Hopeless Teeth Research Articles

Platelet-rich plasma in combination with bovine derived xenograft in the treatment of generalized aggressive periodontitis: A case report with re-entry

Prominence has been given recently to the use of platelet-rich plasma (PRP) in combination with bone graft materials for predictably obtaining periodontal regeneration through bioengineering. The purpose of this report was to present clinical, radiographic and re-entry results of a generalized aggressive periodontitis (GAP) patient with wide intrabony periodontal defects treated with combined PRP and bovine derived xenograft (BDX). A-32 year old GAP patient who received non-surgical therapy and had 12 intrabony defects was treated with PRP and BDX combination. Prior to surgery and at 12 months, probing depth, marginal recession, relative attachment, probing bone and radiographic bone levels were measured. Re-entry was additionally performed at 12 months. Clinical and radiographic measurements together with re-entry results showed marked improvements from baseline with increased stabilization of whole dentition including the hopeless teeth. The surgical technique together with the materials used may be a possible solution for extensive bone loss.

Periodontal therapy in siblings with Papillon–Lefèvre syndrome and tinea capitis: a report of two cases

Report of clinical and microbiological periodontal findings before and 6 months after treatment of two siblings with Papillon-Lefèvre syndrome (PLS) and tinea capitis. Two brothers, RG 3 years and NG 5 years of age, were referred for treatment due to premature mobility of their deciduous teeth. Probing depths (PPD), attachment levels (PAL-V), and furcation involvements were examined clinically. Panoramic radiographs were taken. Subgingival plaque samples within the deepest pocket of each tooth were taken and analysed by real-time polymerase chain reaction (PCR) for Actinobacillus actinomycetemcomitans (AA), Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Fusobacterium nucleatum, and Prevotella intermedia. One-stage full-mouth scaling and extraction of hopeless teeth were performed under general anaesthesia, followed by systemic amoxicillin and metronidazole for 7 days. Clinical and microbiological analyses were performed 6 months after treatment. Before treatment, both siblings had exhibited PPD of up to 13 mm, Class III furcation defects at four teeth, and marginal suppuration. AA was detected in both patients and at all teeth at levels ranging from 3.0 x 10(2) to 5.1 x 10(6). Both patients exhibited palmar and plantar hyperkeratosis. Seven teeth were extracted from RG, and nine from NG. Six months after treatment, PPD had been reduced to <or=5 mm. AA was not detected in any of the remaining teeth. Even periodontally affected deciduous teeth of PLS patients can be treated successfully. Suppression of AA to below detection level seems to be of high significance.

Titanium Membranes in Prevention of Alveolar Collapse After Tooth Extraction

The resorption of alveolar bone following tooth extraction results in a narrowing and shortening of the residual ridge, which leads to esthetic and restorative problems, and reduces the bone volume available for implant therapy. The aim of this study was to evaluate the prevention of alveolar collapse after tooth extraction, using titanium membrane (Frios Boneshield; DENTSPLY Friadent, Mannheim, Germany), associated (or not) with autologous bone graft. A total of 10 nonsmoking healthy subjects, ranging from 35 to 60 years old, were selected for this study. Each patient had a minimum of 2 uni-radicular periodontally hopeless teeth, which were scheduled for extraction. After the procedure, 2 titanium pins were fixed on the vestibular bone surfaces that were used as references for the initial measures (depth, width, and height) of the socket. Of the sockets,1 was randomly chosen to be filled with autologous bone graft (test) removed from superior maxillary tuber, and the other one did not receive the graft (control). A titanium membrane was adapted and fixed, covering the sockets, which remained for at least 10 weeks. After a 6-month healing, the final measures were performed. There was exposure of the membrane in 5 of the 10 treated subjects. Average bone filling (+/-standard deviation) among the 10 subjects was 8.80 +/- 2.93 mm (range 4-13) in the control group and 8.40 +/- 3.35 mm (range 4-13) in the test group. Average bone loss in width in both group was 1.40 +/- 1.97 mm (range -4-1) in the control group and 1.40 +/- 0.98 mm (range -4-0) in the test group. There was no significant statistical difference between groups considering the evaluated standards. The use of titanium membrane, alone or in association with autogenous bone, favored the prevention of alveolar ridge after tooth extraction. This membrane seems to be a possible and safe alternative to other nonresorbable membranes when the prevention of alveolar ridge resorption is the objective.

Osteonecrosis of the jaws in periodontal patients with a history of bisphosphonates treatment

Osteonecrosis of the jaws is being increasingly reported in patients with bone metastasis from a variety of solid tumours and disseminated multiple myeloma receiving intra-venous bisphosphonates. The signs and symptoms that may occur before the appearance of clinical evident osteonecrosis include changes in the health of periodontal tissues, non-healing mucosal ulcers, loose teeth and unexplained soft-tissue infection. A series of nine periodontally involving patients showing osteonecrosis of the jaws that appeared following the intra-venous use of bisphosphonates is reported. Nine consecutive patients with osteonecrosis of the jaws were prospectically studied. Patients' past medical histories and the drugs that they had received for their malignant disease were systematically documented. Clinical, histopathological and radiographic features and proposal for treatment modalities of osteonecrosis are also reported. Of the nine patients (six women and three men) observed, all had osteonecrosis in the mandible; two had maxillary involvement as well. All nine patients had a history of extraction of periodontally hopeless teeth preceding the onset of osteonecrosis. In two patients, the lesions also appeared in edentulous areas spontaneously. All the patients had received intra-venous bisphosphonates as treatment for their disseminated haematological neoplasms or metastatic bone disease. The duration of bisphosphonate therapy at presentation ranged from 10 to 70 months (median: 33 months). Jaw osteonecrosis appears to be associated with the intra-venous use of bisphosphonates. Dental professionals should be aware of this potentially serious complication in periodontal patients receiving long-term treatment with bisphosphonates.

Forced eruption and implant site development: An osteophysiologic response

Before selected hopeless teeth were extracted, the authors orthodontically erupted these teeth to augment the three-dimensional topography of future implant recipient sites. This controlled “biodynamic orthodontic modeling” manipulates teeth, with as little as one fourth to one third of their apical attachment intact, by constructively increasing their local osseous dimensions in the vertical plane. Such vertical remodeling, especially of the strategic labial plate and crest, allows a more ideal placement of the implant (within 1 to 3 mm apically, depending on implant type) in relation to the cementoenamel junction of the adjacent dentition. The more coronal the placement of the implant head, without compromising esthetics, the more readily maintainable the peri-implant soft tissue environment is likely to be, because of the potential for decreased sulcular depth. (Am J Orthod Dentofacial Orthop 1999; 115:583-91)

Retaining Periodontally “Hopeless” Teeth

A case of advanced periodontitis with many hopeless teeth, treated and maintained for 8-1/2 years, is presented. This case suggests a successful departure from traditional treatment.

Autogenous Gingival Grafts as Epithelial Barriers for Immediate Implants: Case Reports

The purpose of this study was to evaluate the use of autogenous gingival grafts as barriers for endosseous implants placed directly into fresh extraction sockets. This study consisted of four patients who presented with hopeless teeth due to endodontic pathology, caries, or root resorption. In all cases, the teeth in question were extracted at the Stage 1 surgery. An endosseous root form implant was immediately placed into the extraction socket in each case. As a consequence of immediate placement, there was a lack of primary closure over the fixture and a large space was present between the fixture and the remaining alveolus. An autogenous gingival graft was sutured in place to cover the fixture and act as a physical barrier to epithelium, food debris, and possibly bacteria. At the Stage 2 surgery, all implants achieved complete osseointegration clinically and radiographically. The results at 16 to 24 months reveal continued success in all four cases. This report demonstrates the potential of autogenous gingival grafts in immediate implant placement. A clinical trial to fully assess the potential of this procedure is recommended.

Intentional replantation: A successful alternative for hopeless teeth

An interesting case of intentional reimplantation, in which the distal root of a mandibular molar was reimplanted after hemisection, is reported for the first time. This root served as the distal abutment for a three-unit bridge. A 3-year follow-up revealed a successful outcome, with a clinically asymptomatic and functional tooth with no radiographic signs of resorption or ankylosis.

Vital root retention: A clinical procedure

Retention of vital roots retards the resorption of residual alveolar ridges under complete dentures. It also eliminates the patient's responsibility of maintaining the periodontal health of overdenture abutments. The procedure involves (1) preparing the teeth to be retained from a periodontal standpoint to reduce the possibility of contamination of the surgical site, (2) removing hopeless teeth, (3) sectioning and contouring the teeth so that the retained roots are contiguous with the crestal bone, (4) preparing and suturing labial and lingual flaps to cover the prepared roots and maintain proper vestibular depth, and (5) placing an immediate denture relined with tissue-conditioning material.

Retained "hopeless" teeth. Effects on the proximal periodontium of adjacent teeth.

The retention of teeth diagnosed as periodontally "hopeless" may accelerate the destruction of the adjacent proximal periodontium. Studies determining the influence these teeth have on the health status of adjacent teeth appear nonexistent. It was the intent of this retrospective study to assess the status of the periodontium in adjacent teeth proximal to the periodontium of "hopeless" teeth. We evaluated 17 teeth, each being mesially adjacent to one "hopeless" tooth, in 17 subjects treated for periodontal disease. In each case, the "hopeless" and the adjacent teeth received the same treatment. Probing depths (P-D), radiographic alveolar bone level (R-BL) and the width of the periodontal ligament space (W-PL) were measured for both the adjacent interproximal and the nonadjacent interproximal surface for each hopeless tooth. At both pretherapy and posttherapy, there were no significant differences for any of the variables (P-D, R-BL and W-PL) for the adjacent interproximal surfaces with the nonadjacent interproximal surfaces. However, there was a significant reduction in the mean probing depth for the adjacent interproximal surfaces, pretherapy to posttherapy. No other significant changes were found in any of the other variables for either the adjacent or nonadjacent interproximal surfaces. These data suggest that teeth considered periodontally "hopeless" and retained have no effect on the proximal periodontium of adjacent teeth prior to and following therapy.

Overdentures in the maxillofacial prosthetics practice. Part I: The cancer patient

The myriad of interacting disciplines and treatments for patients suffering from oral cancer can dramatically influence the planning for dental treatment. Retention of periodontally involved or structurally hopeless teeth is often necessary, if not required, in the rehabilitation phase, making the integration of overdentures into the treatment plan a viable consideration. The potential for increased retention and stability of the final prosthesis with the use of such abutments may be the most critical factor in providing a successful prosthesis. Whether the ultimate prosthesis is temporary or definitive, simple or highly complex, the compromised oral cancer patient will often benefit from the use of overdentures.

Creating Your Own Dentin: Procedures for Rebuilding Badly Broken-down Teeth

It is possible for the dentist to make “dentin” from steel rods and amalgam or from a gold casting retained on the remaining root or tooth structure with parallel pins. As a rule, when treating thin central or lateral teeth or small lower teeth, the gold casting is preferred. In these thin teeth, if we were to use steel rods it would be also necessary to have some amalgam around them. The relatively small bulk of amalgam would not I k * sufficient for strength of this foundation. In the heavier bicuspids or molars or bulkier anterior teeth, the operator has a choice as to which technique he prefers to use. Dentists today are more reluctant to make the decision that a strategic tooth or root must be extracted. We are frequently called upon to rescue teeth in various degrees of breakdown. By applying this new knowledge and new concepts, many badly broken-down teeth can be retained for the patient's welfare. The procedures described have altered our horizons. They are being increasingly taught on the postgraduate and undergraduate levels. In the years to come, it is hoped that we will see in all dental laboratories models of preparations that look as though all dentists are preparing virgin teeth. Now we can solve situations that we never dreamed we could handle formerly. Many previously hopeless teeth are being saved with pins. These methods will facilitate a treatment plan that includes simpler restorative procedures and the avoidance of unnecessary removable prostheses for the patient.