Prognosis Of Teeth Research Articles

Self-reported tooth and implant prognosis evaluation based on radiographic bone loss: a cross sectional study

Abstract Introduction: Tooth prognosis evaluation involves continual assessments to guide patient-centered treatment plans. This means that the tooth prognosis may dictate whether a tooth is restored, extracted, or maintained. Aim of study: The aim of this work was to evaluate current trends in tooth prognosis evaluation based on radiographic bone loss amongst dental practitioners. Material and Methods: A survey including demographic questions and ten radiographs (vertical bitewings or peri-apical) showing bone loss around teeth and implants were distributed to dental practitioners. Practitioners were asked to determine the prognosis of the tooth or implant and suggest a percentage describing the likelihood of the tooth or implant surviving for ten years. Results: One of the ten radiographs provided for assessment was given good to fair prognosis by 100% of the participants. Only three out of the ten radiographs presented had strong suggestions for tooth retention. Recommendation for extraction by dental practitioners varied from 1-66% across the radiographs. Furthermore, practitioners predicted a 0% chance of ten-year survival for many of the teeth. Conclusions: Assessing prognosis based on radiographs only, is insufficient and clinical data provides invaluable information to establishing tooth prognosis. Dental professionals should understand that compromised teeth can outlive dental implants and our role as dental professionals is to prevent and treat oral diseases to preserve the dentition as long as possible.

Are dental implants the first option in case of severely compromised teeth associated with radicular cyst? A critical case report

Background Nowadays, dental implants are frequently used to replace teeth judged as hopeless, even if other treatments should be primarily considered to save them. The reason lies in the fact that extracting a tooth and placing an implant is erroneously considered by many to be easier, faster, and more predictable. This trend of reduced willingness to save compromised teeth is strengthened by the concomitant presence of periapical tooth pathologies, such as radicular cyst. In such cases, affected teeth are condemned prematurely in favour of implant rehabilitations. This case report aims to illustrate a case where compromised teeth were maintained following the enucleation of a radicular cyst, Case report After enucleation of the radicular cyst, retrograde endodontic treatment of the affected teeth was performed. The residual bone defect was then treated with guided bone regeneration to assist and promote healing and improve the prognosis of adjacent teeth. Conclusion The technique proved to be effective and, most importantly, biologically friendly.

Treatment of avulsed immature permanent teeth in Beijing China: A retrospective comparison between 2008 and 2015.

The diagnosis and treatment of dental trauma are developing rapidly in China. Therapeutic methods used to treat immature avulsed teeth remain a unique challenge in the clinical setting. The aim of this study was to compare the differences in the survival rate and management of avulsed teeth over two distinct periods. Forty immature permanent avulsed teeth of 34 patients (28 boys, 6 girls) were included in this study between 1 July 2008 and 30 June 2009 (group 1, 17 teeth), and 1 January 2015 and 31 December 2015 (group 2, 23 teeth). The patients' mean age was 8.8 (range 7-11) years. The follow-up period ranged from 1.5 to 10years (group 1/group 2, 1.5-10/1.5-3years). Variables such as extra-alveolar time and storage media, stage of root development, splinting type, splinting duration, endodontic treatment and management of complications were studied. The variables were analysed in relation to post-operative pulp outcomes and periodontal healing. Pulp extirpation was performed in 36 teeth within 0-14weeks (mean: 1.6+2.0). The incidence of ankylosis-related (replacement) resorption was 30.5% and that of infection-related (inflammatory) resorption was 22.5%. Pulp survival rate curves differed significantly between the two periods, indicating improvement (P<.05). Splinting type had changed between the study periods to more flexible splints. The use of storage media prior to replantation had also improved. Multivariate Cox proportional hazard regression showed a cumulative survival rate of 82.5% at 3years and 29.4% at 10years. A significant improvement was observed in the management and prognosis of avulsed teeth between 2008 and 2015.

Periodontal regeneration versus extraction and dental implant or prosthetic replacement of teeth severely compromised by attachment loss to the apex: A randomized controlled clinical trial reporting 10-year outcomes, survival analysis and mean cumulative cost of recurrence.

BackgroundPeriodontal regeneration can change tooth prognosis and represents an alternative to extraction in teeth compromised by severe intra‐bony defects. The aim of this study was to compare periodontal regeneration (PR) with tooth extraction and replacement (TER) in a population with attachment loss to or beyond the apex of the root in terms of professional, patient‐reported and economic outcomes.MethodsThis was a 10‐year randomized controlled clinical trial. 50 stage III or stage IV periodontitis subjects with a severely compromised tooth with attachment loss to or beyond the apex were randomized to PR or TER with either an implant‐ or a tooth‐supported fixed partial denture. Subjects were kept on a strict periodontal supportive care regimen every 3 months and examined yearly. Survival and recurrence analysis were performed.Results88% and 100% survival rates were observed in the PR and TER groups. Complication‐free survival was not significantly different: 6.7–9.1 years for PR and 7.3–9.1 years for TER (p = .788). In PR, the observed 10‐year attachment gain was 7.3 ± 2.3 mm and the residual probing depths were 3.4 ± 0.8 mm. Recurrence analysis showed that the 95% confidence interval of the costs was significantly lower for PR compared with TER throughout the whole 10‐year period. Patient‐reported outcomes and oral health‐related quality‐of‐life measurements improved in both groups.ConclusionsPeriodontal regeneration can change the prognosis of hopeless teeth and is a less costly alternative to tooth extraction and replacement. The complexity of the treatment limits widespread application to the most complex cases but provides powerful proof of principle for the benefits of PR in deep intra‐bony defect.

Restorative material choices for extensive carious lesions and hypomineralisation defects in children: a questionnaire survey among Finnish dentists.

This survey assessed Finnish dentists' treatment decisions and choices of restorative materials in selected paediatric dental patient cases, with special emphasis on stainless steel crowns (SSCs). A questionnaire with patient descriptions and tooth photographs was e-mailed to members of Finnish Dental Society (n=3,747). The respondents were asked to choose their preferred treatment in cases describing 1) extensive occlusal carious lesion in a primary molar of a cooperative child; 2) an identical lesion, treated under dental general anaesthesia (DGA); and 3) a symptomatic first permanent molar with enamel hypomineralisation (consistent with Molar-Incisor Hypomineralization, MIH) and post-eruptive breakdown. Only responses from dentist treating children were included (final n=765). The majority (47.3%) would have preferred restoration of the extensive primary tooth caries in a normal setting using resin-modified glassionomer cement, and 4.3% by using SSC. The preference of SSC as treatment choice increased to 25.4% upon implementation of DGA. The majority would treat the symptomatic permanent MIH molar with a resin composite restoration (45.0%), while 10.5% suggested SSC. Compared to general dentists, paediatric dentists had a stronger preference for SSCs. Although the respondents emphasised patient cooperation, but also tooth prognosis and material strength behind their treatment decisions, SSC was an uncommon choice.

Functional tooth mobility in young pigs

Mobility is a fundamental characteristic of mammalian teeth, and has been widely used to determine individual tooth prognosis. However, the direction and extent of tooth movement under functional loads are unknown. This study investigated maxillary molar mobility, alveolar bending, and periodontal space (PDL) fluid pressure during mastication and masseter muscle contraction in young pigs, along with PDL space measurements. Twelve three-month-old farm pigs were instrumented with some or all of the following: (1) ultrasonic crystals, one implanted into the pulp chamber of a deciduous maxillary molar and additional crystals glued onto its buccal and palatal alveolar plates; (2) rosette strain gauges affixed to the buccal and palatal of alveolar ridges; (3) a pressure transducer inserted into palatal alveolar bone facing the PDL. Tooth mobility, alveolar bending, and fluid pressure were simultaneously recorded during unrestrained feeding and subsequent masseter muscle stimulation. The PDL widths were measured using micro-CT. The results indicate that during the power stroke of mastication, (1) the molar displaced buccally and apically (192 ± 95 µm) regardless of the side of chewing; (2) compressive bone strain was greater on the buccal than on the palatal alveolar plate; and (3) PDL pressure increased during the power strok (3.63 ± 0.80 kPa). Masseter contraction produced similar results but with generally lower values. The PDL widths were larger than the range of tooth mobility, and showed no correlation with the mobility. Thus occlusal function causes buccal tipping and intrusion of maxillary molars with concomitant compression of the buccal alveolar plate and raised pressure within the PDL space.

Prognostic Factors of Grade 2-3 Endo-Periodontal Lesions Treated Nonsurgically in Patients with Periodontitis: A Retrospective Case-Control Study

Background Endo-periodontal lesions are bacterial infectious diseases involving both the periodontal and pulp tissues with poor outcomes. It is hard for clinicians to predict their prognosis. The aim of this study is to investigate the factors affecting the prognosis of endo-periodontal lesions. Methods A total of 140 teeth diagnosed with grade 2-3 endo-periodontal lesions in patients with periodontitis were recruited in this study. They were divided into high and low responder groups, according to the clinical symptoms and parameters of the teeth involved after nonsurgical treatment of both the endodontic and periodontal components. Clinical parameters and symptoms were compared before and after treatment, and gender, age, smoking, and all clinical parameters were compared between high and low responder groups using univariate analyses. Logistic regression was applied to evaluate the independent effects on endo-periodontal lesion prognosis. Results Compared with the clinical parameters at baseline, the values of tooth mobility (TM), periapical index (PAI), and discomfort when chewing were decreased after endodontic therapy, and the values of periodontal probing depth (PD), clinical attachment level (CAL), sulcus bleeding index (SBI), TM, simplified oral hygiene index (OHI-S), full-mouth periodontitis severity, PAI, and discomfort when chewing were decreased after periodontal therapy. Univariate analysis revealed that smoking, PD, CAL, TM, PAI, clinical crown-root ratio (CR), full-mouth periodontitis severities, and the number of root canals were significantly different between the high and low responder groups (P < 0.05). The logistic regression analysis showed that smoking, PD, CAL, full-mouth periodontitis severities, and the number of root canals remained significantly associated with grade 2-3 endo-periodontal lesions in patients with periodontitis (P < 0.05). The logistic regression analysis showed that smoking, PD, CAL, full-mouth periodontitis severities, and the number of root canals remained significantly associated with grade 2-3 endo-periodontal lesions in patients with periodontitis (Conclusions and Practical Implications. High PD and CAL, multirooted teeth, smoking, and serious full-mouth periodontitis indicated a poor prognosis for teeth with grade 2-3 endo-periodontal lesions.

Clinical performance of non-precious metal double crowns with friction pins in severely reduced dentitions

ObjectivesSeveral in vitro studies have investigated the retention of double crowns with friction pins (DCP); however, clinical data on their long-term success have not been reported. We sought to evaluate the 5-year survival rate of DCPs in patients with severely reduced dentition (SRD) and not severely reduced dentition (NSRD).Materials and methodsA total of 158 patients were treated with 182 dentures on 520 abutment teeth between 2006 and 2016. The SRD group included 144 dentures that had been inserted on 314 abutment teeth. We evaluated the influence of age, sex, jaw, number, tooth vitality, and abutment teeth localization (according to Steffel’s classification) on the 60-month survival rates of dentures and abutment teeth using the Kaplan-Meier estimator, logrank test, and Cox regression.ResultsThe cumulative 60-month survival rate was 84.3% (CI 77.1–91.5%) for all dentures; however, the survival rate in the SRD group (80.3%; CI 71.5–89.1%) was significantly lower than in the NSRD group (100%; p = 0.04). Dentures classified in Steffel’s class A had the lowest survival rate (51.5%; CI 30.9–72.1%). Number, location, and vitality of the abutment teeth had a significant impact on survival rate.ConclusionsDCP dentures showed comparable clinical long-term success to double crown systems that have been previously reported in the literature. The number, localization, and vitality of abutment teeth had the greatest influence on the survival rates of denture and abutment teeth.Clinical relevanceDCP dentures have an acceptable 5-year survival rate. Clinical treatment planning must take into account key factors associated with the prognosis of the abutment teeth.

Management of impacted and dilacerated maxillary central incisor using tractional force

The prominent tooth location and root anomalies of impacted dilacerated incisors are a clinically challenging task for the orthodontist. The absence of anterior maxillary teeth has a significant impact on esthetics, speech, mastication, and psychosocial well-being in young patients. By nature of the vicinity, the impacted maxillary central incisors in children trigger a troubling condition for parents concerned with esthetics. The position, angulation, and direction of the patient's erupting tooth and crown and age are factors that hinder an impacted tooth's prognosis. Among these, the appropriate diagnosis of dilaceration is a crucial determinant of successful treatment. Decisions are made depending on the severity of dilacerations, whether the maxillary central incisor should be exposed and aligned or extracted and replaced by a prosthesis. The first treatment option always chosen to save the impacted maxillary central incisor is the exposure of the tooth surgically, followed by orthodontic traction forces. To prevent more complications, early intervention and detection of such cases are, therefore, most important. This case report elucidates the triumphant management in a 15-year-old female patient of a vertically impacted and dilacerated maxillary right central incisor positioned high in the vestibule, treated with a combined approach of surgical exposure and spontaneous orthodontic traction force.

Knowledge and attitude of emergency management of avulsed teeth among a sample of Indian parents in Vadodara, Gujarat

Background: Traumatic injuries are commonly seen in children and adolescents, affecting their teeth and supporting structures. The most severe form of traumatic injury is tooth avulsion which leads to major psychological and esthetic problems in children. The prognosis of avulsed teeth significantly depends on prompt and efficient action at the site of the accident, thus requiring that parents or caretakers be knowledgeable about the correct management of this situation. Aim: The objective of the present study was to assess the level of knowledge of parents and caretakers regarding the emergency management for tooth avulsion by the help of a questionnaire. Materials and Methods: The study included 1000 parents of children, aged between 6 years and 12 years, who were asked to fill the modified Ralph and Gregory questionnaire for avulsed teeth. Data were analyzed using SPSS software version 20.00, and descriptive statistics were used to compare the results. Results: Nearly 68.8% of the parents believed in self-replantation, but only 42% would attempt self-replantation themselves. Only 15.4% of the parents felt that replantation should be done immediately. Water and salt solution were the most accepted cleaning medium for avulsed teeth by majority of the parents (77.4%). Almost 92% of the parents were interested in saving the tooth and 2.5% of the parents had encountered previous dental avulsion injuries in children. Conclusion: The study shows a significant lack in knowledge among parents with regard to management of tooth avulsion. There is a definitive need to hold educational campaigns imparting knowledge regarding emergency management of tooth avulsion for parents.

Regenerative periodontal surgery

The treatment and management of periodontal disease has gradually shifted from resective to regenerative periodontal therapy due to the recent progress in the understanding of periodontal wound healing and tissue regeneration. This paradigm shift has led to the development of new instruments, equipment, biomaterials and techniques for use in routine clinical practice. Several minimally invasive techniques have now been introduced that aim to regenerate periodontal tissues and improve the prognosis of teeth with periodontal disease.

In the dental implant era, why do we still bother saving teeth?

Teeth are vital sensory organs that contribute to our daily activities of living. Unfortunately, teeth can be lost for several reasons including trauma, caries, and periodontal disease. Although dental trauma injuries and caries are more frequently encountered in a younger population, tooth loss because of periodontal disease occurs in the older population. In the dental implant era, the trend sometimes seems to be to extract compromised teeth and replace them with dental implants. However, the long-term prognosis of teeth might not be comparable with the prognosis of dental implants. Complications, failures, and diseases suchas peri-implantitis are not uncommon, and, despite popular belief, implants are not 99% successful. Other treatment options that aim to save compromised or diseased teeth suchasendodontic treatment, periodontal treatment, intentional replantation, and autotransplantation should be considered on an individual basis. These treatments have competing success rates to dental implants but, more importantly, retain the natural tooth in the dentition for a longer period of time. These options are important to discuss in detail during treatment planning with patients in order to clarify any misconceptions about teeth and dental implants. In the event a tooth does have to be extracted, procedures such as decoronation and orthodontic extrusion might be useful to preserve hard and soft tissues for future dental implant placement. Regardless of the treatment modality, it is critical that strict maintenance and follow-up protocols are implemented and that treatment planning is ethically responsible and evidence based.

In the Dental Implant Era, Why Do We Still Bother Saving Teeth?

Teeth are vital sensory organs that contribute to our daily activities of living. Unfortunately, teeth can be lost for several reasons including trauma, caries, and periodontal disease. Although dental trauma injuries and caries are more frequently encountered in a younger population, tooth loss because of periodontal disease occurs in the older population. In the dental implant era, the trend sometimes seems to be to extract compromised teeth and replace them with dental implants. However, the long-term prognosis of teeth might not be comparable with the prognosis of dental implants. Complications, failures, and diseases such as peri-implantitis are not uncommon, and, despite popular belief, implants are not 99% successful. Other treatment options that aim to save compromised or diseased teeth such as endodontic treatment, periodontal treatment, intentional replantation, and autotransplantation should be considered on an individual basis. These treatments have competing success rates to dental implants but, more importantly, retain the natural tooth in the dentition for a longer period of time. These options are important to discuss in detail during treatment planning with patients in order to clarify any misconceptions about teeth and dental implants. In the event a tooth does have to be extracted, procedures such as decoronation and orthodontic extrusion might be useful to preserve hard and soft tissues for future dental implant placement. Regardless of the treatment modality, it is critical that strict maintenance and follow-up protocols are implemented and that treatment planning is ethically responsible and evidence based.

Predoctoral Dental Education in Tooth Prognosis and Treatment Complexity: A Survey of U.S. Dental Schools.

The aim of this study was to determine the educational methods and tools used to teach tooth prognosis and treatment complexity determination in U.S. predoctoral dental programs. In 2018, an online survey was emailed to the academic deans of all 66 accredited U.S. dental schools. Of these, 42 schools responded (63.6%), and 36 schools completed the entire survey (54.5%). The methods reported for teaching tooth prognosis and case complexity determination varied widely among the participating schools. Among the respondents, 25% reported using the American Association of Endodontists' Endodontic Case Difficulty Assessment, while 10% reported having no specific method for teaching prognosis. The most common method for teaching overall treatment complexity was the Prosthodontic Diagnostic Index, which was used by 24% of the respondents. However, another 24% reported that their school did not have a specific method for teaching treatment complexity. Large percentages of the respondents reported that students sometimes or often made wrong tooth prognosis and case complexity determination (90% and 92%, respectively). The most prominent feedback provided by the respondents based on their experience was the importance of faculty standardization, the understanding of students' inexperience, and the need for an interdisciplinary approach. The majority of these respondents reported that their schools had specific methods of teaching prognosis and case complexity determination. However, there was a wide range of teaching practices related to the contents and levels of evidence.

Factors influencing the long-term prognosis of root tip resected teeth.

Introduction: The aim of the study was to investigate possible predictive factors influencing the long-term success of root tip resection.Methods: The retrospective study included 216 patients (♂ 111, ♀ 106, median age 43.3 years). A total of 261 root tip resections were performed on these patients between 1989 and 2012. In addition to determining the success rates 5 and 10 years postoperatively, the factors gender, age, tooth type, use of bone replacement material and preoperative periodontal tooth status were examined with regard to their significance for the long-term prognosis of root tip resected teeth. Results: The evaluation showed an average success rate of 63.6% for all included teeth over the entire observation period (tooth at least one year postoperatively still in situ). The 5-year success rate was 78.2%, the 10-year success rate 63.1%. A dependence of the success rates on the tooth type could not be evaluated. However, the examination showed a clear dependence of the success on the age of the patients. Root tip resections in patients in the age group 60 years and older had significantly worse success rates compared to the age groups 20 to 39 years and 40 to 59 years. The prognosis was also significantly better for patients in the age group 20 to 39 years than for patients in the age group 40 to 59 years. Periodontally compromised teeth showed only a tendency for a poorer prognosis than periodontally healthy teeth. With regard to sex and intraoperative filling of the resection defect with bone replacement material, no differences in the success rates were found.Conclusions: A root tip resection is a good option, largely independent of the type of tooth, to preserve a tooth in the medium to long term after unsuccessful endodontic treatment. However, a revision of the endodontic treatment or even an extraction with subsequent implantation should always be considered as an alternative, especially with increasing age.

Dental Trauma in Children: A Quick Overview on Management.

Traumatic dental injuries (TDI) or tooth trauma have a global prevalence of 10-15%. These are often the cause of first visit to emergency room. Prognosis of teeth after injury is dependent on type of TDI, emergency treatment and time elapsed till definitive care. The low level of awareness among general public and medical practitioners often leads to delay in seeking treatment which often leads to pain, severe symptoms and poor prognosis. Pediatricians can play a significant role in identification of TDI, health advise, emergency care and referral to dentists. This paper highlights the important features to be noted in children with history of TDI and the key steps which needs to be taken in these situations.

Prognosis of teeth with external root resorption caused by adjacent impacted teeth

This study aimed to investigate the prognosis of permanent teeth with external root resorption (ERR) caused by adjacent impacted teeth. A total of 75 ERR teeth (permanent teeth) caused by adjacent impacted teeth of 63 patients were included. The prognosis of ERR teeth was analyzed followed by minimally invasive extraction of the adjacent impacted teeth. The time of follow-up was six months. The relationship between prognosis of ERR teeth and patients' age, gender, root number, type of root resorption and degree of root resorption were analyzed. In the 75 ERR teeth, 67 teeth (89.3%) did not show pulpitis symptoms. The clinical outcome was found to be related with age (r=0.330, P<0.05), whereas no relationships with gender, root number, as well as type and degree of root resorption were observed (P>0.05). Pulpitis symptom was not found in ERR teeth of patients under 30 years old. For ERR teeth caused by adjacent impacted teeth, keeping the pulp vital after surgical removal of impacted teeth is highly probable. Post-operative follow-up instead of preventive root canal therapy of ERR teeth is recommended.

Periodontal aspects of endodontic–periodontal lesions

Endodontic–periodontal lesions occur as a combination of an endodontic infection and periodontal disease in a single tooth. As an endodontic–periodontal lesion is a complex condition, establishing an accurate diagnosis and prognosis of the involved teeth is crucial while treatment planning. Modern endodontic and periodontal treatment modalities can allow improved prognosis and long-term preservation of teeth with endodontic–periodontal lesions.

Comparative study of DFDBA and FDBA block grafts in combination with chorion membrane for the treatment of periodontal intra-bony defects at 12months post surgery.

The goal of periodontal therapy is to prevent periodontal disease progression and to regenerate lost periodontal tissues. Various bone grafts are used alone or in combination with other treatment modalities for periodontal therapy. In literature no reports are presented with block allografts in the treatment of intrabony defects in periodontitis. Hence the study aimed to evaluate and compare clinically and radiographically freeze dried bone and demineralized freeze dried bone block allografts with chorion membrane in intra-bony defects at 12months post-surgery. Eighteen intra-bony defects (9 intra patient pairs) in 9 patients with chronic periodontitis were randomly assigned to group 1 (FDBA + Chorion membrane) and group 2 (DFDBA + Chorion membrane) for periodontal therapy. Clinical and radiographic (RVG) measurements were made at base line and 12months. Data obtained was subjected to statistical analysis. At 12months on intra-group comparison both the groups showed statistically significant improvement in the plaque and gingival indices with reduction in the mobility, probing pocket depth and gain in clinical attachment (p value<0.001). Radiographs showed significant bone fill and increased bone density (p value<0.001). On inter-group comparison no statistical difference were observed at 12months in clinical parameters and bone fill among both the groups. However, group 1 (FDBA) showed increase in the bone density which was statistically significant (p value<0.001). The use of the FDBA and DFDBA block allografts showed significant improvement in the periodontal prognosis of teeth with intra-bony defects. Within the limitation of the present study, both the groups showed similar results with significant increase in bone density in FDBA group.

Характеристика ускладнень, що виникають після стоматологічного лікування дефектів твердих тканин зубів

Resume. Despite the successes in the use of restoration materials and the continuous improvement of direct and indirect restoration techniques, the number of unsatisfactory results is still considerable. Since dentists make mistakes at various stages of treatment when performing restorations, the problem of improving the methods of restoration of hard teeth tissues occupies one of the leading places among the current problems of modern dentistry.The aim. To study and analyze the complications that occur in patients after dental treatment of defects of hard tissues of teeth.Materials and methods. We studed 80 patients. The first group consisted of 40 patients, who, according to traditional indications and treatment protocols, were shown direct restoration; the second group consisted of 40 patients who were shown indirect restoration. Clinical examinations of patients were performed according to classic methods. Restorations were examined using the USPHS method.Results. It is confirmed that mistakes in the stage of choosing the method of treatment of defects of hard tissues of teeth lead to clinical situations with unfavorable prognosis for such teeth, even to their loss.Conclusion. Our studies allow us to state that mistakes in the stage of choosing the method of treatment of defects of hard tissues of teeth lead to clinical situations with an unfavorable prognosis for such teeth until their loss.Key words: defect of hard tissues of a tooth, restoration, complications.