Search Results (29)

Background/Objectives: Avulsion is a major cause of tooth loss, and its treatment involves replantation. This study analyzed the repair process of incisive teeth subjected to delayed replantation after topical treatment with ampicillin and tetracycline. Methods: Forty male rats were equally divided into four groups: immediate replantation (IM), ampicillin (AM), tetracycline (TR), and dry medium (SE). In the IM group, replantation was performed 5 min after experimental avulsion, whereas in the SE group, the teeth were kept in a dry medium for 60 min. In the AM and TR groups, the teeth were stored in whole bovine milk for 60 min, and then immersed in their respective ampicillin and tetracycline solutions for 5 min. Euthanasia was performed 60 days after the experimental surgery. Histological slides were stained with Hematoxylin and Eosin for quantitative and qualitative analyses. Results: No statistically significant differences were observed among the IM, AM, and TR groups regarding the total resorption area, reattached periodontal ligament fibers, and ankylosis. However, when compared to the SE group, these groups exhibited a smaller total resorption area (IM: p = 0.005; AM: p = 0.0007; TR: p = 0.03), a larger area of periodontal ligament fibers reattachment (IM: p = 0.0002; AM: p = 0.0002; TR: p = 0.02), and a lower presence of ankylosis (IM: p = 0.005; AM: p = 0.0002; TR: p = 0.03). The AM group exhibited the smallest inflammatory resorption. Conclusions: It is concluded that, in an aseptic environment, the use of topical antibiotics such as ampicillin and tetracycline in the treatment of the root surface during replantation of teeth stored in milk is beneficial to the periodontal repair process and root resorption. Notably, ampicillin demonstrated superior efficacy in mitigating inflammatory root resorption and better periodontal ligament reattachment. Full article

Background: Autogenous tooth transplantation is a valuable option for dental rehabilitation, particularly in young patients. Template-guided approaches, using 3D-printed replicas of donor teeth, have recently emerged as a method to increase precision and reduce extraoral time—two critical factors in maintaining periodontal ligament (PDL) vitality, which is essential to improve long-term outcomes. Methods: This report presents the case of a 12-year-old patient who underwent autotransplantation of tooth 18 to the site of tooth 75, which exhibited ankylosis. Patients exhibiting unfavorable root anatomy and morphology, systemic conditions, or completed root development were not considered for this technique. A patient-specific donor tooth replica was digitally designed and 3D-printed via CAD/CAM manufacturing to preoperatively shape the recipient site. The transplanted tooth 18 was then inserted with an extraoral time of less than one minute and subsequently stabilized using a flexible titanium trauma splint (TTS). Results: Longitudinal clinical and radiographic follow-up over 12 months confirmed favorable healing without signs of complications. Conclusions: This case illustrates the practical advantages of a fully digital, template-guided workflow in managing anatomically complex cases. Full article

Introduction: Tooth autotransplantation is a well-established dental surgical procedure. However, third molar autotransplantation to bony free flaps is rarely performed. We present a case of two impacted wisdom teeth that were transplanted to a DCIA free flap using 3D printing technologies. Case report: A 10-year-old girl was diagnosed with ossifying fibroma. She underwent a segmental mandibular resection with nerve preservation and reconstruction using a DCIA free flap. Six years later, due to edentulism, wisdom tooth autotransplantation was performed with digital planning, thermoplastic vacuum-formed guides, and 3D-printed replicas. Postoperatively, splint fixation was required for 12 weeks due to mobility, and a minor wound complication resolved spontaneously. At the one-year follow-up, the transplanted teeth integrated successfully without resorption or ankylosis. Orthodontic treatment was initiated to optimize alignment. Conclusions: This case of an impacted third molar autotransplantation to a DCIA free flap in an adolescent patient after a non-malignant mandibular tumor resection and reconstruction demonstrates promising results. The application of 3D printing technology significantly enhances the feasibility of dental transplantation in challenging cases, particularly for suboptimal donor teeth such as impacted wisdom teeth, by enabling precise surgical planning and optimized recipient site preparation while also reducing damage to the grafted teeth during transplantation. Further research is needed to assess the role of tooth autotransplantation in bony free flaps. Full article

Background/Objectives: Dentoalveolar ankylosis in adolescents involves a series of difficulties related to bone growth and development, especially in a vertical manner. A systematic review of studies on ankylosis in young permanent teeth treated by decoronation which considered the preservation/vertical growth of the alveolar bone as their main objective was carried out. Methods: The PRISMA 2020 guidelines were followed. Our research question was formulated using the PICO structure. Clinical cases or a series of cases of ankylosis in which a tooth had been treated with decoronation, with a minimum follow-up of one year, were included. The search was carried out in five databases. The selection of search terms was based on previous works within this framework and their most cited descriptors. The article selection and data extraction were carried out by two investigators. The JBI critical checklist of clinical cases was used for quality assessment. Results: Twelve articles were selected with a total of 23 cases that met the inclusion criteria. The mean age at the time of trauma was 9 years and the mean age at decoronation was 12.5 years. The traumatic event was avulsion in 10 out of the 14 cases. The upper right central incisor represented 62.5% of the sample compared to 25% for the contralateral tooth. The follow-up period ranged from 1 to 10 years. Vertical bone augmentation was found in all cases except in three cases where it remained stable. Conclusions: Based on the results of the present review, it can be concluded that decoronation is an effective technique for maintaining/stimulating vertical bone growth in young ankylosed permanent teeth and that complete root resorption is an important factor associated with vertical bone growth. Full article

Introduction and Clinical Significance: Tooth ankylosis is a serious complication that can occur because of the replantation of an avulsed tooth. However, few reports have investigated the follow-up of replanted or ankylosed primary incisors because the replantation of primary teeth is not recommended in the guidelines of the International Association of Dental Traumatology. Case Presentation: A boy aged 4 years and 8 months was referred to hospital for further evaluation of the maxillary right primary central incisor. It had been avulsed and replanted 2 years earlier. The tooth was positioned higher than the central incisor on the left side, and a metallic percussion sound was noted, leading to a diagnosis of tooth ankylosis. Long-term follow-up revealed the progression of ankylosis, and the tooth was finally extracted. At the age of 7 years and 6 months, permanent tooth eruption was detected, and no pathological finding was observed. Conclusions: In this case, root resorption of the replanted primary incisor was observed with age, but tooth ankylosis progressed, and natural exfoliation was difficult. The authors extracted the primary incisor appropriately, which aided the eruption of a successor permanent tooth. This report suggests the importance of patients visiting the dentist regularly after trauma to primary teeth and appropriate treatment by dentists to erupt the permanent teeth. Full article

Objectives: This prospective clinical study investigated the efficacy of adjunctive antibiotic therapy (doxycycline) and the patient’s risk factors during initial healing of autogenous canine tooth transplantations. Methods: Sixty-seven patients (ranging from 11 to 37 years of age) treated with tooth transplantations were allocated to three parallel groups based on the tooth’s intraoperative extraoral storage time (EST 0–3, 4–6, and 7–15 min) receiving different antibiotic regimens: (1) no antibiotics; (2) intraoperative intravenous (i.v.) single-shot antibiotics; and (3) intraoperative i.v. single-shot plus postoperative oral antibiotics for five days. Initial healing was rated according to pain intensity and clinical signs of pathology over a 21-day period. The influence of the following parameters was investigated using RStudio (linear regression and partial eta squared statistics): group, sex, age, nicotine abuse, tooth apex condition, preoperative ankylosis, displacement severity, jaw location, the number of simultaneous transplantations and other interventions, preoperative orthodontic extrusion, EST, and intraoperative complications. Results: No significant influence for sex (43 females, 24 males), tooth apex condition (19 open, 48 closed), displacement severity, jaw location (51 upper, 16 lower jaw), EST (mean 4.99 min), intraoperative complications (n = 13), or antibiotic regimen on pathology signs or pain intensity were found. Six patients reported medication side effects. Preoperative ankylosis (n = 15) and unsuccessful orthodontic extrusion (n = 16) increased postoperative pain (p = 0.020, ηP² = 0.08; p = 0.035, ηP² = 0.07). Multiple transplants (n = 14) and interventions in multiple regions (n = 27) affected pain and pathology (p = 0.002, ηP² = 0.14; p = 0.001, ηP² = 0.17). Increased age and nicotine abuse (n = 6) were associated with increased pathology signs (p = 0.024, ηP² = 0.08; p = 0.029, ηP² = 0.07). Conclusions: The results suggest that personalized rather than routine antibiotic therapy might be sufficient for initial healing in canine tooth transplantation. Deteriorating factors include preoperative ankylosis, orthodontic extrusion, an increased number of surgical sites, age, and nicotine abuse. Clinical Significance: Routine antibiotic prevention regimes may not be mandatory for initial healing in autogenous tooth transplantation, but a nuanced antibiotic strategy tailored to each patient’s specific risk factors, which is in line with the principle of antibiotic stewardship, is needed. Full article

The optimal repair of rigid mineralized tissues, such as bone, in cases of fracture, surgical resection, or prosthetic placement, is a complex process often necessitating the use of bone graft materials. Autogenous bone from the patient is generally the gold standard in terms of outcomes but also has disadvantages, which have resulted in extensive research in the field of tissue engineering to develop better and more convenient alternatives. In the dental field, several initiatives have demonstrated that the dentin material derived from extracted teeth produces excellent results in terms of repairing bone defects and supporting dental implants. Dentin is acellular and thus, in contrast to autogenous bone, cannot provide osteoblasts or other cellular elements to the grafted region, but it does contain growth and differentiation factors, and has other properties that make it an impressive material for bone repair. In this review, the beneficial properties of dentin and the ways it interacts with the host bone are described in the context of bone graft materials. Autogenous tooth material has limitations, particularly in terms of the need for tooth extraction and the limited amount available, which currently restrict its use to particular dental procedures. The development of a xenograft dentin-derived material, which retains the properties of autogenous dentin, is described. Such a material could potentially enable the use of dentin-derived material more widely, particularly in orthopedic indications where its properties may be advantageous. Full article

Background: As the functional and aesthetical importance of the canine cannot be overstated, the management of a missing canine is challenging. This case report describes the treatment of an infra-occluded ankylosed maxillary canine in a patient with previously failed orthodontic treatment. Case description: A 20-year-old patient sought a second opinion for orthodontic treatment failure. The patient presented with an impacted, ankylosed, and severely infra-occluded right maxillary canine, as well as an iatrogenic clockwise cant of the maxillary occlusal plane and several root resorptions. The treatment corrected the cant of the occlusal plane while avoiding further root resorption, partially extracted the upper right canine, improved the quality and quantity of the soft tissue in the newly edentulous area, and provided a prosthetic rehabilitation using a lithium disilicate ceramic resin-bonded cantilever bridge. Conclusions: The use of a cantilevered bridge resulted in an aesthetically pleasing and minimally invasive rehabilitation. This technique is reversible, does not affect pulp vitality, and is a viable solution for rehabilitating the smiles of young patients. Clinical significance: The smile rehabilitation for an ankylosed maxillary canine, especially in the case of a previously failed orthodontic treatment, is an important clinical challenge. A minimally invasive long-term restoration with a cantilever bridge is a viable solution. Functional and aesthetically pleasant results can be achieved with a multidisciplinary approach. Full article

Aim/Objective: This umbrella review of systematic reviews aims to summarize the available data regarding both success and survival rates of tooth autotransplantation, in addition to analyzing the risk factors that are connected to those rates. Methods: This umbrella review was performed according to the evaluation of various meta-analyses and systematic reviews following AMSTAR2 guidelines. A systematic search of literature on PubMed, Scopus, MEDLINE, EMBASE, and the Cochrane Database. Six systematic reviews were included. Explicit inclusion and exclusion criteria were applied. It is registered in PROSPERO under the registration number (CRD-42023415623). Results: The studies reviewed were written from 2014 to 2018, which extracted the information from various studies spanning from 1968 to 2014. According to the selected studies regarding autotransplanted teeth in humans, they showed the following: A survival rate overall of 87.39% and a success rate overall of 90.29%. These factors were the most common in relation to the success of the autotransplanted teeth: age, gender, and stage of root development. On the other hand, common unfavorable results linked to the transplanted teeth in these studies were failure, ankylosis, and internal root resorption, followed by extraction and hypermobility. Conclusions: The wide body of evidence gathered illustrates that autotransplantation is an operation that dispenses high rates of survival and success. Furthermore, risk factors like root development stage, recipient site, and donor tooth type established a remarkable association with the negative outcomes of the procedure. For successful tooth autotransplantation, patient selection is crucial. Younger patients and those with donor teeth at an optimal stage of root development typically experience better outcomes. Preoperative planning should include comprehensive evaluations and advanced imaging techniques to accurately assess both the donor tooth and the recipient site. Nonetheless, on account of heterogeneity and the quality of the studies included in this investigation, caution should be taken when interpreting the mentioned results. Full article

(1) Background: Orthodontic treatment may be a potential predisposing factor for ECR. The affected tooth goes to ankylosis, which could lead to a malocclusion. Although teeth severely affected by ECR (class IV Heithersay) are usually extracted, this case report aims to present the use of an ECR class IV upper canine, both as ankylosed to solve the malocclusion and the occlusal plane canting, as well as not ankylosed to correct its ridge defect with orthodontic extrusion. (2) Methods: A 14-year-old male, complaining of an ugly smile and a failed orthodontic attempt to recover an impacted canine, was referred to the orthodontic clinic. He was diagnosed with class II right subdivision, midline deviation, both upper and lower occlusal plane canting, and an upper left canine, previously impacted, showing ECR class IV. The treatment first included canting resolution with a cantilever and a spring, exploiting the anchorage offered by the ankylosed ECR canine. Then, a coronectomy, endodontic treatment, and orthodontic extrusion of that canine were performed to obtain the implant site development. (3) Results: Clinical and radiographic outcomes showed normocclusion and better bony conditions for safer implant placement in the aesthetic zone. (4) Conclusions: The high aesthetics and the periodontal and bony conditions obtained are probably not achievable by other therapeutic alternatives. Full article

Aim: The aim of this systematic review is to explore the pathology, diagnosis, treatment, and genetic basis of Primary Failure of Eruption (PFE) in the field of pediatric dentistry and orthodontics. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this review. The databases PubMed, Science Direct, Scopus, and Web of Science were searched from 1 July 2013 to 1 July 2023, using keywords “primary failure of tooth eruption” OR “primary failure of eruption” OR “tooth eruption failure” OR “PFE” AND “orthodontics”. The study selection process involved screening articles based on the inclusion and exclusion criteria. Results: A total of 1151 results were obtained from the database search, with 14 papers meeting the inclusion criteria. The review covers various aspects of PFE, including its clinical features, diagnosis, treatment options, and genetic associations with mutations in the PTH1R gene. Differentiation between PFE and Mechanical Failure of Eruption (MFE) is crucial for accurate treatment planning. Orthodontic and surgical interventions, along with multidisciplinary approaches, have been employed to manage PFE cases. Genetic testing for PTH1R mutations plays a significant role in confirming the diagnosis and guiding treatment decisions, although some cases may not be linked to this mutation. Conclusions: This systematic review provides valuable insights into the diagnosis, treatment, and genetic basis of PFE. Early diagnosis and personalized treatment planning are crucial for successful management. Genetic testing for PTH1R mutations aids in accurate diagnosis and may influence treatment decisions. However, further research is needed to explore the complex genetic basis of PFE fully and improve treatment outcomes for affected individuals. Full article

The tooth impaction of the lower second premolars is an occasional condition but is still seen in clinical practice with a prevalence of 0.6–2.6%. The present case report describes a rare condition of the lower second premolar impaction. An 11-year-old female patient presented with the anteroposterior dental discrepancy, midline shift, and occlusal cant. Intraoral examination revealed the absence of the lower right second premolar with no space available for the eruption. X-ray examination revealed the impaction of tooth #45 in a vertical position, tilting of the adjacent teeth, and two-thirds root length development. The orthodontic treatment plan included space opening using a fixed appliance with a coil spring. The natural eruption of the tooth was expected according to dental age and root development. When the space was opened, no change in the position of tooth #45 was observed. Surgical exposure and active traction were performed. However, the intrusion and tilting of adjacent teeth were observed during the next appointments with no vertical change of tooth #45. Ankylosis was suspected as no tooth movement was recorded. The surgical luxation and osteotomy of the coronal alveolar bone of the impacted tooth were planned for the imminent forced eruption, which was expected due to the young age of the patient. Consequently, the crown of tooth #45 emerged and the bracket was placed. Further traction was planned to use a micro-screw. Following the traction, no vertical displacement of the tooth was observed in the subsequent appointments. Radiographic examination revealed radiolucency in the coronal third of the root. The patient was referred to the endodontist, and CBCT revealed external cervical root resorption in the late reparative stage. ECR in an impacted tooth, mimicking the manifestation of tooth ankylosis, can cause orthodontic treatment failure. Full article

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. Full article

Background: Infraocclusion of deciduous molars is a clinical disturbance that occurs during primary and mixed dentition and has some orthodontic implications. Infraoccluded teeth are believed to be potential sites of malocclusion, with a risk of tipping neighbouring teeth and losing space. This systematic review aims to analyse the management of primary molars infraocclusion and to provide updated guidelines. Methods: A literature search was performed using PubMed, Scopus, and Web of Science databases from 1 January 2017 to 28 November 2022. The inclusion criteria were: studies only on human subjects, open access studies, case reports, randomised trials, retrospective, observational studies, and English language. Results: A total of 372 publications were identified from the databases and a final number of nine studies were included in the review for qualitative analysis. Conclusion: Management of patients suffering from infraocclusion depends on the severity, age at diagnosis, and presence of succeeded premolars. Early diagnosis of infraoccluded primary elements is fundamental and cannot be postponed. Preservation of the primary molars may be a valid option with long-term stability if there is no or moderate primary molar infraocclusion, root resorption of less than half of the root, and no decay or restoration. Full article

Orthodontic miniscrews (OM) are widely used in modern orthodontic clinical practice to improve skeletal anchorage and have a high safety profile. A complication at the time of OM insertion is tooth root perforation or periodontal ligament trauma. Rarely, OM injury can cause permanent damage, such as ankylosis, osteosclerosis, and loss of tooth vitality. The aim of this work was to analyze potential risks and dental complications associated with the use of OMs. A search of the PubMed, Cochrane, Web of Science, and Scopus databases was conducted without a time limit using the keywords “orthodontic mini-screw” and “dental damage”, resulting in 99 studies. After screening and eligibility, including articles obtained through a citation search, 13 articles were selected. Four studies revealed accidental injuries caused by OM. Most of the damage was localized at the root level and resolved spontaneously with restorative cement formation after prompt removal of the OM, while the pain disappeared. In some cases, irreversible nerve damage, extensive lesions to the dentin–pulp complex, and refractory periapical periodontitis occurred, requiring endodontic and/or surgical treatment. The choice of insertion site was the most important element to be evaluated during the application of OMs. Full article