Severe Tooth Mobility Research Articles

Combination Treatment of Splinting with Wire Composite and Artificial Tooth Pontic for Improved Aesthetics: A Case Report

Advanced bone loss in patients with periodontitis often leads to increased tooth mobility, sometimes resulting in tooth loss. The mobility of teeth necessitates splinting to optimize periodontal treatment outcomes in terms of aesthetics and periodontal health. This case report presents a novel approach using an artificial tooth pontic as a periodontal splint, utilizing wire stabilization to prevent severe tooth mobility and enhance esthetics. A 37-year-old male with aggressive periodontitis (Stage III, Grade C) exhibited extensive periodontal destruction, particularly in the upper and lower anterior regions. Pathological migration was evident following the loss of teeth 31 and 41, with additional anterior teeth in the lower jaw showing mobility and trauma from occlusion, notably tooth 33. The patient underwent nonsurgical periodontal therapy, including scaling, subgingival debridement, occlusal adjustment, and splinting. Stabilization was achieved by applying a wire splint from teeth 34 to 43, incorporating an artificial tooth pontic. Subsequent evaluations revealed improvements in clinical parameters such as probing pocket depth, tooth mobility, and bleeding on probing during supportive periodontal therapy visits. The splint remained stable, and the patient expressed satisfaction with their appearance remaining unaffected. This case demonstrates that severe tooth mobility can be effectively stabilized using a composite wire splint and an artificial tooth pontic, enhancing the patient's esthetic outcomes.

Managing Short Root Anomalies in Pediatric Cancer Survivors: Utilizing Resin Wire Splints and Miniscrews for Skeletal Anchorage

Patients with pediatric cancer often undergo multiple therapies, such as chemotherapy, radiation therapy, and stem cell transplantation. These treatments, while essential, can result in dental developmental issues, including hypodontia, microdontia, short roots, and delayed dental development. This report presents two cases of pediatric patients diagnosed with neuroblastoma who exhibited severe tooth mobility due to short roots as a complication of cancer treatment. Moreover, we investigated the conservative management of the patients’ conditions using resin wire splints and orthodontic miniscrews for skeletal anchorage along with long-term follow-ups to evaluate their prognosis.

Patterns and predictors of periodontal disease and tooth loss among users of smokeless tobacco

BackgroundSmokeless tobacco (SLT) products of several different types are widely used in several South Asian countries including Pakistan. These products are consumed in different forms and with different names. The study aims to determine adverse effects of the SLT consumption on periodontal tissues.MethodsThis cross sectional study was conducted in Karachi, Pakistan. It recruited 377 users of (SLT) with 231 males (61.3%) and 146 females (38.7%) of age 15 to 45 years. After obtaining informed consent, quantitative data were collected via a questionnaire followed by intra oral clinical examination to determine presence of periodontal diseases using community periodontal index (CPI). To determine the association between periodontal diseases and smokeless tobacco consumption habits, Chi Square test was conducted.ResultsGingival recession (Class II-IV) (65.8%) was the most prevalent periodontal disease among SLT users. CPI score was high (CPI score 3 and 4) in 31.3% participants, whereas tooth loss was found in 21%. Among types of SLT products, gutka (28.6%) and betel quid (23.3%) were most commonly used. Using SLT for five or more years was found to be associated with a high CPI score, gingival recession (Class II-IV), moderate to severe tooth mobility, and presence of tooth loss.ConclusionsThe study found statistically significant association between duration in years of using SLT and periodontal disease including gingival recession, tooth mobility and tooth loss. However, no significant results were found between retention during single use and frequency of SLT use per day. However, the link of these factors with the periodontal disease cannot be eliminated.

An analog-digital hybrid technique for immediate dentures with idealized border extensions

In patients with severe tooth mobility, conventional impression making can be challenging because of the risk of accidental tooth extraction. Digital intraoral scanning avoids such a complication but does not capture optimal border extensions for a complete denture. This clinical report presents a combined digital and analog recording technique which allows the recording of optimal vestibular border extensions without the risk of tooth extraction.

The Role of Type-2 Diabetes Mellitus in the Progressivity of Periodontitis Stage IV Grade C: A Case Report

Background: According to the American Academy of Periodontology (AAP)’s classification of periodontal disease in 2017, diabetes mellitus is one of the grade modifiers of the progressivity of the disease, which is determined by the HbA1c level of a patient. Systemic condition is often considered as a risk factor that aggravates periodontal tissue breakdown. However, the progressivity of periodontal disease can also be found in healthy (nondiabetic) patients.
 Objective: To identify the role of type-2 diabetes mellitus and its effect on the severity of periodontal breakdown in periodontitis stage 4 grade C patients.
 Case Report: This case report describes the condition of female patients, aged 30–40 years, who presented to the periodontology clinic in RSKGM FKG UI, with the chief complaint of severe tooth mobility. The patients reported were healthy and diabetic (type-2 diabetes mellitus) patients diagnosed with periodontitis stage 4 grade C. Initial therapies were carried out, such as, such as scaling, occlusal adjustment and dental splint.
 Results: Clinical outcomes after one week showed no inflammation, no oedematous, no redness on gingiva and less mobility on several teeth. Both groups showed extended and aggressive progress of the disease, however, the systemic conditions also played a critical role in the overall periodontal tissue breakdown.
 Conclusion: Management of systemic disease is crucial in order to prevent periodontal breakdown or complications that could happen in periodontal therapies.
 Keywords: periodontitis, systemic disease, diabetes mellitus, case report

Sociomedical and oral factors affecting masticatory performance in an older population.

To assess the sociomedical and oral factors affecting masticatory performance in a community-dwelling older population. Community-dwelling persons over 60 years were investigated using medical and dental oral interviews, oral and denture examination (natural teeth, tooth mobility, number of occluding tooth pairs, and removable dentures' prevalence and quality), and evaluation of masticatory performance using a mixing ability test. A total of 130 participants with a mean age of 73.9±8.5 years were recorded. Fifty-eight (44.6%) used various types of removable prostheses. Twenty were edentulous and used a pair of complete dentures. Univariate analyses revealed statistically significant associations (p≤0.05) between masticatory performance and aging, marital status, subjective chewing ability, use of removable dentures, use of various combinations of complete dentures, pain caused by maxillary denture, number of teeth, tooth mobility, posterior chewing pairs, all chewing contacts natural or prosthetic, retention of mandibular partial dentures, and dentures' occlusion. The multivariable quantile regression analysis revealed that fewer natural teeth (95% CI: -0.02-0.01, p<0.001), being edentulous and using a pair of complete dentures (95% CI: 0.09-0.35, p=0.001), and larger percentage of severely mobile teeth (95% CI: 0.07-0.82, p=0.020) were associated with lower masticatory performance. Poor masticatory performance in older adults was associated with fewer teeth, being edentulous and using a pair of complete dentures, and increased prevalence of severe tooth mobility. Retaining the natural dentition and preventing and treating periodontal disease are important measures to maintain masticatory performance in older adults.

Growing gingival mass in a patient affected by hyperparathyroidism

A 65-year-old man was referred to the oral medicine department for a painless growing gingival mass of the right mandible that had appeared 4 weeks earlier. The patient reported that the gingival lesion increased in size after extraction of the mandibular right second molar, which had been performed 2 months earlier owing to severe tooth mobility and mild local gingival swelling.

Periodontal and peri-implant diseases in centenarians.

To report the prevalence of periodontal and peri-implant diseases in centenarians in South-Western Germany, examine associations with sociodemographic factors and explore age-related trends. Eligible persons born before 1920 were identified from population registries in South-Western Germany. A total of 55 centenarians were visited at home or in nursing care facilities. Of them, 35 were dentate, 33 of which underwent periodontal examination. Implants in 2 edentulous patients were also registered. The mean number of teeth was 9.5±7.1; centenarians in need of nursing care had considerably less teeth than others (8.5 versus. 17.0 teeth, p=.03). Mean probing depth was 2.7±0.8mm; mean clinical attachment loss was 4.2±1.7mm. Severe tooth mobility (degree 2 or 3) and furcation involvement were present in approximately 3% of eligible teeth. According to CDC/AAP classification, 25.8% of centenarians had no or mild periodontitis, 54.8% of centenarians had moderate periodontitis, and only 19.4% were severely affected. Of 27 implants examined in 5 centenarians, 59.3% were classified as healthy, 29.6% had peri-implant mucositis, and 11.1% had peri-implantitis. This study reveals the predominance of moderately severe disease in centenarians. While there were high levels of moderate periodontitis and peri-implant mucositis, signs of severe periodontitis, severe furcation involvement, tooth mobility or peri-implantitis were less frequent.

Periodontal Treatment in Cancer Patients: an Interdisciplinary Approach

Dental care is an essential component in the comprehensive treatment for the cancer patient. As such, a review of the literature was completed to determine the relationships between periodontal and dental care in the cancer patient and provide strategic suggestions. Periodontal treatment must be personalized depending on the patient's current oral health status, systemic status, and progress in treatment. Oral mucositis, periodontal status, and osteonecrosis of the jaw (ONJ) remain periodontal concerns in the cancer patient. Contributing factors of ONJ include root amputation (OR= 6.64), extraction of a single tooth (OR=3.7), severe tooth mobility (OR = 3.60), and unclosed wound (OR = 2.51). Preventive maintenance, oral hygiene instruction, use of fluoride and chlorhexidine are all important therapeutic strategies. If extractions are required in patients who have received bone modifying drug infusions, flap management and primary wound closure is needed to reduce the risk of complications.

Periodontitis in Chédiak-Higashi Syndrome: An Altered Immunoinflammatory Response.

Chédiak-Higashi syndrome (CHS), a rare autosomal recessive disorder caused by mutations in the lysosomal trafficking regulator gene (LYST), is associated with aggressive periodontitis. It is suggested that LYST mutations affect the toll-like receptor (TLR)-mediated immunoinflammatory response, leading to frequent infections. This study sought to determine the periodontal status of patients with classic (severe) and atypical (milder) forms of CHS and the immunoregulatory functions of gingival fibroblasts in CHS patients. In contrast to aged-matched healthy controls, atypical (n = 4) and classic (n = 3) CHS patients presented with mild chronic periodontitis with no evidence of gingival ulceration, severe tooth mobility, or premature exfoliation of teeth. As a standard of care, all classic CHS patients had undergone bone marrow transplantation (BMT). Primary gingival fibroblasts obtained from atypical and BMT classic CHS patients displayed higher protein expression of TLR-2 (1.81-fold and 1.56-fold, respectively) and decreased expression of TLR-4 (-2.5-fold and -3.85-fold, respectively) at baseline when compared with healthy control gingival fibroblasts. When challenged with whole bacterial extract of Fusobacterium nucleatum, both atypical and classic CHS gingival fibroblasts failed to up-regulate TLR-2 and TLR-4 expression when compared with their respective untreated groups and control cells. Cytokine multiplex analysis following F. nucleatum challenge showed that atypical CHS gingival fibroblasts featured significantly increased cytokine expression (interleukin [IL]-2, IL-4, IL-5, IL-6, IL-10, IL-12, interferon-γ, tumor necrosis factor-α), whereas classic CHS cells featured similar/decreased cytokine expression when compared with treated control cells. Collectively, these results suggest that LYST mutations in CHS patients affect TLR-2 and TLR-4 expression/function, leading to dysregulated immunoinflammatory response, which in turn may influence the periodontal phenotype noted in CHS patients. Furthermore, our results suggest that atypical CHS patients and classic CHS patients who undergo BMT early in life are less susceptible to aggressive periodontitis and that hematopoietic cells play a critical role in mitigating the risk of aggressive periodontitis in CHS. Knowledge Transfer Statement: Results from this study can be used to create awareness among clinicians and researchers that not all CHS patients exhibit historically reported aggressive periodontitis, especially if they have atypical CHS disease or have received bone marrow transplantation. LYST mutations in CHS patients may affect TLR-2 and TLR-4 expression/function leading to dysregulated immunoinflammatory response, which in turn may influence the periodontal phenotype noted in CHS patients.

A multicenter retrospective study of the risk factors associated with medication-related osteonecrosis of the jaw after tooth extraction in patients receiving oral bisphosphonate therapy: can primary wound closure and a drug holiday really prevent MRONJ?

Osteonecrosis of the jaws can occur following tooth extraction in patients receiving bisphosphonate drugs. Various strategies for minimizing the risk of MRONJ have been advanced, but no studies have comprehensively analyzed the efficacy of factors such as primary wound closure, demographics, and drug holidays in reducing its incidence. The purpose of this study was to retrospectively investigate the relationships between these various risk factors after tooth extraction in patients receiving oral bisphosphonate therapy. Risk factors for MRONJ after tooth extraction were evaluated using univariate and multivariate analysis. All patients were investigated with regard to demographics; type and duration of oral bisphosphonate use; whether they underwent a discontinuation of oral bisphosphonates before tooth extraction (drug holiday), and the duration of such discontinuation; and whether any additional surgical procedures (e.g., incision, removal of bone edges, root amputation) were performed. We found that root amputation (OR=6.64), extraction of a single tooth (OR=3.70), bone loss or severe tooth mobility (OR=3.60), and an unclosed wound (OR=2.51) were significantly associated with increased risk of developing MRONJ. We recommend a minimally traumatic extraction technique, removal of any bone edges, and mucosal wound closure as standard procedures in patients receiving bisphosphonates. We find no evidence supporting the efficacy of a pre-extraction short-term drug holiday from oral bisphosphonates in reducing the risk of MRONJ.

Fiber composites as a method of treatment splinting tooth mobility in chronic periodontitis

Patients with periodontal disease can lead to severe tooth mobility so often complains of pain when eating, decreased chewing ability and functional occlusion. Tooth mobility is a movement in a horizontal or vertical direction and one of the most unpleased effects from periodontal disease. Basically, tooth mobility is not a disease that requires treatment, but it is a symptom of periodontal tissue morphology changes, so it became a challenge for dentists in making decisions to maintain proper care of the teeth. Recent studies improved the use of periodontal splint with fiber reinforced composite (FRC) or fiber composite may lead to a long-term prognosis of teeth mobility due to periodontal disase. The case report describes treatment of chronic periodontitis patients with splinting fiber composites as a method for stabilization of the lower anterior teeth providing aesthetics, comfort, improved functionality occlusion, mastication and a good prognosis.

Elastic band causing exfoliation of the upper permanent central incisors.

Objective. This study reports a case in which elastic band use culminated in the loss of the incisors. Case Report. An 11-year-old white girl was seen complaining of pain, with purulent discharge and severe tooth mobility. The bone destruction detected radiographically in the region, despite its single location and absence in posterior quadrants of the maxilla and/or mandible, was similar to that observed in Langerhans cell disease. To our surprise, an elastic band involving the midportion of the roots of the two upper central incisors was found during biopsy. The debris was removed and a metal wire was placed in permanent maxillary right and left incisors. The patient was followed up, but no improvement in tooth mobility was observed. Bone loss increased, and internal resorption and root exposure occurred, which culminated in the extraction of permanent maxillary right and left incisors. Conclusion. The present case highlights the fact that professionals sometimes are confronted by anamnestic reports never seen before.

Adverse events of surgical extrusion in treatment for crown–root and cervical root fractures: a systematic review of case series/reports

Crown-root and cervical root fractures constitute a restorative challenge due to sub-gingival position of the fracture margin. Surgical tooth extrusion is one of the treatment options. There is uncertainty regarding the prognosis of such treatment modality. To assess adverse events of surgical tooth extrusion in the treatment for crown-root and cervical root fractures in permanent teeth. PubMed, Embase, and Google Scholar were searched through 15th of June 2012. Search was limited to English and Arabic languages. Reference list of relevant studies were hand-searched. Grey literature was searched using Open Grey. Two review authors independently extracted data, while only one assessed trial quality using 8-point methodological index for non-randomized studies (MINORS) scale. A sensitivity analysis was performed to exclude studies with suspected patients' duplicates. Eleven case reports and eight case series involving 226 patients with 243 teeth were identified. No randomized controlled trials were found. The mean quality score for all case series was 9 suggesting a fair quality, while that of all case reports was 5 suggesting poor quality. Non-progressive root resorption is the most common finding following surgical extrusion with an event rate of 30% (95% CI 24.6-36.7%). This is followed by low event rates of tooth loss (5%), slight mobility (4.6%), marginal bone loss (3.7%), and progressive root resorption (3.3%). No ankylosis occurred to any extruded tooth, while severe tooth mobility showed negligible overall event rate of 0.4%. The available evidence suggests that surgical tooth extrusion is a valid technique in management of crown-root and cervical root fracture of permanent teeth. Minimal adverse events and good prognosis are expected. Further, surgical extrusion can be considered as a treatment option in teeth suffering sub-gingival decay.

Tooth separation: A risk-free procedure?

This article reports the case of a 12-year-old patient with tooth extrusion, pain, gingival bleeding, and localized periodontitis near the maxillary second premolar. Despite probing and radiographic examination, it was not possible to establish the etiology. Tooth extraction was indicated because of the severe tooth mobility and extrusion. Curettage of the tooth socket revealed a rubber separator. Preventive approaches are suggested to avoid iatrogenesis and legal problems.

어린이의 하악골에서 발생한 Burkitt 림프종

Burkitt`s lymphoma is a malignant tumor originated from B lymphocyte and a type of non-hodgkin lymphoma. It is clinically classified by endemic, sporadic and immune deficient forms. In the past, it had poor prognosis but in recent years survival rate is 50~80% treated by intensive chemotherapeutic regimens. Mostly it is a lesion of the jaws. Clinical symptoms are severe tooth mobility, displacement, gingival redness and swelling. This case is about a patient with aggressively progressing Burkitt`s lymphoma of the jaws. Initial diagnosis was done in dental hospital and it has shown satisfactory outcome by prompt and appropriate treatment.

Mucocutaneous dyskeratosis with periodontal destruction and premature tooth loss

We report the case of a 16-month-old boy who presented an exuberant erythematous gingival swelling and severe tooth mobility. Radiographic examination confirmed alveolar bone loss, and gingival biopsy showed epithelium containing numerous dyskeratotic cells. Because of feeding difficulties, the enlarged gingival tissue and involved teeth were removed. One year later, similar problems were encountered during the eruption of the deciduous second molars. The patient also exhibited papular skin lesions. Histopathologic features on biopsies of the skin and oral lesions were similar. The oral and cutaneous lesions presented by this patient were similar to those described by From et al. in 1978 in a father and son, reported as dyskeratosis benigna intraepithelialis mucosae et cutis hereditaria--the sole report in the English language. To avoid confusion with hereditary benign intraepithelial dyskeratosis (Witkop-von Sallmann syndrome) we have renamed the condition as mucocutaneous dyskeratosis with periodontal destruction and tooth loss.

Metastatic Mandibular Neuroblastoma: A Rare Cause of Tooth Mobility

Neuroblastoma (NBL), a malignant embryonic tumor derived from neural crest cells, is the most common tumor worldwide among children less than 1 year of age. Metastasis to the mandible is uncommon. This article reports the case of a 15-month-old male diagnosed with NBL with bone metastasis including the mandible which resulted in severe tooth mobility. Dentists or pediatricians should consider the primary or metastatic tumors of the maxillofacial region in the differential diagnosis in children presenting with premature loss of teeth related to tooth mobility.

周期性好中球減少症に伴う歯周疾患の１例

A case of periodic neutropenia with specific symptoms of gingiva and alveolar bone loss in primary dentition is reported. The patient was a boy, and it was followed between the ages of 3- and 9 years-old. At the period of neutropenia he was suffered from recurrent redness, swelling and bleeding of the gingiva, and also with cold-like symptoms with fever. Although the cause of these symptoms was not definite at first, even in medical exploration, we could diagnose this disease as periodic neutropenia by the process of dental therapy. By alveolar bone resorption, pocket formation and severe tooth mobility, the patient had lost more than half of his primary teeth at the end of 2 years after the initial examination. However throughout this period we motivated and instructed the patient and his mother how to brush his teeth. His oral hygiene was improved in the mixed and permanent dentition stages. Then there was no evidence of bone resorption around the teeth of the permanent dentition stage, but recurrent gingival symptoms are continuing now. The specific feature of this case is found in the gingival findings. There was no ulceration of the oral mucosa, but a bright red jelly-like appearance was found periodically in the area of the marginal and attached gingiva. The junction between the reddened attached gingiva and the alveolar mucosa was well-defined. The serial examination of peripheral blood in this case revealed the cycle of neutropenia as 16 to 21 days. During this examination, and at the almost time of neutropenia of this patient, hyperplasia of monocytes and lymphocytes occurred. In this situation there was no clinical signs except for gingival redness. However at other times, generally marked signs were recurrent. This may have occurred due to the lack of both neutrophils and monocytes. From the above results we think that periodic neutropenia may be diagnosed first in the dental clinic by the distinctive redness in the gingival area as one specific sign of this disease. We also think that plaque control procedures may retain the teeth.

Bacterial bone resorption in advanced cases of human periodontitis.

In advanced cases of human periodontitis with pocket depths over 4 mm, severe tooth mobility and bone loss involving approximately two‐thirds of the alvelor height as assessed radiographyically, numerous Gram negative and Gram postitive filamentous, rodshaped, and coccoid bacteria were seen inflitrating the periodontal ligament, coming into close contact with the alveolar bone surface and even invading superfical osteocyte lacunae. Typical bone resporption occured along the bacterial front. This was characterized by a scattered dissolution of individual apatite crystals denuding corssstriated collagen fibrils which were finally destroyed. In the vicinity of such areas, two types of calculus formation were observed in the ligament. Calcification occurred at the surface and between the microorganisms with entrapped bacterial remnants. The second type of calcification developed on cellular remnants. The presence of microorganisms alongs resorbing alveolar bone surfaces in advanced cases of periodonitis cannot be considered as an artifact.