of panoramic tomography findings, we compared the oral health of middle-aged (33–69 yrs) male victims (Helsinki Sudden Death Study) of sudden cardiac death (n = 117) with that of controls, who died of non-cardiac diseases (n = 63) or suffered unnatural sudden death (n = 120). The mean number of teeth was 15.2, and 17.4% of the men were edentulous. Frequent age-associated findings in dentate victims were fillings (79.9%), horizontal bone loss (72.1%), periapical lesions (45.6%), residual roots (38.2%), and vertical pockets (30.9%). In multivariate analysis with coronary heart disease risk factors and number of teeth as covariates, poor oral health was associated (p = 0.053) with the risk of sudden cardiac death along with age, smoking, and body mass index. This association was especially strong (p = 0.009) among victims < 50 yrs.

3D reconstruction images of cone beam computed tomography in dental medicine application: A case study and mini-review

Dental cone beam computed tomography (CBCT) is a new approach in diagnosis and predication of various dental diseases, including trauma, congenital defects, tumors and inflammatory. In this study, we reported the outcome of CBCT for a complicated case of malocclusion, accompanied with tooth loss and periodontitis. A combined application of CBCT with 3D-static images and rotated reconstruction images is reviewed as a systematic model in diagnosis, treatment and progonsis of a complex malocclusion.

Preoperative radiological evaluation of missing single teeth: A review

AIMS

Missing single teeth can be treated in several ways and preoperative radiological evaluation varies accordingly. The main area of controversy relates to the need for cross-sectional imaging in the context of implant treatment. In this context, the aim of the systematic component of this review was to determine whether the use of additional cross-sectional imaging has any impact on diagnostic thinking, treatment planning or outcome, compared with conventional imaging alone. An additional aim was to present information relating to diagnostic efficacy, dose of radiation, economic aspects of imaging and selection criteria.

MATERIALS AND METHODS

PubMed/MEDLINE, OVID/Embase and the Cochrane central register of controlled trials were searched up to and including June 2015. Studies were eligible for inclusion if they compared the impact of conventional and cross-sectional imaging when placing implants. Quality assessment of studies was performed. Synthesis was qualitative.

RESULTS

Twelve studies were included, all of which had a 'before-after' design. Only three of these were limited to single implant treatments with none limited to immediate implants. There were methodological problems with most of the studies and results were sometimes contradictory regarding the impact of cross-sectional imaging.

CONCLUSIONS

It is tentatively suggested that cross-sectional imaging may not be required in straightforward, unchallenging, cases of missing single teeth being considered for implant treatment. Beyond this, no strong evidence exists to inform the choice of imaging. Existing guidelines on preoperative imaging for missing single teeth are not unanimous in their recommendations, either for implant or non-implant treatments.

Clinical assessment of non carious cervical lesion using swept-source optical coherence tomography

Non-carious cervical lesions (NCCLs) involve various forms of tooth loss with different etiologies. This study aimed to utilize swept-source optical coherence tomography (SS-OCT) at 1300 nm wavelength range in vitro and in vivo to evaluate and clarify the mechanism of NCCLs. In the in vitro phase, a dentin attenuation coefficient (μt ) derived from the SS-OCT signal at NCCL was compared with mineral loss obtained from transverse microradiography (TMR) to determine a μt threshold to discriminate demineralization of cervical dentin in vivo. In the clinical study, 242 buccal surfaces were investigated in 35 subjects. Presence and dimensions of NCCLs, cervical cracking and the degree of demineralization at the exposed cervical dentin were determined using SS-OCT. Dentin demineralization was observed in 69% of NCCLs. SS-OCT results confirm that dentin mineral loss and occlusal attrition were associated with larger NCCLs, and can be considered as an etiological factor in formation and progress of these lesions. (A) We determined the attenuation coeffcient (μt ) threshold of SS-OCT signal for the detection of demineralization (1.21) from in vitro study. DEM: demineralized dentin, sound: sound dentin. (B) Using the μt threshold, we observed NCCLs in vivo to detect the demineralization in cervical dentin. SS-OCT scanning was performed along the red line. (C) SS-OCT image obtained along the red line in B. In SS-OCT, brightness of dentin beneath the NCCL was increased (arrow) compared with intact zone. The cervical dentin was slightly demineralized (μt : 1.25). e: enamel, d: dentin, g: gingiva.

Influence of unilateral tooth loss in the temporomandibular joint and masseter muscle of rabbits

OBJECTIVE

The purpose of this study was to evaluate the influence of the masticatory system in patients with missing teeth.

STUDY DESIGN

The influence of tooth loss on the masticatory system was analyzed with the use of bone scintigraphy ((99m)Tc-MDP) and histochemistry. Eight white rabbits (New Zealand, 12 weeks old) were used. The rabbits were divided into 2 groups: 6 weeks and 12 weeks. Teeth were extracted unilaterally in each rabbit under general anesthesia. Six and 12 weeks after extraction, scintigraphy was conducted, and the rabbits were killed and their masseter muscles removed for histochemical analysis.

RESULTS

The results of bone metabolism (relative ratio) measured by bone scintigraphy were 48.27% at extraction sites and 51.73% at nonextraction sites at 6 weeks and 39.96% at extraction sites and 60.04% at nonextraction sites at 12 weeks. There was a significant difference at 12 weeks (P < .05). Tissue calcium contents and osteoclast counts showed different results between the extraction and nonextraction sites, but these differences did not reach statistical significance.

CONCLUSIONS

The bone metabolism of temporomandibular joints and histochemical aspects of masticatory muscles may be associated with occlusal alterations following tooth loss.

[Clinical opportunities of 3D-modeling for implant treatment planning for the patients with full or partly adentia in difficult anatomo-topographic conditions]

The message is about dental rehabilitation in difficult anatomo-topographic conditions of full adentia and high-grade atrophy of alveolar processes. The more high quality level decision of this problem using the methods of 3D-computer modeling during the diagnostic examination and planning of dental implantation is proposed.

The effect of image content on detail preservation and file size reduction in lossy compression

OBJECTIVES

To demonstrate the effect of image content on image detail preservation and file size reduction.

METHODS

The first set, containing 16 in vitro images with variable projection geometry, exposure time, bone level and number of teeth, was compressed with three compression modes: JPEG quality factor (JPQF), JPEG2000 quality factor (J2QF) and JPEG2000 compression ratio (J2CR). Image detail degradation was evaluated by local mean square error (MSE) on a standardized region of interest (ROI), containing bone. The second set, containing 105 clinical bitewings, was compressed with the same compression modes at 3 quality factors/compression ratios and local MSEs were calculated on two ROIs, containing bone and crown.

RESULTS

For the first image set, nearly constant MSE was found for the JPQF and J2QF compression modes, while file size depended on projection geometry, exposure time, bone level and the number of teeth. In contrast, file size reduction was nearly constant for the J2CR compression mode, while MSE depended on the abovementioned factors. Similarly, for the second image set, nearly constant MSE and variation of file size reduction were found for JPQF and J2QF but not for the J2CR compression mode. All of these results were consistent for all three quality factors/compression ratios.

CONCLUSIONS

Constant image detail preservation, crucial for diagnostic accuracy in radiology, can only be assured in QF compression mode in which the file size of the compressed image depends on the original image content. CR compression mode assures constant file size reduction, but image detail preservation depends on image content.

Prognosis for Abutment Teeth of Removable Dentures: A Retrospective Study

PURPOSE

This retrospective study evaluates the clinical success of conical crown-retained removable dentures.

MATERIALS AND METHODS

Ninety-seven patients were treated with 97 dentures at the University of Frankfurt, Department of Prosthodontics, between 1993 and 2000. The average observation period was 4.9 +/- 2.8 years. The dentures were supported by 445 natural abutment teeth. To evaluate the long-term success of the restorations, the variables abutment loss, tooth mobility, mean probing depths, and radiological bone loss were used. Data were obtained by one clinical examiner at baseline, by systematic evaluation of patient records, and at clinical re-examinations. Survival-time methods were used to analyze time-to-event data. Specifically, the Cox model with frailty term was applied to account for correlations between intra-patient survival data. Thirty abutment teeth had to be extracted during the observation period.

RESULTS

Statistical analysis showed no significant effects of the variables tooth mobility (p= 0.42), mean probing depths (p= 0.23), and radiological bone loss (p= 0.59) on the time to tooth extraction. For the non-extracted abutment teeth significant changes during time for the variables tooth mobility (p < 0.0001) and radiological bone loss (p= 0.0240) were observed.

CONCLUSION

Removable partial dentures retained by conical crowns have a favorable clinical prognosis.

Interaction of obesity and skeletal bone mineral density in tooth retention in Japanese postmenopausal women

OBJECTIVE

To investigate whether being overweight is associated with increased or decreased risk of tooth loss in Japanese postmenopausal women.

DESIGN

The number of remaining teeth (total, anterior, and posterior teeth), mandibular bone height, and mandibular cortical mass were evaluated on the dental panoramic radiographs of 450 Japanese postmenopausal women. The bone mineral densities (BMDs) at the lumbar spine and femoral neck were measured by dual-energy x-ray absorptiometry. These measurements were compared among participants in three body mass index (BMI) categories (underweight, normal BMI, and overweight).

RESULTS

Analysis of covariance adjusted for confounding variables revealed that participants who were overweight had a significantly lower number of total (P = 0.019) and anterior (P = 0.012) remaining teeth than did those with normal BMI, although the former had significantly higher skeletal BMD values than the latter. No significant difference was observed in mandibular bone height between the overweight participants and those with normal BMI. There were no significant differences in the number of remaining teeth between the under- and overweight participants. Overweight participants had significantly higher skeletal BMDs (P < 0.001) and tended to have larger mandibular cortical masses than those who were underweight.

CONCLUSIONS

Despite their higher skeletal BMD, postmenopausal women who are overweight may have an increased risk of tooth loss, especially of the anterior teeth, compared with women who have normal BMI. This risk appears to be similar to that for underweight women.

The potential prognostic value of some periodontal factors for tooth loss: a retrospective multilevel analysis on periodontal patients treated and maintained over 10 years

BACKGROUND

The great challenge in clinical periodontology is assigning a prognosis to a periodontally affected patient. Many different factors can affect the long-term maintenance of periodontally compromised teeth. The main questions usually considered by the periodontist are: 1) Will a tooth lose more bone in the future? 2) Will the tooth itself be lost in the future? The purpose of this retrospective study was to evaluate the value of some clinical, genetic, and radiographic variables in predicting tooth loss in periodontal patients (aged 40 to 60 years) treated and maintained for 10 years.

METHODS

Sixty consecutive non-smoking patients (aged 46.77 +/- 4.96 years) with moderate to severe chronic periodontitis (CP) were treated with scaling and root planing (SRP). Some patients also underwent additional surgical treatments. All patients were maintained in the same private practice for 10 years. The frequency of recall appointments was 3.4 +/- 1.0 months. At baseline (T(0)) and 10 years later (T(2)) the following clinical variables were evaluated: the number of teeth, probing depths (PD), tooth mobility (TM), and presence of prosthetic restorations (PR). In addition, radiographic measurements were taken of the mesial and distal distances from the cemento-enamel junction (CEJ) to the bottom of the defect (BD), to the bone crest (BC), and to the root apex (RA). At T(2), a genetic test to determine the IL-1 genotype and genetic susceptibility for severe periodontal disease was performed for all 60 patients, and they were classified as IL-1 genotype positive (G+) or negative (G-) according to the test results. Tooth loss was used as the outcome variable. Different predictor variables were then tested using a two-level statistical model (patient and tooth levels). At the patient level, these were: age, gender, mean bone loss (mean CEJ-BD)(T0), the interleukin-1 (IL-1) genotype, the interaction between mean bone loss, and IL-1 genotype (mean CEJ-BD(T0) x IL-1 genotype). At the tooth level, the variables were: TM(T0), prosthetic restorations (PR)(T0), molar teeth (MT)(T0), the infrabony component of the defect (BC-BD)(T0), PD(T0), bone level (CEJ-BD)(T0), and residual supporting bone (BD-RA)(T0).

RESULTS

Among the considered predictor variables, the following were significantly associated with the outcome variable: 1) MT(T0) (P <0.0001); 2) BC-BD(T0) (P = 0.0377); and 3) BD-RA(T0) (P <0.0001). MT(T0) were found to be more prone to loss and the amount of BD-RA(T0) prognostic for tooth loss: the lower the residual amount of supporting bone, the higher the probability of tooth loss. Conversely, the BC-BD(T0)was associated with a reduced probability of future tooth loss: the greater the infrabony component, the lower the probability of tooth loss. None of the other considered predictors proved predictive for tooth loss.

CONCLUSIONS

Within the scope of this study, many traditional prognostic factors were ineffective in predicting future tooth loss and, therefore, were of no prognostic value. Conversely, a few specific factors at the tooth level emerged as viable prognostic factors. The use of these factors may be of great value to practitioners as predictors of tooth loss when assigning a prognosis.

Prognostic model for tooth survival in patients treated for periodontitis

BACKGROUND

In patients with periodontitis, a quantitative prognostic assessment is needed in order to make evidence-based decisions about retaining teeth or extracting and replacing them with a dental prosthesis.

METHODS

One hundred and ninety eight patients receiving active periodontal treatment in 1989 or 1990 and complying with supportive periodontal therapy (SPT) over an average of 11.8+/-2.3 years were included in the study. A generalized linear model was established and fitted via generalized estimating equations to identify predictors for tooth loss during SPT.

RESULTS

Of the 4559 teeth present at baseline, 166 (3.6%) were extracted during active treatment and 249 (5.5%) during SPT. Baseline findings of diabetes mellitus (OR=4.17), reduced alveolar bone levels (OR=1.04 for each 1% increment), increased tooth mobility (III versus 0: OR=5.52), multiple roots (OR=1.82), and non-vital pulp (OR=2.24) were significant (p<0.05) predictors for tooth loss during SPT. Based on these parameters, a prognostic model was constructed that provides estimates of tooth survival probability when periodontal therapy is rendered.

CONCLUSION

Using a multivariate approach, a prognostic model was developed that may be of value for clinical decision making.

[Bidirectional and unidirectional distraction of defects of the alveolar process comparative clinical study]

AIM

The purpose of the retrospective study was to compare bidirectional distraction osteogenesis with the currently used unidirectional method of alveolar ridge distraction with regard to bone height attained and complications.

PATIENTS AND METHODS

Overall 21 patients were treated by distraction osteogenesis for localized defects of the alveolar ridge. Vertical augmentation of the mandible and maxilla was performed using 10 unidirectional (group A) and 12 bidirectional (group B) devices. The effect of therapy was evaluated by height of bone gain and observed complications.

RESULTS

The average gain of vertical bone height was approximately 6 mm. No statistically significant differences occurred between the two treatment groups (p=0.09). For the entire study two complications were observed: beside breakage of a distractor device (unidirectional distraction) an infection during the retention time (bidirectional distraction) developed.

CONCLUSIONS

It could be shown that osteodistraction is a potentially valuable therapy for the correction of alveolar defects. We observed complications in both groups. No statistical differences were noted in regard to gained bone height and complications between the two groups.

The differences in panoramic mandibular indices and fractal dimension between patients with and without spinal osteoporosis

OBJECTIVES

The aims of this study were to evaluate the relationship between osteoporosis, oral signs, body mass index and age; and to assess the possibility of using these parameters as an indicator of post-menopausal osteoporosis. The oral signs were panoramic-based mandibular indices, such as cortical width, cortical index, panoramic mandibular index and mandibular crest resorption degree; the number of teeth and fractal dimension analysis.

METHODS

Forty-eight post-menopausal women between the ages of 40 years and 64 years were evaluated. Mandibular indices and the number of mandibular teeth were measured and evaluated from panoramic radiographs and fractal dimension was calculated from the direct digital periapical radiographs of the mandibular premolar-molar region in box-counting method. Weight, height, menopausal status and age of the patients were recorded by questionnaire. Bone mineral densities of the patients were measured with dual energy X-ray absorptiometry.

RESULTS

In this study there were no statistically significant differences between the osteoporotic and non-osteoporotic patients for cortical width, panoramic mandibular index, alveolar crest resorption degree, fractal dimension and the number of mandibular teeth, but there was a difference for cortical index. Binary logistic regression analyses demonstrated that age (P = 0.015) was an important risk factor for osteoporosis.

CONCLUSION

The results of this study demonstrated that osteoporotic patients were more likely to have altered inferior cortex morphology than non-osteoporotic patients and age is an important risk factor for osteoporosis.

Premature loss of primary teeth associated with congenital syphilis: a case report

Congenital syphilis is an infectious disease transmitted by an infected mother to her fetus. Several reports in the literature have focused on oral manifestations of congenital syphilis, mainly about Hutchinson's teeth and dysplastic molars, which are more common. However, this paper describes an unusual feature of congenital syphilis in a four-year-old child. A case of premature loss of primary teeth associated with congenital syphilis is reported.

Periodontal Status in Two Siblings With Severe Congenital Neutropenia: Diagnosis and Mutational Analysis of the Cases

BACKGROUND

Severe congenital neutropenia (SCN), also known as Kostmann syndrome, was originally reported as an autosomal recessive disease of neutrophil production. The disease is characterized by a maturation arrest of neutrophil precursors at the promyelocytic stage of differentiation and by extremely low levels of mature neutrophils in peripheral blood.

METHODS

A 6-year-old male presented with a complaint of gingival swelling and bleeding, and swelling at the left side of his face. Upon clinical examination, severe inflammation of all gingival tissues was apparent, and a periapical abscess with mobility was noted on the left mandibular second molar. Medical and dental histories revealed numerous recurrent bacterial infections associated with oral and non-oral tissues. His medical history with recurrent infections led us to evaluate his 3-year-old sister to determine the status of her oral health. Inflammation of her oral tissues and recurrent bacterial infections were apparent. Their consanguineous parents were in good health. To assist in identifying possible systemic diseases underlying the inflammatory situation in the siblings, consultations were requested from the Pediatric Hematology Department at Selcuk University and Pediatric Oncology Department at Gulhane Military Medical Academy.

RESULTS

Based on absolute neutrophil count (< or =200/mm(3)) and bone marrow aspiration findings consistent with early maturation arrest in myelopoiesis, the cases were diagnosed as SCN. No chromosomal abnormality was detected upon cytogenetic examination. Sequencing analysis also revealed no mutation in the neutrophil elastase or growth factor independent-1 (GFI-1) genes in these patients. Severe periodontal disease, attachment loss, and mobility for over 50% of the deciduous teeth were noted. Within 6 months, the male sibling lost all of his deciduous teeth due to periapical and periodontal infections. His sister presented with tooth mobility for all mandibular incisors. Monthly visits, including scaling, polishing, and 0.2% chlorhexidine digluconate irrigation were performed to support their oral hygiene and to avoid recurrent oral infections. We have been able to stabilize these patients' periodontal conditions during a 2-year follow-up period.

CONCLUSION

This case report emphasizes the role of periodontists and pediatric dentists in the diagnosis of diseases linked with neutrophil and other systemic disorders and highlights the need to optimize the health of oral tissues with regular appointments.

[Following tooth loss: fixed partial denture or implant?]

Zur Rekonstruktion der Einzelzahnlücke stehen heute die konventionelle Brückenversorgung und die implantatgetragene Krone im Vordergrund. Während die Brücke an den Nachbarzähnen verankert werden muss, stellt das Implantat eine Einzelversorgung dar. Die entscheidenden Faktoren für die adäquate Therapiewahl sind neben dem Patientenwunsch und der Bereitschaft evtl. erforderliche Vorbehandlungen durchführen zu lassen vor allem die Situation der Nachbarzähne, das vorhandene Knochenangebot und die Platzverhältnisse unter Berücksichtigung der anatomischen Nachbarstrukturen.

Transplantation of a lower bicuspid after traumatic loss of three upper incisors

BACKGROUND

Prosthodontic and orthodontic procedures have been described for the treatment of patients with traumatic loss of teeth.

PATIENT AND METHODS

Both upper central incisors and the upper right lateral incisor had to be extracted in an 8-year-old patient after failure of conservative procedures following a sports accident. The patient was treated on a temporary basis with a space retainer as a substitute for the teeth. Definitive therapy was carried out by transplanting a lower bicuspid germ into the upper arch with subsequent orthodontic gap closure.

RESULTS

8 years after the intervention, the transplanted tooth is still in place. The patient is fully rehabilitated both functionally and esthetically with no discomfort.

CONCLUSIONS

The transplantation of bicuspid germs in conjunction with orthodontic gap closure is a valuable alternative to prosthodontic treatment, particularly in the case of loss or aplasia of several teeth.

Oral manifestations of congenital neutropenia or Kostmann syndrome

Infantile congenital agranulocytosis or Kostmann syndrome is a rare hereditary kind of severe neutropenia. The typical symptoms, which appear since the first days of life, are abscesses located on various parts of the body: ear, cutis, lung and oral cavity. These abscesses are due to an almost total disimmunity typical of the neutropenia. The aim of this article is to describe the most typical signs of this pathology in the oral cavity, reporting a case observed in our department in Florence, Italy. On the basis of the personally observed case and of the review of the literature, it is possible to consider, as a characteristic finding in Kostmann syndrome, a typical very serious periodontal pathology, which is similar to the prepubertal periodontitis in deciduous dentition. At the age of 19 years the patient showed a dramatic compromise of the masticatory function. It is obvious that the lack of response of the host can obstruct the interaction between the host and the microbic flora, because the lack of neutrophils increases the susceptibility of the patient to every kind of infection, even to periodontitis. A periodontal prophylaxis, since the very first observations, followed by a rigorous maintenance with frequent and regular professional hygienic treatments could be effective in controlling the effects of periodontal disease and could reduce the tragic evolution. We need to recognise that it could be hard to monitor the oral situation correctly in these patients, as they have a continuously poor systemic condition. Finally in these cases the rehabilitative therapy is very problematical.

Dental diseases and loss of teeth in a group of Finnish alcoholics: a radiological study

A total of 85 Finnish alcohol-dependent subjects and 53 controls were studied with panoramic radiography. The aim was to study the possible associations between prolonged alcohol consumption and dental health. The mean number of teeth, caries lesions, endodontic treatments, periapical lesions, marginal bone loss, and periodontal infrabony pockets was studied. The subjects met the diagnostic criteria of alcohol dependence as set out in DSM-IV and ICD-10. The control group comprised social drinking volunteers with an AUDIT score < or =8. For the final results the subjects were divided into groups on the basis of sex and age. The social backgrounds of the subjects were similar, except for employment and smoking. The results show significantly fewer teeth and more caries in the alcoholic group. There was a tendency for the alcoholics <45 years of age to have more endodontically treated teeth than the controls, but no difference in the number of periapical lesions in endodontically treated teeth was found. Horizontal bone loss and the presence of calculus were more frequent in alcoholic men than in alcoholic women. Significantly more horizontal bone loss was observed in the group of alcoholic nonsmokers than in nonalcoholic nonsmokers. In the nonsmoking groups alcoholics had significantly more periodontal destruction than the nonsmoking controls. We conclude that radiological dental health among individuals dependent on alcohol is weakened by more caries, more horizontal bone loss, and more numerous vertical infrabony pockets than social drinkers.

Longitudinal radiological study of the oral health parameters in an elderly Finnish population

In the oldest elderly, an increase in the number of remaining teeth may increase oral infection foci. The aim of this follow-up study was to examine the radiologically detected oral health condition of a group of home-living elderly in Helsinki at 5-year intervals. The population of this study comprised 103 home-living elderly people, all participants of the population-based Helsinki Aging Study. Panoramic radiography supplemented by intraoral radiographs was performed on all these participants at the Institute of Dentistry, University of Helsinki, in 1990-1991. Follow-up radiographic examination was completed in 1995-1996. Mean number of teeth decreased during the follow-up period from 13.2 +/- 9.0 to 12.5 +/- 9.2 (P= 0.0001). Mean number of teeth with periapical lesions decreased in men from 1.3 +/- 1.4 to 0.6 +/- 0.9 (P = 0.007), but no differences in number of teeth with periapical findings were observed in women. There were relatively few changes in the subjects' radiographic periodontal findings. However, fewer teeth with vertical bone pockets >1-3 mm deep were found in the follow-up study than 5 years earlier (0.6 +/- 1.2 vs 1.1 +/- 1.8; P= 0.0008). In both the baseline and the follow-up studies the radiographic findings occurred in the subjects who had retained more natural teeth. In the follow-up study, 68% of the subjects had radiographically detected signs of chronic oral infection foci. It may be concluded that radiographically detected oral health parameters remain relatively unchanged, but treatment need is higher among those who have successfully retained their natural dentition into old age.

Variation in the apparent density of human mandibular bone with age and dental status

This study examines the variability in the anatomy of mandibles of differing ages and different stages of tooth loss. Mandibles from individuals between 19 and 96 y were sectioned into 2 mm thick vertical plane-parallel slices and cleaned of marrow and periosteum. The apparent density (mass per unit volume in g/ml) from midline (MID) and mental foramen region (MF) sites was determined by weighing the slices and dividing by a volume calculated as the product of section thickness and the mean area of the 2 sides of the section. The cortical thickness of the inferior border and the basal and alveolar bone heights were measured in radiographs of the slices. Mandibular apparent density was negatively correlated with the cross sectional area (midline r=-0.48, mental foramen r=-0.45), and at the midline was significantly greater in edentulous than in dentate individuals (means (+/-S.E.M.) edentulous n=13: 1.43 (+/-0.07) g/ml; dentate n=17: 1.27 (+/-0.04) g/ml, P < 0.05). Where a large enough age range was available, mandibular apparent bone density showed a significant increase with age (midline males: r=0.53, n=18) especially for dentate individuals (r=0.91, n=8). There was a correlation between the apparent densities at the two sites in the same mandible (r=0.64), with the values obtained for the midline being significantly greater than for the mental foramen region (midline 1.34 (+/-0.04) g/ml; mental foramen 1.19 (+/-0.04) g/ml, P < 0.001, paired t test). The mandible shows great interindividual variability, but there may be a considerable reduction in cross sectional girth of the mandible following tooth loss, and, unlike postcranial sites, an increase in apparent density with age.

Radiography of spontaneous periodontitis in dogs

The pattern and distribution of periodontitis were investigated in 162 randomly selected dogs available for necropsy in veterinary practice. There were 82 males and 80 females of 50 different breeds (150 dogs were pure-bred and 12 were mongrels, aged between 7 months and 14 yr. Presence of periodontitis was determined by assessment of alveolar bone loss on radiographs of the skulls and jaws. Periodontitis occurred frequently with increasing age, although the prevalence varied markedly among and within different breeds. Of the breeds most represented in the sample, periodontitis was most frequently seen in poodles and dachshunds but was rarely recognized in German shepherd dogs. Regardless of age, the vast majority of the dogs displayed either one or both of two different radiographic patterns of alveolar bone loss. One pattern was characterized by slight, horizontal alveolar bone loss involving interradicular and interdental areas. The other pattern was one of predominantly crater-like, or narrow, vertical bone defects which, when advanced, often extended around a single root or tooth to surround the root apices. The two types of patterns did not seem to be breed-dependent. The posterior maxillary and mandibular premolars and molars were the most frequently affected teeth. Alveolar bone loss was most severe in the maxilla, while corresponding bone loss in the mandible was more often related to increasing age.

[Auto-transplantation of tooth germs. Discussion and presentation of 3 treated cases]

The authors examine the theoretical possibilities of human dental transplants: autologous, homologous and heterologous. They, then discuss-with reference to autologous transplants-an autotransplant as an alternative to prosthodontic treatment. This would apply both to traditional prosthodontic treatment and on implants or orthodontic treatment aiming at filling dental gaps. They show both general and local counterindications against this operational method the knowledge of which is necessary for an adequate selection of patients. They stress the determining factors for a successful autotransplant: 1) particular care with the choice of the germ to be transplanted taking into account its morphology and the stage of root development; 2) adequate surgical preparation of the receiving site in relation to the size of the germ to be transplanted; 3) suitable surgical technique entailing a particular care in the manipulation of soft and hard tissues and of the germ and appropriate conditions of sterilization; 4) use of appropriate retention means to ensure stability of the transplanted germ so as to favour cellular proliferation and reduce osteoclastic activity; 5) reduction of occlusal pressure on the transplanted germ. The authors describe for example's sake 3 out of 32 cases treated with the documentation of the achieved long-term success. They also analyse the possible causes of failure of such operational method (careless manipulation of the germ, incorrect surgical technique, removal of the germ in a too early stage of its development, too long exposure of the germ outside the oral cavity, poor oral hygiene, caries, periodontal disease, occlusal trauma.

Prognosis and mortality of root-resected molars

The purpose of the present study was to compare tooth mortality of root-resected molars with that of root-filled, single-rooted teeth. Survival rates were 68% for root-resected molars and 77% for root-filled single-rooted teeth over a 10-year period. This difference was not statistically significant. Ten-year survival of root-resected molars in patients with radiographic attachment loss in single-rooted teeth of greater than 6 mm was 56% while survival was as high as 89% for root-resected molar patients with radiographic attachment loss in single-rooted teeth less than or equal to 6 mm. In conclusion, the prognosis of root-resection is not poorer than the prognosis of single-rooted teeth with an equal susceptibility to periodontitis, if endodontic conditions and maintenance care are optimal.

Missing front teeth in exile Tamils--an unresolved phenomenon

In the period from 1986 to 1995, the Department of Public Health in Wuppertal conducted an examination of 263 patients who had come from Sri Lanka as refugees and applied for political asylum in the Federal Republic of Germany. Isolated front tooth gaps were observed in more than 60% of the patients, an incidence significantly higher than in a control group of asylum seekers from countries other than Sri Lanka, and much higher than the incidence of traumatic tooth loss reported in the literature. The aetiology of this tooth loss remains largely unresolved. The bulk of the medical histories given by the patients did not correspond with the clinical and X-ray evidence gathered. Since medical and dental causes for the loss of the teeth can be excluded, one must ask whether social, cultural or religious causes are responsible.

Radiographic findings in cats with intranasal neoplasia or chronic rhinitis: 29 cases (1982-1988)

OBJECTIVE

To compare radiographic findings and determine useful criteria to differentiate between intranasal neoplasia and chronic rhinitis in cats.

DESIGN

Retrospective study.

ANIMALS

Cats with chronic nasal disease caused by neoplasia (n = 18) or by chronic rhinitis (n = 11).

PROCEDURE

Radiographs were reviewed by 3 radiologists, followed by group review. Diagnosis was determined by intranasal biopsy or necropsy, and specimens were reviewed by a pathologist to confirm cause and histologic diagnosis.

RESULTS

Lymphosarcoma was the most common (n = 5) of the 6 histopathologic types in the neoplasia group. Cats in the neoplasia and chronic rhinitis groups had a high prevalence of aggressive radiographic lesions. Prevalence of a facial mass in cats with neoplasia (8/18) versus in those with chronic rhinitis (4/11) and of deviation (9/18 vs 6/11, respectively) or lysis (12/18 vs 7/11) of the nasal septum was similar. However, significantly (P = 0.02) more cats with neoplasia than with chronic rhinitis (13/16 vs 3/7, respectively) had unilateral turbinate destruction/lysis. Additionally, unilateral lateral bone erosion and loss of teeth associated with adjacent intranasal disease were more prevalent in cats with neoplasia (7/8 and 5/18, respectively) than in cats with chronic rhinitis (1/3 and 0/11, respectively).

CLINICAL IMPLICATIONS

Features that may assist in radiographic diagnosis of neoplasia include the appearance of unilateral aggressive lesions, such as lysis of lateral bones, nasal turbinate destruction, and loss of teeth. Bilaterally symmetric lesions are more suggestive of chronic rhinitis than of neoplasia.

Orthopantomography and INAIL assessment of dental injury. Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro

The protection of workers' health is defended by the Italian Constitution, and sees its most extensive application in the work of the INAIL (Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro-National Institute for Assurance against Work-related Accidents). In the T.U. (Testo Unico-Complete Text of Legislation) 1124/1965, dental injury is compensated with fixed percentages for permanent impairment, depending on whether the prosthesis applied is effectual or otherwise. The INAIL's primary task of assigning the necessary treatment and recovering the claimant's occupational aptitude requires that it meets in full the cost of his dental rehabilitation. In Turin in 1981 a systematic procedure was set up for the provision and monitoring of the dental treatment received by the injured person. Legislation relating to prostheses has further widened the scope of dental treatment. To deal correctly with the legal medicine aspects of dental rehabilitation, the authors illustrate a working procedure which is based on the reading of radiological evidence in order to determine the prior situation, extent of injury, results of the treatment and evaluation of residual permanent injury.

Radiological findings in edentulous Kenyan patients

Seven hundred and seventy five files of edentulous patients seen at the Department of Dental Surgery, University of Nairobi were scrutinized for the presence or absence of routine radiographs prior to treatment. 180 (23.2%) had radiographs. 26% of the radiographs had 51 positive radiological findings. 17.3% were roots, 3.9% were unerupted teeth, 6.7% were radiopacities and 0.6% were radiolucencies. 52.9% of the radiological findings were in the mandible and 47.1% were in the maxilla. In the mandible, 44.4% of the radiological findings were in the anterior region and 55.6% were found posteriorly. 66.7% of the maxillary radiological findings were in the anterior region and 33.3% were found posteriorly. Since some of the positive radiological findings such as the retained roots and unerupted teeth might lead to infection, cysts or poor dentures fit, it is recommended that whenever possible, all edentulous patients be examined radiographically prior to treatment.

Intrusion of an incisor tooth into the contralateral frontal sinus following trauma

Although intrusions of glass fragments into the frontal sinuses are not uncommon in traffic accidents, a case with a tooth in the frontal sinus has never been reported. We report a patient with traumatic inclusion of an incisor tooth in the contralateral frontal sinus. Radiographic investigations demonstrated the tooth in the frontal sinus though no skin damage was recognized on the upper face. The usefulness of CT scan in localizing the missing tooth after facial trauma and its route of entry into the contralateral frontal sinus is discussed.

A radiographic study of dental health in adult patients with dental anxiety

The objective of this study was to compare the dental health in a group of 90 patients with severe dental fear (FP), aged 20-41, with that of a matched control group of ordinary dental patients (OP). All registrations were made from radiographic intraoral full mouth surveys. Mean number of missing teeth among FP and OP patients was 4.4 and 2.5, respectively. On average, FP patients had 19.5 decayed surfaces compared to 7.9 in OP patients. Mean number of filled surfaces was 13.1 and 8.1 in OP and FP patients, respectively. FP patients, on average, had significantly more periradicular bone lesions as well as pronounced marginal bone loss than OP patients. This study showed that dental fear patients in general have a substantially deteriorated dental health compared to ordinary dental patients. Moreover, different dental care habits were evident between FP and OP patients. A progressive severity in dental disease pattern was found among FP patients.

Use of shell crowns in Hong Kong dental hospital attenders

In 1984 an oral health survey of Hong Kong adults aged 35-44 years revealed that 15% of subjects presented with metal shell crown restorations, often as components of fixed-bridge reconstructions. The aim of this study was to describe the patterns and means of use of shell crowns, and to describe the patterns of tooth loss in patients who presented with such restorations, attending for treatment at the dental teaching hospital in Hong Kong over a 2-year period. A total of 1563 such patients attended. The records, which included radiographs, of 165 of these patients aged 35 years and above, obtained by means of a systematic sampling frame, were studied by one trained examiner. On initial presentation each patient was found to have a mean of 4.0 shell crowns, 77% of these being components of bridge restorations. The bridges involved a mean of only 3.9 units (retainers and pontics). The tooth type most commonly replaced by a bridge of this type was the first molar. It was concluded that most shell crowns used in this patient group are abutment retainers for predominantly short-span bridge restorations.