Severe Tooth Research Articles

Porous phosphate-based bioactive glass /β-TCP scaffold for tooth remineralization.

The total or partial loss of teeth in the Mexican population due to periodontal diseases and trauma causes the development of other conditions, such as limitations in chewing and grinding food, pronunciation difficulties, and oral aesthetic alterations. In Mexico, oral diseases have been described to affect 87% of the population, according to reports by the health services, emphasizing that pregnant women and patients with diabetes mellitus have the highest risk of presenting with severe periodontal diseases or tooth loss, according to findings by the Mexican Health Department's Specific Action Program for the prevention, detection, and control of oral health problems (2013-2018). There was a 92.6% prevalence of dental caries in the population examined, and the prevalence of periodontal problems, mainly in 40-year-olds, was above 95%. The objective of this investigation was to manufacture and characterize porous 3D scaffolds with innovative chemical compositions, using phosphate-based bioactive glass, beta-phase tricalcium phosphate, and zirconium oxide, in variable quantities. The scaffold manufacturing method combined two techniques: powder metallurgy and polymer foaming. The results obtained in this research were promising since the mechanically tested scaffolds showed values of compressive strength and modulus of elasticity in the range of human trabecular bone. On the other hand, the in vitro evaluation of the samples immersed in artificial saliva at days 7 and 14 presented the calcium/phosphorus ratio = 1.6; this value is identical to the reported state-of-the-art figure, corresponding to the mineral phase of the bones and teeth. Likewise, the precipitation of the flower-like morphology was observed on the entire surface of the scaffold without zirconia; this morphology is characteristic of hydroxyapatite. On the other hand, the samples with 0.5 and 1.0 mol% zirconia showed less hydroxyapatite formation, with a direct correlation between scaffold dissolution and the amount of zirconia added.

Association of Dental Infections with Intracranial Atherosclerotic Stenosis

Introduction: Periodontal disease (PD) and dental caries are oral infections leading to tooth loss that are associated with atherosclerosis and cerebrovascular disease. We assessed the hypothesis that PD and caries are associated with asymptomatic intracranial atherosclerosis (ICAS) in the Atherosclerosis Risk in Communities (ARIC) study. Methods: Full-mouth clinical periodontal measurements (7 indices) collected at 6 sites per tooth from 6,155 subjects from the Dental Atherosclerosis Risk in Communities Study (DARIC) without prior stroke were used to differentiate seven PD stages (Periodontal Profile Class [PPC]-I to -VII) and dental caries on coronal dental surface (DS) and dental root surface (DRS). A stratified subset underwent 3D time-of-flight MR angiogram and 3D high isotropic-resolution black blood MRI. ICAS was graded according to the criteria established by the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. We evaluated the relationship between PD stage and dental caries with asymptomatic ICAS, graded as no ICAS, <50% ICAS, and ≥50% ICAS. Results: Among dentate subjects who underwent vascular imaging, 801 (70%) had no ICAS, 232 (20%) had <50% ICAS, and 112 (10%) had ≥50% ICAS. Compared to participants without gum disease (PPC-I), participants with mild-moderate tooth loss (PPC-VI), severe tooth loss (PPC-VII), and severe PD (PPC-IV) had higher odds of having <50% ICAS. Participants with extensive gingivitis (PPC-V) had significantly higher odds of having ≥50% ICAS. This association remained significant after adjusting for confounding variables: age, gender, race, hypertension, diabetes, dyslipidemia, 3-level education, and smoking status. There was no association between dental caries (DS and DRS) and ICAS <50% and ≥50%. Conclusion: We report significant associations between mild-moderate tooth loss, severe tooth loss, and severe PD with <50% ICAS as well as an association between extensive gingivitis and ≥50% ICAS. We did not find an association between dental caries and ICAS.

Camouflage Correction of Skeletal Class III Severe Open Bite with Tooth Ankylosis Treated by Temporary Anchorage Devices: A Case Report

Tooth ankylosis is a disorder characterized by the fusion of tooth and alveolar bone. This case report describes the treatment of a severe open bite due to tooth ankylosis. A 14-year-old female patient with a chief complaint of masticatory dysfunction was diagnosed with skeletal Class III severe anterior open bite and tooth ankylosis. She visited our university hospital with a chief complaint of an anterior open bite. After the surgical luxation of the ankylosed maxillary right central incisor, the tooth was orthodontically retracted using a nickel-titanium wire. The right mandibular lateral incisor and canine were luxated and retracted using intermaxillary elastics from a temporary anchorage device (TAD), which was inserted in the opposite jaw. During the treatment, skeletal Class III malocclusion deteriorated due to anterior growth of the mandible. Therefore, TADs were inserted into the retromolar pad on both sides of the mandible and retracted into the mandibular dental arch. Although the mandibular right canine was luxated several times, it could not be brought to the occlusal line, and was thus extracted; the extraction space was replaced with a prosthesis. Consequently, a normal overjet and overbite with a straight profile were achieved. Extrusion of ankylosed teeth by intermaxillary elastics from a TAD is a valid treatment option for patients with severe open bites.

Association of Tooth Loss and Diet Quality with Acceleration of Aging: Evidence from NHANES

BackgroundAlthough tooth loss is widely recognized as a typical sign of aging, whether it is associated with accelerated aging, and to what extent diet quality mediates this association are unknown. MethodsData were collected from the National Health and Nutrition Examination Survey. The missing tooth counts were recorded as the number of edentulous sites. Phenotypic accelerated aging was calculated using 9 routine clinical chemistry biomarkers and chronological age. Healthy Eating Index 2015 (HEI-2015) score was used to evaluate diet quality. Multivariate logistic regression and linear regression were used to analyze the association between tooth loss and accelerated aging. Mediation analyses were used to examine the mediation role of diet quality in the association. ResultsThe association between tooth loss and accelerated aging was confirmed. The highest quartile of tooth loss showed a positive association with accelerated aging (β=1.090; 95% confidence interval, 0.555 to 1.625; P < .001). Diet quality decreased with increase number of missing teeth and showed a negative association with accelerated aging. Mediation analysis suggested that the HEI-2015 score partially mediated the association between tooth loss and accelerated aging (proportion of mediation: 5.302%; 95% confidence interval, 3.422% to 7.182%; P < .001). Plant foods such as fruits and vegetables were considered the key mediating food. ConclusionsThe association between tooth loss and accelerated aging, as well as the partially mediating role of dietary quality in this association was confirmed. These findings suggested that more attention should be paid to the population with severe tooth loss and the changes of their dietary quality.

Severe tooth loss and mortality risk: a population-based, longitudinal prospective study in a rural setting.

Information on the relationship between tooth loss and mortality among individuals living in rural settings is limited. In this prospective cohort study, Atahualpa residents ≥40y of age (n=933) were followed for a mean of 7.3±3.2y to estimate mortality risk according to whether they had severe tooth loss (<10 remaining teeth). Overall, 151 individuals (16%) died, resulting in a crude mortality rate of 2.35 per 100 person-years of follow-up. Individuals with severe tooth loss were more likely to die (73/276) compared with those with mild-moderate tooth loss (78/657), after adjusting for relevant covariates (hazard ratio 1.45 [95% confidence interval 1.02 to 2.04]). Severe tooth loss is associated with increased mortality in remote communities.

Symptom Cluster Experiences of Patients Operated for Oral Cancer: A Mixed Methods Study

ObjectiveThis convergent mixed methods study aimed to obtain a comprehensive understanding of symptom cluster experiences in patients with oral cancer. Survey and phenomenological interviews were conducted in parallel to identify distinct patient subgroups based on symptom cluster experiences along with their predictors and explore experiences of living with symptom clusters, respectively. Data SourcesA convenience sample of 300 patients with oral cancer who had completed surgery provided the quantitative data, and a maximum variation purposive subsample of 20 participants, drawn from the survey sample, provided the qualitative data. Agglomerative hierarchical cluster analysis was used to identify subgroups, multivariate analyses were done to identify predictors, and thematic analysis was used for patient narratives. ConclusionAlmost 94% of the survey participants had two or more co-occurring symptoms. The four most severe and prevalent symptoms were dysphagia, problems with teeth or gums, speech difficulty, and dry mouth. A distinct subgroup consisting of 61% of patients reported severe dysphagia and teeth problems, which was associated with age, oral cancer stage and site. Interviews revealed the causes and the context influencing the perception and response to these symptoms. Thus, the quantitative data provided information on severity and patient subgroups based on symptom cluster experiences, while the qualitative data validated these conclusions and additionally provided in-depth details and meaningful insight on perceived causes and contextual influences of their experiences. This comprehensive picture of symptom cluster experiences can aid in the development of patient-centered interventions for people with oral cancer. Implications for Nursing PracticeAn interdisciplinary approach to targeting concurrent symptoms incorporating psychological and physical interventions is necessary. Older patients treated for Stage IV cancers and for buccal mucosa tumors are at high-risk of having severe dysphagia postoperatively, and these patients should be targeted for dysphagia interventions. The contextual factors play an important role in developing patient-centered interventions.

Oral Health of Sambaqui Groups in Saquarema, Brazil

This article presents differences and similarities in dietary practices of fisher-gatherer groups excavated from two sambaquis (shell-mound archaeological sites) in Saquarema, Rio de Janeiro state, Brazil. We analyzed the buccal apparatus of 35 individuals excavated from Sambaqui da Beirada, dated from 5437 to 3440 years cal BP, and Sambaqui do Moa, dated from 4770 to 3199 years cal BP. Our oral health analysis of 852 alveoli and 704 teeth assessed the frequency and degree of teeth wear and the prevalence and frequency of caries, linear enamel hypoplasia, calculus, periapical cavities, and antemortem teeth loss. We applied the chi-square test and Fisher exact test to test statistical significance. Severe tooth wear, the absence of caries, a high frequency and prevalence of dental calculus, and a low prevalence of linear enamel hypoplasia were found in both sites, although periapical cavities and antemortem teeth loss indexes varied greatly. Despite a superficial homogeneity, the results point to variation in the physiopathological processes that occurred at both sites, including differences related to age and sex. These oral health-related results, together with other archaeological data from both sambaquis, showcase the expected cultural differences stemming from dietary practices.

Primary failure of eruption: From molecular diagnosis to therapeutic management.

Primary Failure of Eruption (PFE) is a rare condition affecting posterior teeth eruption resulting in a posterior open bite malocclusion. Differential diagnosis like ankylosis or mechanical eruption failure should be considered. For non-syndromic forms, mutations in PTH1R, and recently in KMT2C genes are the known etiologies. The aim of this work was to describe the variability of clinical presentations of PFE associated with pathogenic variants of PTHR1. Diagnosis of non-syndromic PFE has been suggested for three members of a single family. Clinical and radiological features were collected, and genetic analyses were performed. The clinical phenotype (type and number of involved teeth, depth of bone inclusions, functional consequences) is variable within the family. Severe tooth resorptions were detected. A heterozygous substitution in PTH1R (NM_000316.3): c.899T>C was identified as a class 4 likely pathogenic variant. The multidisciplinary management is described involving oral biology, pediatric dentistry, orthodontics, oral surgery, and prosthodontics. In this study, we report a new PTH1R variant involved in a familial form of PFE with variable expressivity. Therapeutic care is complex and difficult to systematize, hence the lack of evidence-based recommendations and clinical guidelines.

Total mandible and bilateral TMJ reconstruction combining a customized jaw implant with a free fibular flap: a case report and literature review

BackgroundThe need for whole mandibular bone reconstruction and bilateral joint replacement is fortunately rare, but it is an extremely challenging topic in maxillofacial surgery, due to its functional implications. CAD-CAM techniques development has opened new broad horizons in the surgical planning of complex maxillofacial reconstructions, in terms of accuracy, predictability, and functional cosmetic results. The review of the literature has revealed a small number of scientific reports on total mandibulectomy including the condyles, with only eleven cases from 1980. Most of the works describe reconstructions secondary to dysplastic or inflammatory diseases affecting the lower jaw. The aim of this work, reporting a rare case of massive fibrous dysplasia of the whole mandible, is to share our experience in the management of extended mandibular and bilateral joint reconstruction, using porous titanium patient-specific implants.Case presentationThe authors present a 20-year-old male patient suffering from massive bone fibrous dysplasia of the mandible. The mandibular body and both the rami and the condylar processes had been involved, causing severe functional impairment, tooth loss, and facial deformation. The young patient, after repeated ineffective conservative surgical treatments, has required a biarticular mandibular replacement. Using virtual surgical planning (VSP) software, the authors, in collaboration with medical engineers, have created a custom-made original titanium porous mandibular implant, suspended from a bilateral artificial temporomandibular joint. The mandibular titanium implant body has been specifically designed to support soft tissues and to fix, in the alveolar region, a free fibular bone graft, for delayed dental implant prosthetic rehabilitation.ConclusionThe surgical and technical details, as well as the new trends in mandibular reconstructions using porous titanium implants, are reported, and discussed, reviewing literature reports on this topic. Satisfactory functional and cosmetic restorative results have been obtained, and no major complications have occurred. The patient, currently in the 18th month clinical and radiological follow-up, has recently completed the functional restoration program by an implant-supported full-arch dental prosthesis.

Prevalence and etiology of dentoalveolar trauma in 1,592 United States military working dogs: A 1-year retrospective study.

The objective of this study was to quantify the overall prevalence and classification of traumatic dentoalveolar injury (TDI) in a large population of military working dogs (MWDs). The medical records of 1,592 MWDs undergoing routine oral exam and periodontal treatment over a 1-year period were reviewed. The MWDs were located at over 100 military veterinary treatment facilities across the globe. Patient signalment, occupational duty certification, tooth injured, and trauma etiology were recorded. The overall prevalence of TDI was 43.6%. The mean number of TDI per MWD was 1.2. Maxillary tooth fractures were the most common at 60.9% compared to mandibular tooth fractures 39.1%. The most common TDI was enamel-dentin-pulp fractures which accounted for 59.9% of all injuries. Specialized Search Dogs (SSDs) had the highest average of enamel-dentin and enamel-dentin-pulp tooth trauma. Incidental findings with an unknown cause accounted for the majority of tooth trauma 69.2% followed by housing 18.2%, bite work 6.2%, and blunt force trauma 6.0%. The frequency of TDI in the MWD population was substantial, with more than one out of every four MWDs requiring treatment. The probability of a tooth injury in the MWD population was nearly double compared to the pet dog population. Tooth type and age were significant predictors of severe tooth trauma requiring treatment. Improved understanding of MWD tooth trauma prevalence and risk factors will help drive change while maintaining deployment readiness of the team.

Saving the pulpless teeth

Endodontically treated teeth become fragile unless optimally restored. Treatment planning of these teeth should take into account the remaining coronal tooth structure as well as the functional requirements. A successful treatment of these teeth with significant tooth structure loss requires not only an effective endodontic therapy but also prosthodontic rehabilitation of the tooth. Simple and successful procedures can be viable treatment options for conserving the endodontically treated teeth with severe coronal tooth structure loss. Hence, the aim of this case series was to present different approaches to restore endodontically treated teeth with minimal coronal structure.

Guided Endodontic Access Cavity of Maxillary Obliterated Pulp Canal Lateral Incisor

Background: Managing severe calcified teeth in endodontics seems to be challenging for clinical, so static and dynamic guided endodontics ware developed to reduce the professional stress, increasing the patient\&amp;apos;s comfort, gives shorter clinical or procedural sessions with minimal invasive approach, and predictable canal location to avoid iatrogenic mishaps to be happened. Case Presentation: Preoperative investigations were conducted, tooth #12 had calcified chamber. Cone beam computed tomography (CBCT) was taken (Sirona GALILEOS Comfort CBCT scanner) showed that the coronal third of root canal is obliterated. For Guide planning, maxillary alginate impression was taken and scanned by digital scanner (smart optics - Vinyl High Resolution). Digital planning was done by 3Shape Implant Studio Software using sleeve size 3.5 mm (external diameter). Guided was printed by Digital Light Processing (DLP) 3d printing machine (NextDent 5100 3D printer). Enamel drilling by diamond round bur, guide was adapted to mouth and drill through until reach to 10 mm, periapical radiograph was taken to confirm the drilling depth. Conclusion: Guided treatment modality is not only used for anterior teeth or initial endodontic treatment, for posterior teeth and re-treatment endodontic cases as well. Finally, guided endodontic should be considered as mandatory treatment modality for pulp canal obliteration.

Saúde bucal e desigualdades relacionadas entre pessoas com deficiência visual em um município brasileiro

ABSTRACT Objective: To evaluate the oral health and related factors among people with visual impairment in a municipality in southeastern Brazil. Methods: A cross-sectional and descriptive household study was carried out on a representative sample of people with visual impairments in a medium-sized city in Brazil. A clinical-dental examination was performed (evaluating tooth loss, caries, periodontal health, dental plaque use and need of prosthesis) and a semistructured questionnaire was applied, investigating the socioeconomic conditions (sex, age, marital status, skin color and income) and the use of dental services (reason, time since, and type of service used [private/public] in last dental visit). Descriptive and bivariate analysis were performed to asses the factors related to oral health. Results: The mean age of participants was 65 years (±15.05), with the majority women (70.9%). 53.1% of the interviewees were edentulous, but 58.2% had a good perception of oral health. The blind ones use less public services (p=0.038) and with a lower frequency (p=0.014) than subjects with low vision. Those with less schooling had higher tooth loss and lower periodontal problems (p &lt;0.05). There was a reduction of dental plaque six months after the educational action (30.7%; p=0.01), especially among the low vision participants (p=0.01). Conclusion: Severe tooth loss and unsatisfactory hygiene contrast with self-perception of oral health. Visual acuity and schooling were related to access and oral health. Actions for promotion and equity are necessary to overcome the inequalities encountered.

Dose Dependence Effect in Biallelic WNT10A Variant-Associated Tooth Agenesis Phenotype.

The goal of this study was to identify the pathogenic gene variants in patients with odonto-onycho-dermal dysplasia syndrome (OODD) or nonsyndromic tooth agenesis. Four unrelated individuals with tooth agenesis and their available family members were recruited. Peripheral blood was collected from four probands and five family members. Whole-exome sequencing (WES) and Sanger sequencing were used to identify the pathogenic gene variants. The harmfulness of these variations was predicted by bioinformatics. We identified four biallelic variants of the WNT10A gene in four patients, respectively: the proband#660: c.1176C &gt; A (p.Cys392*) and c.812G &gt; A (p.Cys271Tyr); the proband#681: c.637G &gt; A (p.Gly213Ser) and c.985C &gt; T (p.Arg329*); the proband#829: c.511C &gt; T (p.Arg171Cys) and c.637G &gt; A (p.Gly213Ser); and the proband#338: c.926A&gt; G (p.Gln309Arg) and c.511C &gt; T (p.Arg171Cys). Among them, two variants (c.812G &gt; A; p.Cys271Tyr and c.985C &gt; T; p.Arg329*) were previously unreported. Bioinformatics analysis showed that the pathogenicity of these six variants was different. Tertiary structure analysis showed that these variants were predicted to cause structural damage to the WNT10A protein. Genotype-phenotype analysis showed that the biallelic variants with more harmful effects, such as nonsense variants, caused OODD syndrome (#660 Ⅱ-1) or severe nonsyndromic tooth agenesis (NSTA) (#681 Ⅱ-1); the biallelic variants with less harmful effects, such as missense variants, caused a mild form of NSTA (#829 Ⅱ-2 and #338 Ⅱ-1). Individuals with a heterozygous variant presented a mild form of NSTA or a normal state. Our results further suggest the existence of the dose dependence of WNT10A pathogenicity on the tooth agenesis pattern, which broadens the variation spectrum and phenotype spectrum of WNT10A and could help with clinical diagnosis, treatment, and genetic counseling.

Wear behaviour of direct composite restorations in tooth wear patients: a 5-year clinical study

ObjectiveThis study aimed to investigate the wear behaviour of direct composite restorations after 5 years and associated patient factors. Methods38 patients (6 females, 32 males; 35.2 ± 7.6y) from the Radboud Tooth Wear Project with generalized moderate to severe tooth wear were treated with direct composite restorations on all teeth. Ethical approval was sought and granted before the study was undertaken. Intraoral 3D scans were recorded at 1 month (baseline) and 5 years (recall) after treatment. The amount of height loss was measured at six index teeth (first molars and upper central incisors). Patient factors (age, vertical dimension of occlusion increase, bite force, aetiology score, jaw position and bearing/ non-bearing cusps) were included in the analysis. Multilevel multiple regression with bootstrapping was used to analyse the influence of these factors on wear behaviour of restorations. Observer reliability was tested by paired t-tests and Band-Altman plots (p<0.05) ResultsAfter 5 years, the mean height loss was 0.23± 0.19 mm for incisors and 0.43± 0.24 mm for molars (p≤0.001). Patient factors did not show any significant influence on height loss of the composite restorations, while bearing cusps showed significant more wear compared to non-bearing cusps (p≤0.001). The observer reliability tests confirmed the repeatability (correlation of 0.809, DME 0.103). ConclusionsWear of composite restorations is a significant and relevant factor over time in patients treated with severe tooth wear. Within the limitations of this clinical study, patient factors were found not to have a significant effect on wear behaviour of direct composite restorations.

Measuring tooth wear with regular intra-oral 3D scanners: for still in the future, or is it already possible?

Quantitative tooth wear measurement is a method of increasing importance when measuring tooth wear progression. The Radboud university medical center has developed a protocol that measures height and volumetric differences on regular 3D-scans. Intra-oral scans were made on patients with tooth wear and superimposed. To assess reliability the precision , as well as intra- and inter-rater precision of the protocol was tested. T-tests were performed to determine the structural and random error. Our findings indicate that the method is precise enough to measure height differences in patients with severe tooth wear progression, or tooth wear with an interval longer than 1 year. The method is not precise enough to measure volumetric changes.

Association of Diet-Related Systemic Inflammation with Periodontitis and Tooth Loss: The Interaction Effect of Diabetes.

Diet is an important factor that can affect inflammatory processes. Diet-related systemic inflammation is closely linked to periodontitis and tooth loss. However, the role that systemic conditions play in influencing this association remains unclear. A cross-sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014. Diet-related systemic inflammation was assessed by the Dietary Inflammatory Index (DII). Multivariate Cox regression models were used to investigate the association between DII and periodontal results, including total periodontitis, tooth loss, severe tooth loss, and the number of teeth lost. The interaction effects between DII and established covariates were tested. Higher DII scores, corresponding to a higher pro-inflammatory potential of the diet, were associated with an increased risk of periodontitis and tooth loss among the 10,096 eligible participants. There was an interaction between diabetes and DII on total periodontitis (p = 0.0136). No significant interaction effect was detected between DII and other established covariates. Participants who consumed an anti-inflammatory diet, and did not have diabetes, experienced the lowest risks of periodontitis and tooth loss. However, in the context of diabetes, the efficacy of such a diet may be weakened or even eliminated. Dietary interventions to manage oral health problems may need to take the individual’s metabolic condition into account.

A 5-year observation of the dahl principle to manage localized anterior tooth wear

This clinical report reviews and assesses a 5-year observation of a minimal intervention approach (using the Dahl concept) for the management of severe anterior tooth wear in a 44-year-old male. CPD/Clinical Relevance: The Dahl concept is a versatile, inexpensive and conservative technique for the management of localized severe anterior tooth wear.

Mandibular full-arch rehabilitation with increased vertical dimension of a patient with severe tooth wear

Mandibular full-arch rehabilitation with increased vertical dimension of a patient with severe tooth wear

Age accelerated effect of tooth loss on cognitive function among Chinese older adults

ObjectivesFocusing on older adults in China, this study aims to examine the association between tooth loss and cognitive impairment. MethodsThis study used six waves of data from the Chinese Longitudinal Healthy Longevity Survey across 16 years and applied generalized estimation equation regression models. ResultsSevere tooth loss was significantly related to cognitive impairment after adjusting for sociodemographic characteristics, health behaviors, and self-rated poor health. The adjusted prevalence ratios of cognitive impairment were 1.35 (95%CI: 1.30, 1.40) for edentulousness vs. no or mild tooth loss (0–9), and 1.25 (95%CI: 1.20, 1.30) for severe tooth loss (10 or more) vs. no or mild tooth loss. The effect of tooth loss increased with age from <1% for all three groups to 50.9% for edentulousness, 35.6% for severe tooth loss and 30.7% for no or mild tooth loss. DiscussionThis study lends support to the hypothesis that oral health is an important covariate of cognitive impairment. Future studies should continuously explore this topic by adding more objective oral health assessments and speculate potential pathways that may underlie the relationship using high quality longitudinal data.