Complete Root Formation Research Articles

The relationship between tooth mineralization and early radiographic evidence of the ulnar sesamoid.

The relationship between early radiographic evidence of calcification of the adductor sesamoid of the first metacarpophalangeal joint and the state of maturity of certain teeth was investigated. Data were obtained from the records of one hundred and forty children of Caucasoid origin, comprising ninety-three girls and forty-seven boys. Calcification of the adductor sesamoid was closely related to the completion of root mineralization of the mandibular canine prior to apical closure. No significant sex differences were noted in the state of maturation of the tooth in relation to this particular stage of skeletal development. Correlations among the remaining teeth studied were low, the distribution of calcification stages being widely dispersed with significant sex differences evident. Based on the findings of this study, the completion of root formation of the mandibular canine prior to apical closure may be used as a maturity indicator for the commencement of the circumpubertal growth spurt with a similar degree of confidence as the calcification of the adductor sesamoid of the thumb. It should be noted, however, that racial variations might exist in the relationship between the state of maturity of this tooth and the commencement of mineralization of the sesamoid. Caution should thus be exercised in the application of these findings to other racial groups.

12- AUTO-TRANSPLANTATION OF MAXILLARY IMPACTED CANINE, A CLINICAL STUDY OF 25 CASES

Twenty five patients underwent auto-transplantation surgery. Seventeen were females and 8 males. Preoperative PA films were taken for each case for localization of impacted canine. Eleven were palatal impacted and 14 were labially impacted. The technique used is shifting technique and OPG. The status of surrounding tissues was evaluated radiographically. No case was associated with any pathology and complete mature root formation. The average age of patients ranged from 20 to 35 years. In most of them, there was a retained deciduas teeth.

The effect of orthodontic forces on autogenous tooth transplantation with complete root formation: a case report

Background and Objectives: Auto transplantation is an alternative treatment for replacing lost teeth when suitable donor teeth are available. This paper presents a case of a successful autogenous tooth transplant.

Long-term evaluation of autotransplanted third molars

Purpose: The purpose of this study is to evaluate the long term clinical and radiographic outcome and stability after trans- plantation of third molar with complete root formation. Methods: The subjects were 31 teeth (male 17, female 14, aged 22-55, average 39.9 yr old) of 31 patients who visited the department of periodontics and passed more than two years after autotransplantation procedure and still under regular check up. Modified success criteria of Chamberlin and Goerig was applied to determine the success of autotransplantation. Results: Three out of 31 teeth failed and resulted 90.3% of success rate. When compared according to sex, 15 out of 17 teeth had succeeded in male, 13 out of 14 succeeded in female. When compared the success rate according to cause of ex- traction, tooth loss due to caries and root fracture had all succeeded but 3 out of 24 had failed in tooth loss due to periodontal disease. When compared according to donor teeth, 12 out of 14 maxillary third molars and 16 out of 17 man- dibular third molars had succeeded. Conclusions: In long term evaluation over two years, if appropriate surgical procedure and proper case selection is made, autotransplantation of the third molar with complete root formation can be the alternative choice that substitutes prosthetic or implant treatment and it is a functionally acceptable procedure. (J Korean Acad Periodontol 2009;39:431-435)

External apical root resorption in patients treated with conventional and self-ligating brackets

Our aim was to comparatively investigate the amount of external apical root resorption (EARR) between conventional and passive self-ligating brackets. Ninety-six patients were selected from a pool of patients satisfying the following inclusion criteria: no evidence of resorption on the pretreatment panoramic radiographs; no contributing history of trauma; no dilacerations of lateral incisor roots, maxillary anodontia, and impacted canines; complete root formation at the start of treatment; intact and caries-free maxillary incisors; and no endodontically treated incisors. Patients received treatment with either a passive self-ligating bracket system or a conventional edgewise appliance, both with a 0.022-in slot. EARR of the maxillary incisors was evaluated on panoramic radiographs, taken before and after orthodontic treatment measured in millimeters. Distortion of measurements caused by panoramic radiographs was investigated by using a calibrated periodontal probe attached to the lateral incisor, and the extent of magnification was estimated to be 14%. Statistical comparisons of EARR between appliance type, age, sex, extraction treatment, and duration of treatment were investigated with univariate and multivariate regression modeling. Overall, no difference was found in the amount of EARR between appliance systems. Age, sex, and extraction treatment were not reliable predictors of EARR, but a positive association between EARR and duration of treatment was observed. No difference should be expected for root resorption between conventional and passive self-ligating brackets.

Erbium Laser Treatment Of An Impacted First Mandibular Premolar: A Case Report

Dental impaction defines a tooth that, instead of erupting to occupy its functional position, is partially or totally retained and remains within the bone. Retained teeth can be placed in the normal arch position through a combination of orthodontics and conventional surgical techniques, or a combination of orthodontics and laser surgery, as in the case here presented of a 14-year-old boy with an impacted first mandibular premolar, covered by bone, and with complete root formation and an erupted second premolar. The impacted premolar was surgically exposed using an Er,Cr:YSGG laser and at the same time an orthodontic bracket was bonded to provide traction to move the first premolar into its arch position.

Radiographic Study of the Positional Changes and Eruption of Impacted Third Molars in Young Adults of an Asian Indian Population

The aim of the study was to assess changes in the angular position and eruption status of third molars in students of an Asian Indian population during a 4-year follow-up period. The series consisted of 43 students (11 males, 32 females). Standardized panoramic radiographs were taken at baseline (mean age, 19.1 +/- 0.7 years) and at the end of study (mean age 23.1 +/- 0.7 years). Angulation and degree of impaction of third molars were determined by their sagittal relationship to the adjacent second molar and eruption to the occlusal plane. Root formation was also assessed. During the 4-year follow-up period, 11 of 72 of the mandibular teeth (15%) and 17 of 74 of the maxillary teeth (23%) changed their sagittal inclination. Thirty-one of 118 impacted teeth (26%; level B + C) achieved level A eruption more so in the mandible, ie, 15 of 52 (29%), than in the maxilla, ie, 16 of 66 (24%). In the mandible, 9 of 24 impacted vertical teeth (37.5%), 3 of 6 distoangular teeth (50%), and 3 of 22 mesioangular impacted teeth (13.6%) erupted to the occlusal plane. In the maxilla, 9 of 36 impacted vertical teeth (25%) and 7 of 27 distoangular teeth (26%) erupted to the occlusal plane during the follow-up. The number of teeth with complete root formation increased in mandible from 61% to 93% and in maxilla from 62% to 94.5%. Unpredictable changes in the position and angulation of teeth continued to occur even after the age of 19 years, more so in vertical and distoangular teeth than in mesioangular teeth.

Direct Pulp Capping With Mineral Trioxide Aggregate: An Observational Study

Pulp capping in carious teeth has been considered unpredictable and therefore contraindicated. A recently developed material, mineral trioxide aggregate (MTA), resists bacterial leakage and may provide protection for the pulp, allowing repair and continued pulp vitality in teeth when used in combination with a sealed restoration. Forty patients aged 7 to 45 years accepted pulp-capping treatment when they received a diagnosis no more severe than reversible pulpitis after undergoing cold testing and radiographic examination. The primary author removed caries using a caries detector dye and sodium hypochlorite solution for hemostasis and placed MTA over the exposures and all surrounding dentin. The operator then restored the teeth provisionally with unbonded Clearfil Photocore (Kuraray Medical, Okayama, Japan). During a second visit, the operator restored the teeth with bonded composite after sensibility testing and confirmed MTA curing. At recall appointments, patients were evaluated for reparative dentin formation, pulpal calcification, continued normal root development and evidence of pathosis. Over an observation period of nine years, the authors followed 49 of 53 teeth and found that 97.96 percent had favorable outcomes on the basis of radiographic appearance, subjective symptoms and cold testing. All teeth in younger patients (15/15) that initially had open apexes showed completed root formation (apexogenesis). MTA can be a reliable pulp-capping material on direct carious exposures in permanent teeth when a two-visit treatment protocol is observed. Vital pulp therapy using MTA is a treatment option for teeth diagnosed with a condition no more severe than reversible pulpitis.

Autogenous transplantation of tooth with complete root formation

Purpose: Autogenous transplantation of teeth can be defined as transplantation of teeth from one site to another in the same individual, involving transfer of impacted or erupted teeth into extraction sites or surgically prepared sockets. Successful autogenous transplantation of teeth depends upon a complex variety of factors. Such factors include damage to the periodontal ligament of the donor tooth, residual bone height of the recipient site, extra-oral time of tooth during surgery. Schwartz and Andreasen previously reported that autogenous transplantation of teeth with incomplete root formation demonstrated higher success rate than that of teeth with complete root formation. Gault and Mejare yielded similar rate of successful autogenous transplantation both in teeth with complete root formation and in teeth with incomplete root formation when appropriate cases were selected. This case report was aimed at the clinical and radiographic view in autogenous transplantation of teeth with complete root formation. Materials and Methods: Patients who presented to the department of periodontics, Chonnam National University Hospital underwent autogenous transplantation of teeth. One patient had vertical root fracture in a upper right second molar and upper left third molar was transplanted. And another patient who needed orthodontic treatment had residual root due to caries on upper right first premolar. Upper right premolar was extracted and lower right second premolar was transplanted. Six months later, orthodontic force was applied. Results: 7 months or 11/2 year later, each patient had clinically shallow pocket depth and normal tooth mobility. Root resorption and bone loss were not observed in radiograph and function was maintained successfully. Conclusion: Autogenous transplantation is considered as a predictive procedure when it is performed for the appropriate indication and when maintenance is achieved through regular radiographic taking and follow-up. (J Korean Acad Periodontol 2008;38:709-716)

Evaluation of Autotransplantation

Purpose: Many clinical studies have reported that higher success rates are achieved with teeth that have immature roots than other autotransplanted teeth that have more immature root. However, based on date published recently, the success rate of auto- transplantation of teeth with complete root formation was higher. The purpose of this study was to examine the long term(2 to 6 years follow-up) success rate of autotransplantation of third molar with complete root formation and to discuss some conditions and prerequisites for success. Materials and Methods: 26 sites of 24 patients aged 26 to 55 (mean age 40.8) were autotransplanted with third molars with complete root formation. These cases were followed for 2 to 6 years after surgery. The success criteria included (1) no dis- comfort during functioning (2) absence of progressive root resorption and alveolar bone resorption. Result: Of 26 teeth 5 teeth were failed, therefore success rate is 81%(21/26 teeth). The results suggested that higher success rate is acquired from (1) extraction socket due to dental caries (2) mandibular recipient site (3) patient younger than 40 years old. Autotransplantation of third molar to replace molars with advanced periodontal disease also showed considerably high suc- cess rate(84%). Conclusion: With appropriate case selection, autotransplantation of third molar with complete root formation remains a viable alternative for replacing a missing molar tooth. (J Korean Acad Periodontol 2008;38:225-230)

Central Incisor Impacted by an Odontoma

The aim of this report is to present a clinical case of impaction of a maxillary left central incisor in a mixed dentition caused by the presence of an odontoma as well as a review of the pertinent dental literature. Knowledge of the normal tooth eruption patterns is essential for the identification and appropriate treatment of deviations in eruption that may endanger physiologic development. A delay in time between the exfoliation of a deciduous tooth and the eruption of its permanent successor may be related to a disorder known as dental retention. This occurs when tooth eruption does not occur within a normal time frame, the tooth is not present in the dental arch, and there is no potential for eruption due to the presence of a completely formed root or when the homologous tooth has been erupted for at least six months with complete root formation. A 10-year-old boy in the mixed dentition stage presented with an impacted maxillary left central incisor due to the presence of an odontoma. Treatment included the surgical removal of the lesion and the follow up of the spontaneous eruption while a partial fixed appliance was used to recover the space of the missing tooth. Since spontaneous eruption failed to occur within the expected time frame, surgical exposition of the crown and bonding of an orthodontic appliance for traction was done to facilitate eruption. The incisor was integrated to the dental arch without any root or periodontal sequelae. The treatment was considered a success, since both health and aesthetics of the smile were recovered. The importance of the clinical and radiographic diagnosis of the retention of a permanent tooth associated with a pathological entity should be emphasized. The participation of a multidisciplinary team to accomplish the appropriate treatment of such patients is extremely relevant because of the esthetic and functional ramifications of a missing anterior tooth as well as the psychological well-being of the individual.

Clinical study on the influence of hydroxyapatite on apexogenesis in monkeys

Management of the affected pulp in teeth with incomplete root formation is still an issue. Calcium hydroxide and other materials have been employed for this purpose to a greater or lesser success. Bioceramic materials are in the last decades well established in a number of different medical fields. Having its constituents the same as those of the unorganic portion of bone tissue, hydroxiapatite (HAP), one of the two forms of calcium-phosphate ceramics, is already accepted in endodontic treatment of teeth with completed root formation. The aim of this study was to examine apexogenesis in teeth with immature roots, following the use of HAP on their affected pulp. Examination was performed on eight young monkeys (Cercopithecus Aethiops) with incomplete root development. The 100 _m synthetic HAP material was applied on 32 teeth divided into two groups of 16 teeth each. In one group teeth underwent pulpotomy, in the other high pulpotomy. Evaluation of root growth was recorded from radiographs (pre-treatment, 3 and 12 months following treatment) and by Demjrian's scale for dental maturity and tooth age determination. On the basis of radiographic analysis, immature teeth with affected pulp treated with HAP, both with pulpotomy and high pulpotomy, reached the same stage of root development as control teeth in 50% of cases at 3-months radiographic assessment. After 12 months all tested teeth had the same rate of root development as control teeth, except for 1 of 8 with high pulpotomy. Dentinal bridge was radiographically visible in 50% and 87.5% of pulpotomized teeth after 3 and 12 months, respectively. Neither obliteration of the root canal, presence of denticles nor the presence of deformities in the periapical region were found in any of the observed teeth.

Pulp and root development after partial extrusion in immature rat molars: a histopathological study.

Experimental studies were undertaken in immature rat molar teeth to investigate the relationship between root development and the prognosis after partial extrusion. The experimental partial extrusion was induced at 1/2 root formation, 2/3 root formation and 3/4 root formation, using an extrusion device designed by the author. Histopathological studies and SEM observation of the pulpal tissue in rat maxillary first molars with partially formed roots after partial extrusion were conducted and evaluated. The degree of extrusion was changed according to the development of the root to produce a similar luxated state. The rats were sacrificed immediately after experimental extrusion, immediately after operation, and after 3 days, 7 days, 14 days, 30 days, and 60 days to compare the histopathological and SEM findings between experimental groups and control groups. Immediately after the extrusive injury, ablations of the odontoblast layer from dentin were seen with retention of a fluid component in the ablated spaces in the pulp. On 1 and 3 days after surgery, cellular components such as erythrocytes and leukocytes due to bleeding were seen. Ablations of the odontoblast layer were seen in the coronal pulp most frequently in the pulp horn, cervical area and floor of the pulp chamber. In general, pulp reaction after extrusion in groups with more complete root formation was more severe than in groups with less complete root formation. It is suggested that the more complete the root formation, the greater the effect on the pulp as result of partial extrusion, while with less complete root formation, the greater the malformation of the root apices.

Poster 140: Clinical Study of Autotransplantation of Tooth With Complete Root Formation—Unsuccessful Cases

Poster 140: Clinical Study of Autotransplantation of Tooth With Complete Root Formation—Unsuccessful Cases

Progressive dental development in regional odontodysplasia

Regional odontodysplasia (RO), also known as ghost teeth, is an unusual nonhereditary developmental anomaly of tooth formation that characteristically affects enamel and dentin formation of the primary and/or permanent dentition. In the present paper, we report a case of RO affecting a 7-year-old boy, with 9 years of follow-up. During this time, progressive development of dental tissue was observed, including complete root formation. However, delayed dental eruption was evident. In view of these findings, we discuss the clinical presentation, pathogenesis, differential diagnosis, and treatment of RO.

Third Molar Root Development and Recovery from Third Molar Surgery

This study was conducted to determine if the completeness of the root formation of mandibular third molars prior to removal affected clinical and health-related quality of life (HRQOL) recovery. Data from HRQOL responses from patients and clinical outcome data were available after third molar surgery conducted by surgeons in community practice and academic centers. The root development of each mandibular third molar on presurgery panoramic radiographs for these patients was assessed by trained clinician observers. Patients were categorized as those with complete root formation (both mandibular third molars had 100% completely formed roots) or as those with incomplete root formation (at least 1 mandibular third molar not completely formed). The proportion of patients who experienced delayed clinical or HRQOL recovery that exceeded a clinically relevant criterion value were compared for these 2 groups of patients using chi2 statistics. Level of significance was set at 0.05. Both mandibular third molars had 100% completely formed roots in 118 patients; at least 1 mandibular third molar was not completely formed in 218 patients. If patients had a mandibular third molar with roots less than 100% complete, they more likely: were female (65% vs 58%), were less than 25 years old (95% vs 54%), P < .01, and had not finished high school (59% vs 28%), P < .01. For those with incomplete root formation, bone removal for both mandibular third molars was more likely (84% vs 67%), P < .01, and the surgeons' overall estimate of degree of difficulty was greater (14/28 vs 12/28), P = .02. Median surgery time did not differ between groups. The proportion of patients who experienced delayed clinical or HRQOL recovery did not differ between the incomplete and complete root formation groups. Incomplete lower third molar root formation presurgery may not be a predictor of better or worse clinical or HRQOL recovery after surgery. Other clinical, demographic, and health indicators should influence surgeons' recommendations and patients' decisions regarding third molar treatment including surgery.

Influence of cervical preflaring on apical file size determination in maxillary lateral incisors

The purpose of this study was to investigate the influence of cervical preflaring on determination of the initial apical file in maxillary lateral incisors. Forty human lateral incisors with complete root formation were used. After standard access cavities, a size 06 K-file was inserted into each canal until the apical foramen was reached. The WL (WL) was set 1 mm short of the apical foramen. Four groups (n=10) were formed at random, according to the type of cervical preflaring performed. Group 1 received the initial apical instrument without previous preflaring of the cervical and middle root canal thirds. Group 2 had the cervical and middle root canal thirds enlarged with nickel-titanium Orifice Opener instruments. Group 3 had the cervical and middle root canal thirds enlarged with Gates-Glidden drills. Titanium-nitrite treated, stainless steel LA Axxess burs were used for preflaring the cervical and middle root canal thirds of group 4. Each canal was sized using manual K-files, starting with size 08 files with passive movements until the WL was reached. File sizes were increased until a binding sensation was felt at the WL, and the instrument size was recorded for each tooth. The apical region was then observed under a stereoscopic magnifier, images were recorded digitally and the differences between root canal and maximum file diameters were recorded (in mm) for each sample. Significant differences were found between the groups regarding the anatomical diameter at the WL and the first file to bind the canal (p = 0.01). The major discrepancy was found when no preflaring was performed (0.1882 mm average). Canals preflared with Orifice Opener instruments (0.0485 mm average) and Gates-Glidden drills (0.1074 mm average) also showed great discrepancy. The LA Axxess burs produced the smallest differences between anatomical diameter and first file to bind (0.0119 mm average). Instrument binding technique for determining anatomical diameter at WL was not accurate. Preflaring of the cervical and middle thirds of the root canal improved anatomical diameter determination; the instrument used for preflaring played a major role on determination of the anatomical diameter at the WL. Canals preflared with LA Axxess burs created a more accurate relationship between file size and anatomical diameter.

Autogenous transplantation of teeth with complete root formation: two case reports

Autotransplantation is an alternative treatment for replacing lost teeth when suitable donor teeth are available. This paper presents two cases of successful autogenous tooth transplantation. Two third molars with complete root development were autogenously transplanted from their original sockets into new recipient sites on the same side of the mouth, one in the maxilla and one in the mandible. In both cases, the third molars were transplanted immediately after the first molar extractions. To provide better adaptation of the donor teeth, the recipient alveolar sites were remodelled using surgical burs. Semi-rigid splints were maintained for 45 and 15 days, respectively. Root canal treatment commenced one a week after transplantation and the canals were medicated with a calcium hydroxide paste before they were filled. Clinical and radiographic findings after 5 and 3 years of follow-up, respectively, are discussed in relation to the literature. Autogenous transplantation of teeth with complete root formation may be considered as a viable treatment option to conventional prosthetic and implant rehabilitation for both therapeutic and economic reasons. Careful surgical and endodontic procedure, together with careful case selection may lead to satisfactory aesthetic and functional outcomes.

Traumatic intrusion of permanent teeth. Part 3. A clinical study of the effect of treatment variables such as treatment delay, method of repositioning, type of splint, length of splinting and antibiotics on 140 teeth

A prospective study of 140 intruded permanent teeth was examined for the following healing complications: pulp necrosis (PN), root resorption (RR; surface, inflammatory and replacement resorption), and defects in marginal periodontal bone healing (MA). The occurrence of these healing complications was related to various treatment factors such as treatment delay, method of repositioning (i.e. expecting re-eruption, orthodontic reposition and surgical reposition), type of splint (rigid, semirigid and flexible), length of splinting (days) and the use of antibiotics. Treatment delay, i.e. before and after 24 h, had no effect upon healing. Active repositioning in individuals with incomplete root formation (surgical or orthodontic) had a negative effect upon the three healing parameters compared with spontaneous eruption. In teeth with complete root formation and an age of 12-17 no repositioning was still the best treatment in regard to MA. In individuals older than 17 years of age, cases were not anticipated to spontaneously erupt and in these cases, the general choice of treatment was either active orthodontic or surgical repositioning. The former procedure appeared in this treatment scenario to slightly reduce the risk of MA complications. However, this treatment procedure was also found to be more time demanding (an average of 22 consultations for orthodontic repositioning compared with 17 consultations for surgical repositioning). If a surgical repositioning was performed, the type of splint (i.e. flexible, semirigid or rigid) appeared to have no significant effect on the type of healing. The same applied to the length of splinting time (shorter or longer than 6 weeks). No effect of dentin covering procedures for associated crown fractures (enamel-dentin fractures) could be demonstrated. Likewise, antibiotics had no apparent effect upon healing. In conclusion, in patients with intruded teeth with incomplete root formation, spontaneous eruption should be expected. In patients with completed root formation and with an age of 12-17 spontaneous eruption can still occur, but must be monitored very carefully. In older patients (i.e. >17 years) with completed root formation, either surgical or orthodontic extrusion should be attempted. The latter procedure appeared to lead to a slight reduction (not significant) in the risk of MA complications. The extent and direction of the intrusion may however favour surgical repositioning.

Traumatic intrusion of permanent teeth. Part 2. A clinical study of the effect of preinjury and injury factors, such as sex, age, stage of root development, tooth location, and extent of injury including number of intruded teeth on 140 intruded permanent teeth

A prospective study of 140 intruded permanent teeth was done to evaluate the following healing complications: pulp necrosis (PN), root resorption (surface, inflammatory and replacement resorption) (RR) and defects in marginal periodontal healing (MA). These complications were related to various preinjury and injury factors. Age appeared to be related to all three healing complications in that patients younger than 12 years had the lowest complication rate. Stage of root formation at the time of the injury was very strongly related to PN and MA, with immature root formation (i.e. incomplete root formation or completed root formation with wide open apex) having better prognosis than more mature root development. Lateral incisors showed significantly more defects in MA, a finding possibly explained by the observation that lateral incisors were more often involved in multiple intrusions compared to other teeth and noting that multiple intrusions had a significantly higher frequency of MA. An associated crown fracture with exposed dentin resulted in more frequent PN, a finding possibly related to bacterial invasion through dentinal tubules into an ischemic pulp. The presence of a gingival laceration added to both PN and MA. The extent of intrusion (in mm) showed some relation to both RR with intrusion 1-3 mm having the lowest frequency of RR, whereas PN and MA showed no significant relation to the extent of intrusion. Finally, multiple adjacent intruded teeth were more frequently involved in a significantly greater loss of interproximal marginal bone (MA) than single intrusions. In conclusion, the relationship between healing complications and preinjury and injury factors could generally be explained by better healing possibilities in teeth with immature root formation. A possible explanation for that could be the softer bone surrounding the tooth, whereby trauma to the periodontium might be diminished.