Retention Of Molars Research Articles

Efectos de la furcación sobre la supervivencia molar en pacientes sometidos a tratamiento periodontal

Objective: This study aims to analyze the survival time of molar tooth according to furcation involvement (FI) classification among periodontally treated patients under a supportive periodontal care program. Materials and Methods: A retrospective study was con-ducted among 77 periodontitis patients with 240 molars who had undergone periodontal therapy that were followed up with supportive periodontal therapy (SPT) for at least five years. Periodontitis patients’ data were retrieved from the periodontic clinical record. The clinical parameters of all involved molars and treatment modality were recorded at baseline and SPT. Results: A total of 69 (28.8%) molars were extracted during active periodontal therapy, while 17 (7.1%) were lost during SPT. The 5-year survival rate of molars was 83.5% (95% confidence interval [CI], 76.9-88.4) for FI=0 (n=141), 81.0% (95% CI, 56.9-92.4) for FI=I (n=18), 50.0% (95% CI, 33.8-64.2) for FI=II (n=21), and 25.0% (95% CI, 6.9-48.8) for FI=III (n=4). Additionally, the 10-year survival rate for molars with FI = III was 12.5% (95% CI, 1.0-39.2), which was lower than that of molars with FI = 0 (77.1%; 95% CI, 69.7-83.0). Conclusions: The presence of a high degree of FI classifica-tion, especially Class III, is associated with a lower survival rate of molars among periodontally treated patients. Retention of molars is possible on a long-term basis through a maintenance program of periodontal therapy.

RETENTION OF MANDIBULAR MOLARS: ETIOLOGICAL FACTORS, CURRENT DIAGNOSTIC APPROACHES, AND TREATMENT OPTIONS

The problem of tooth eruption is a common issue affecting nearly 20% of the population. Along with this, there is a growing trend of increased dentoalveolar anomalies in children and adults. One of such anomalies is the retention of the mandibular molars, which has always been a complex dentoalveolar pathology posing clinical challenges for orthodontists and oral surgeons. The aim of this study is to review and analyze relevant literature sources regarding the current etiological factors, diagnostic methods and treatment options for the retention of the mandibular molars. Tooth eruption is a complex and highly regulated process, which is currently the subject of research by many authors. There are various theories about the process of tooth eruption, often contradicting each other. Retention of molars should be considered as a pathological phenomenon with a multifactorial aetiology. Consequently, the approach to the diagnosis and treatment of this pathology cannot be standardized or unified. Therefore, there is a tendency to personalized approach both in the diagnosis and treatment of patients with dentoalveolar anomalies. In most cases, the diagnosis of molar retention is based on a clinical and x-ray examination. Notably, decision-making and treatment strategy selection rely on constantly evolving methods. Unfortunately, the acceleration and early completion of bone tissue maturation increase the frequency of tooth retention, pushing clinicians towards the early intervention. This, in turn, requires a revision of existing recommendations and protocols. The development of technology and the modern possibilities of digital planning open up new horizons and provide tools for addressing complex challenges; however, they require a multidisciplinary approach to implementing non-standard treatment methods involving both orthodontists and oral surgeons. Apparently, all novel techniques require careful analysis, which provides researchers with space for further investigations.

Primary Retention of Molars and RANKL Signaling Alteration during Craniofacial Growth.

The primary retention of molars observed in clinic corresponds to a still-unexplained absence of molar eruption despite the presence of an eruption pathway, resembling the experimental transient inhibition of RANKL signaling in mice. The aim of the present study was to confront the hypothesis according to which the primary retention of molars is associated with transitory perturbations to RANKL signaling during growth as part of a wider craniofacial skeleton pattern. The experimental strategy was based on combining a clinical study and an animal study corresponding to the characterization of the craniofacial phenotypes of patients with primary retention of molars and analyses in mice of the consequences of transient inhibition of RANKL signaling on molar eruption and craniofacial growth. The clinical study validated the existence of a particular craniofacial phenotype in patients with primary retention of molars: a retromandibular skeletal class II typology with reduced mandibular dimensions which manifests itself at the dental level by a class II/2 with palatoversion of the upper incisors and anterior overbite. The animal study demonstrated that transient invalidation of RANKL signaling had an impact on the molar eruption process, the severity of which was dependent on the period of inhibition and was associated with a reduction in two craniofacial morphometric parameters: total skull length and craniofacial vault length. In conclusion, primary retention of molars may be proposed as part of the craniofacial skeleton phenotype associated with a transitory alteration in RANKL signaling during growth.

Retained Primary Molars and Related Reasons in Umm Al-Qura University, Makkah: A Retrospective Study

Background: Retention of primary molars beyond the expected time of exfoliation is uncommon; this condition is known as persistence. A retained primary tooth, with the crown in good condition, roots, and supporting alveolar bone can serve adults for many years. Objective: To determine the prevalence of retained primary molars and investigate the reasons for their persistence in Umm Al-Qura University. Methods: Overall, 500 extra-oral panoramic radiographs were assessed to investigate whether primary molars persisted beyond the expected exfoliation period. Dental records were also reviewed to investigate the possible reasons for persistence. The collected data were tabulated and statistically analyzed, with P < .05 considered significant. Results: Seventy-six retained primary molars were identified (39 in females and 37 in males) in 500 panoramic radiographs (from 260 females and 240 males). Agenesis of the permanent successor tooth was the most frequently encountered reason for the retention of primary molars (19%). The second most frequent reason was ectopic deviation of the path of eruption of the successor (11%). The third most common reason was impaction of the successor (10%). Conclusion: The incidence of retained primary molars in the investigated population was 15.2%. The most common reason for the persistence of primary molars was agenesis of the permanent successor, followed by ectopic eruption and impaction of the successor teeth. These data highlight the need for education and awareness of dentists and patients to preserve the primary tooth when there is no permanent successor present and support an appropriate treatment plan for each case.

Retention of molars after root-resective therapy: a retrospective evaluation of up to 30years.

Long-term retention of teeth and especially molars in function is the ultimate goal of periodontal therapy. Root-resective therapy is a treatment option for molars with advanced furcation involvement, which has been questioned because of the heterogenous success rates published in literature. This study aimed to evaluate long-term results of root-resective treatment over a period of up to 30years. In this retrospective cohort, 90 root-resected molars in 69 patients were examined for 4-30years (14.7±6.8years). The complete treatment sequence was performed by one of the authors in a general dental practice. Overall cumulative survival rate was 90.6% after 10years, but then decreased considerably. Molars after root resection had a median survival time of 20years. The incidence of endodontic complications leading to tooth extraction was only 26.7%, 50% were lost due to periodontal problems, and 16.7% because of caries. Mandibular molars had a significantly lower relative risk of loss than molars in the maxilla (HR 0.31, 95% CI 0.1-0.91, p=0.033). Mandibular molars showed a survival probability of almost 80% even 20years after root resection. Root-resective therapy is a predictable treatment option, when care is administered at each phase of therapy. This study provides important information about what is possible in daily practice under the outlines of public health care, when care is administered at each phase of resective therapy.

Endodontic status and retention of molars in periodontally treated patients: results after 10 or more years of supportive periodontal therapy.

To assess the influence of endodontic status on retention of molars in patients under supportive periodontal treatment (SPT). A total of 136 subjects with 1015 molars at baseline were examined retrospectively, including 188 endodontically treated molars in 90 patients. Multilevel Cox regression analysis identified factors contributing to loss of molars. Root canal treatments contributed significantly to loss of molars during on average 13.2years of SPT (Hazard ratio: 2.98, 95% CI: 1.74-5.1, p<0.001). Endodontic treatment was more frequently present in first molars (p<0.001) and in the maxilla (p=0.01). In endodontically treated molars, degree III furcation involvement could be detected more often compared to molars without root canal treatment (p<0.001). Among the root canal-treated molars, several patient and tooth-related factors showed an impact on tooth retention, but only molars with a periapical index of 4 and 5 (labelled "diseased") were significantly more often lost. The retention of molars in periodontally compromised patients after periodontal treatment is influenced by periodontal as well as endodontal factors. On a long-term basis, it is feasible to retain these teeth via active periodontal treatment and SPT for more than 10years.

Management of periodontal furcation defects employing molar bisection; a case report with review of the literature

Introduction: The management and long-term retention of molars exhibiting furcation invasion have always been a challenge in dentistry. Latest innovations in dental sciences and higher patient's expectations have led to more conservative treatment approaches in saving the teeth with hopeless periodontal prognosis. When periodontal disease affects the furcation area of tooth, the chance of its exfoliation increase considerably. Here, authors have sought to discuss a comprehensive review of literature with case report for the management of decayed mandibular first molars (with furcation invasion) using bicuspidization procedure. Case Report: The furcation defect (in mandibular first molars) was clinically detected in a middle aged male, which was converted into two bicuspids by intentional bisection procedures. The definitive treatment included restoration with double crowns. Bicuspidization procedure with double metal crowns truly yielded a satisfactory result. Discussion: The treatment of furcations affected by periodontal disease is one of the most difficult problems for the general dentist and periodontist. An increase in the exposed root surface, anatomical peculiarities and irregularities of the furcation surface all favor the growth of bacteria. These problems make it harder for the patient to maintain hygiene, and impede adequate treatment. Bisection/bicuspidization of the decayed molars can be a practicable treatment option when there is vertical bone loss involving root/roots with furcation defect. In real terms, it is the separation of mesial and distal roots of mandibular molars along with its crown portion, where both segments are then retained individually.

Impaction and Retention of Second Molars: Diagnosis, Treatment and Outcome

To evaluate treatment outcome in patients with second molar impaction and retention. A total of 135 second molars, 65 in the maxilla and 70 in the mandible were collected from 87 patients (45 girls and 42 boys) with a mean age of 15 years (range: 11- 19 years). Available patient records, x-rays, study casts, and photos were studied. The mean follow-up period was 22 months (range: 4-106 months). A total of 166 second molars were diagnosed as impacted, 24 as primary and 5 as secondarily retained; 80% of the second molars were orthodontically or surgically treated. In more than half of the treated patients the second molars failed to erupt into a proper position. Surgical exposure of the retained or impacted second molar was the treatment found most successful (71%). The least successful treatment (11%) used the third molar to replace the second molar after the second molar was extracted. No clear difference in treatment outcome could be detected between the impacted and the primary or secondary retained teeth. However, a clear difference was found between the impacted and the primary retained second molars regarding treatment strategy: 9% of the impacted and 67% of the primary retained teeth were left untreated. Dental crowding was found in 70% of the patients. In more than half of the treated patients the second molars failed to erupt into a proper position. The most common treatment given (extraction of the second molar) was the least successful.

Secondary retention of permanent molars in otherwise healthy adults: three case reports

Secondary retention of permanent molars is an uncommon condition with poorly understood causative factors. Data concerning the mechanism of secondary retention in the permanent molars are insufficient, although a possible role of ankylosis of unknown origin has been suggested. The localization of a genetic/biological defect in the eruption phenotype of secondary retention is largely unknown at present. The intent of this article is to consolidate and organize available information regarding the aetiopathogenesis and to corroborate the current evidence in terms of overall management using three adult case reports exhibiting secondary retention of permanent molars.

Impaction and Retention of Second Molars: Diagnosis, Treatment and Outcome

Impaction and Retention of Second Molars: Diagnosis, Treatment and Outcome

Retention of Maxillary Molars with Class III Furcation Involvement Utilizing Glass-Ionomer: Two Case Reports

Advanced furcation invasion has long been a treatment dilemma for the clinician. The present two case reports used a glass ionomer restorative material as a barrier in the treatment of maxillary Class III furcation defects. One year follow-up results showed a reduction in tooth mobility and probing depths and no bleeding on probing with the use of the glass ionomer. These case reports offer another option in the treatment of a seemingly hopeless periodontally involved maxillary molar.

Jaw malformations plus displacement and numerical aberrations of teeth in neurofibromatosis type 1: a descriptive analysis of 48 patients based on panoramic radiographs and oral findings

Aim: The aim of this study was to analyse jaw malformations and tooth displacement in patients with neurofibromatosis type 1 (NF1). Material and Methods: Forty-eight patients were included in the study (male or female 24 each). All fulfilled the current NIH diagnostic criteria for NF1. The age range was 2.5–66 years. The type of neurofibroma was histologically proven in surgically treated patients. Patients with disseminated cutaneous neurofibromata and those with the plexiform type were distinguished. The analysis was based on physical investigation, photographs, panoramic radiographs and dental casts. Results: With the emphasis on alterations of tooth position, deformities of the adjacent bones and malocclusion, the majority of these patients (26) were affected by plexiform neurofibromata. In the other 22 patients with disseminated neurofibromata, malformations of the alveolar ridge were absent and individual oral symptoms were rarely found and were mild, and in all cases were unimpaired. Numerical aberrations and retention of molars was exclusively associated with a trigeminal nerve affected by plexiform neurofibroma. Aplasia of a second lower molar was recognized in four of these plexiform-neurofibroma patients. Conclusion: It is widely accepted that malformations of the facial skeleton are often of genetic origin. However, in this study these malformations were strongly associated with plexiform neurofibromata originating from the trigeminal nerve. Thus, in addition to presently unknown genetic factors, the pattern of skeletal malformation can be caused by tumour invasion and local destruction, e.g. the neuromuscular unit or prenatal development of the plexiform neurofibroma in the inferior alveolar nerve. It is further concluded that epidemiologic studies on the incidence and severity of NF1 in the oral and maxillofacial region have to distinguish between patients with or without plexiform neurofibroma, especially when analysing alterations and deformities of the jaws, teeth and malocclusion. Aplasia of second inferior molars is an additional (dental) finding associated with plexiform neurofibromata in NF1.

Eruption disturbances of the first and second permanent molars: Results of treatment in 43 cases

Impaction or retention of first and second permanent molars is an uncommon condition with diverse therapeutic approaches. To ascertain the success rate of different treatment possibilities, a retrospective study was made of 25 patients with a total of 43 permanent molars with eruption disturbances. In most cases, the nonerupted teeth were mandibular second molars (65%), followed by maxillary second molars (21%). Their position, degree of impaction (inclusion), clinical features, repercussion on the neighboring teeth, type of treatment, and outcome were evaluated. Infraocclusion was often associated with malposition of neighboring teeth, as well as extrusion and infraocclusion of opposing teeth. Due mostly to a delay in the diagnosis of the condition, an acceptable final position of the nonerupted molar was obtained in only 8 of 13 conservatively treated second molars. In order to prevent this situation, radiographic examination (ideally during the early mixed dentition period) and early diagnosis of eruption disturbances of permanent first and second molars are recommended, particularly when considering that these anomalies are associated with a high rate of occlusal disturbances that may require orthodontic correction. (Am J Orthod Dentofacial Orthop 1999;116:651-8)

Secondary retention of permanent molars: a report of five families

The aetiopathogenesis of secondary retention is not fully understood, but heredity is involved in at least some cases. In this study first-degree relatives of 52 patients with secondary retention of permanent molars were screened for the presence of the same phenomenon in their dentition. Familial occurrence could be shown in five families. The pedigrees are compatible with autosomal dominant inheritance. HLA phenotypes and bloodgroups ABO, rhesus and P 1 were studied in two families. The lod scores for linkage with secondary retention were added to previously reported information. The lod score for linkage for bloodgroup system P increased from + 0.940 to + 1.475 at a recombination fraction of 5 per cent. It is concluded that secondary retention of permanent molars is an aetiologically heterogeneous condition in which some cases are caused by the presence of an abnormal autosomal dominant gene.

Secondary retention of permanent molars: an assessment of ankylosis by scanning electron and light microscopy

Secondary retention refers to the cessation of eruption of a tooth after emergence. This may be the result of pathological changes in the periodontal ligament. The aim of this study was to describe the morphological and histological aspects of the radicular surface of secondarily retained permanent molars. The roots of 12 secondarily retained molars and two control molars, were examined by means of scanning electron microscopy (SEM) and light microscopy (LM) in order to analyse the occurrence and localisation of ankylosis. With SEM it was observed that the root surface of retained molars showed local areas covered with bonelike tissue. LM of these areas showed that this tissue was bone in direct contact with the root surface (ankylosis). In 11 cases, the areas of ankylosis were observed in the bifurcation area and at the interradicular root surface. In the remaining case, ankylosis was located at the outer root surface. The results of this study endorse the assumption that focal ankylosis is an important factor in secondary retention. Treatment recommendations must be based on this fundamental principle, because orthodontic movement of ankylosic molars is not possible.

Clinical, radiographic and histological characteristics of secondary retention of permanent molars

Secondary retention refers to the cessation of eruption of a tooth after emergence neither due to a physical barrier in the path of eruption nor as a result of an abnormal position. In this study, the clinical and radiographic features of 81 secondary retained permanent molars in a group of 53 patients were evaluated. Retained molars removed for therapeutic reasons ( n = 38) were examined histologically to detect any areas of ankylosis. The first molars in the mandible and maxilla were most frequently affected. The mean infraocclusion at the patients' first visit was 4.3 ± 1.9 mm. After 6 months, infraocclusion increased in adolescents but was stable in adults. Tilting of the adjacent teeth was observed in 39 cases. A sharp, solid percussion sound and a partial absence of the periodontal ligament space on radiographs were noted in less than one-fifth of the affected molars, while histological evaluation revealed that local areas of ankylosis were present in all cases. From the data relating to the 38 molars removed for therapeutic reasons, the sensitivity of the percussion test and radiographic evaluation was found to be 29 and 21 per cent respectively. During a period of 4 years, six new cases of secondary retention were observed in the same population. From this study it is concluded that secondary retention of permanent molars seems to be associated with focal ankylosis and that percussion tests and radiographs are not sufficiently reliable to exclude the presence of ankylotic areas. The presence of ankylotic areas and tendency of infraocclusion to increase in adolescents but to be stable in adults have major implications for therapy.