Nonrestorable Teeth Research Articles

Lack of Osteoradionecrosis of the Mandible After Intensity-Modulated Radiotherapy for Head and Neck Cancer: Likely Contributions of Both Dental Care and Improved Dose Distributions

To assess the prevalence and dosimetric and clinical predictors of mandibular osteoradionecrosis (ORN) in patients with head and neck cancer who underwent a pretherapy dental evaluation and prophylactic treatment according to a uniform policy and were treated with intensity-modulated radiotherapy (IMRT). Between 1996 and 2005, all patients with head-and-neck cancer treated with parotid gland-sparing IMRT in prospective studies underwent a dental examination and prophylactic treatment according to a uniform policy that included extractions of high-risk, periodontally involved, and nonrestorable teeth in parts of the mandible expected to receive high radiation doses, fluoride supplements, and the placement of guards aiming to reduce electron backscatter off metal teeth restorations. The IMRT plans included dose constraints for the maximal mandibular doses and reduced mean parotid gland and noninvolved oral cavity doses. A retrospective analysis of Grade 2 or worse (clinical) ORN was performed. A total of 176 patients had a minimal follow-up of 6 months. Of these, 31 (17%) had undergone teeth extractions before RT and 13 (7%) after RT. Of the 176 patients, 75% and 50% had received >or=65 Gy and >or=70 Gy to >or=1% of the mandibular volume, respectively. Falloff across the mandible characterized the dose distributions: the average gradient (in the axial plane containing the maximal mandibular dose) was 11 Gy (range, 1-27 Gy; median, 8 Gy). At a median follow-up of 34 months, no cases of ORN had developed (95% confidence interval, 0-2%). The use of a strict prophylactic dental care policy and IMRT resulted in no case of clinical ORN. In addition to the dosimetric advantages offered by IMRT, meticulous dental prophylactic care is likely an essential factor in reducing ORN risk.

Forced eruption of adjoining maxillary premolars using a removable orthodontic appliance: a case report

Forced eruption can be performed in teeth with caries, fracture, resorption or perforation in the cervical third of the root or isolated teeth with one- or two-walled vertical periodontal defects. The purpose of this case report is to introduce an innovative orthodontic appliance which enables forced eruption. This appliance is easy to fabricate, cost-effective and very effective in forced eruption of non-restorable teeth.

CAUSES OF FAILURE AMONG CUSPAL-COVERAGE AMALGAM RESTORATIONS: A CLINICAL SURVEY

Investigations of cuspal-coverage amalgam restorations suggest that tooth fracture is the leading cause of failure, while for Class I and II restorations, the leading cause is caries. In this study, the authors evaluated the causes of failure for a large number of cuspal-coverage restorations. The causes of failure for 706 cuspal-coverage amalgam restorations were determined through the use of a questionnaire. Dentists from a variety of dental schools; Army, Navy, Air Force, Public Health and Veterans Affairs dental clinics; and private practice were asked to record pertinent information regarding patients and restoration failures from choices provided on a survey form. The survey documented 706 failed restorations. Mandibular first molars accounted for 36.25 percent of all failures. The majority of failures were caused by fractured teeth (24.3 percent), caries (20 percent) and fractured restorations (17.1 percent). Among all of the failed restorations, 82.15 percent were restorable, 9.35 percent were repairable and 8.50 percent were nonrestorable. Among the fractured teeth, 80 percent were restorable, 14.5 percent were nonrestorable and 5.5 percent were repairable. Among the carious teeth, 84 percent were restorable, 8 percent were nonrestorable and 8 percent were repairable. A chi 2 analysis revealed that tooth fracture was more likely to be associated with nonrestorability than either caries (chi 2 = 5.013, P < .05) or restoration fracture (chi 2 = 6.202, P < .05). The leading cause of failure among the 706 restorations was tooth fracture, which resulted in significantly greater numbers of nonrestorable teeth than either caries or fractured restorations. Tooth fracture creates a greater risk of nonrestorability than any other cause of failure. Replacement or coverage of fracture-prone cusps is likely to improve the life expectancy of complex amalgam restorations.

Pararadicular cementum deposition as a criterion for age estimation in human beings

The purpose of this article is to ascertain if pararadicular cementum can be used as a reliable criterion for age estimation in human beings. Fifty-two nonrestorable teeth were extracted from 42 patients at the Veterans Administration Medical Center at Ann Arbor, Mich. The specimens were prepared to a thickness of 500 μm with a Buehler Isomet bone saw (Bronwell Scientific, Inc., Rochester, N.Y.). Longitudinal sections were cleaned of artifacts in an ultrasonic cleaner and stained with 1% alizarin red. Photomicrographs were taken of each prepared section. The cementum was composed of multiple light and dark bands that were counted on the photograph and added to the average eruption time of the individual tooth. There was an overall Pearson's product-moment correlation coefficient of r = 0.93 between the patient's predicted age with the use of cementum annulations as compared with the actual chronologic age of the person. Predicted age counts showed greater divergence from actual age in persons older than 55 years. A formula is presented to adjust for this discrepancy. The data indicate that quantitation of cementum annuli is a moderately reliable means for age estimation in humans.

The influence of the major and minor foramen diameters on apical electronic probe measurements

There have been conflicting reports on the accuracy of electronic devices used for determining working length. The influence of the major and minor diameters on electronic probe measurements were evaluated to ascertain whether anatomical features of the apical portion of the canal might be responsible for these discrepancies. Forty-seven nonrestorable teeth selected from 22 patients were studied. Conventional access was made. A Kerr file was placed to a position 0.5 mm from the major foramen as registered by the Neosono-D apex locator. The electronic probe length was then measured. After the tooth was extracted, the file was fixed with autopolymerizing composite in the canal. A Buehler Isomet lapadary saw was used to prepare specimens to a thickness of 500 microns. A Bioquant II Image Analysis System was used to measure and record distances. It was found that as the width of the major foramen increased, the discrepancy between the electronic probe tip length induction and the actual position of the major foramen increased.

Orthodontic extrusion and biologic width realignment procedures: methods for reclaiming nonrestorable teeth

A multidisciplinary approach to the management of teeth traditionally classified as nonrestorable is presented. Three case histories are described in which such teeth are extruded orthodontically, the gingiva and biologic width are repositioned apically, and the teeth are restored.

Orthodontic Extrusion: A Multidisciplinary Treatment Approach

A multidisciplinary approach, using orthodontic and periodontic treatment and restorative dentistry, is described for restoration of an apparently nonrestorable tooth.

Forced Eruption: Part II. A Method of Treating Nonrestorable Teeth—Periodontal and Restorative Considerations

In selected cases, forced eruption may be a useful approach in treating isolated nonrestorable teeth as a result of trauma, caries, or iatrogenic dentistry. This paper has presented the biologic rationale, objectives, technics and clinical cases to demonstrate the principle. Evaluation has been made of potential difficulties which may develop with the technic and areas for future research have been identified.

Dental Problems of Alcoholic and Nonalcoholic Psychiatric Patients

Although both alcoholics and psychiatric patients at a Veterans Administration Hospital exhibited severe oral neglect, the alcoholics had more missing teeth and more nonrestorable teeth than the ps...

Surgical Repositioning of the Posterior Maxillary Segment as an Aid to Fixed Prosthodontics

The cooperation of an oral surgeon, orthodontist, and a restorative dentist ended in the successful treatment of a 21-year-old woman. Several teeth were missing and other nonrestorable teeth had to be extracted. Clinical examination revealed the premature contact of the maxillary left second molar and mandibular left second premolar. The patient objected to a removable appliance. The surgical repositioning of the maxillary alveolar segment containing the second molar, in a two-stage procedure, permitted the use of a fixed bridge and the establishment of the proper plane of occlusion.