Tooth mobility is one of the most important clinical parameters in examination, diagnosis, prognosis and treatment planning procedure. In order to determine the differences of tooth mobility according to radiographical bone level, clinical root length, clinical crown/root ratio, and bleeding on probing, 90 male adults with periodontal disease and 10 male adults with periodontal health($25{\sim}45$ years old) were selected through clinical examinations including occlusal relationship, probing depth, attachment level, and bleeding on probing. On the mandibular anterior teeth, standard periapical radiographs were taken, and tooth mobility was measured by Periotest(Siemens Co., Germany). The radiographic bone level of individual tooth was evaluated as coronal 1/3, middle 1/3, and apical 1/3 to anatomical root length, and clinical crown length from incisal edge to bone level and clinical root length from bone level to root apex were measured with Boley gauge, and subsquently clinical crown/root ratio was calculated. The difference of tooth mobility(Periotest value) according to radiographical bone level, clinical root length, clinical crown/root ratio, and bleeding on probing was statistically analyzed by unpaired Student t-test. Tooth mobility was significantly higher in bleeding group than non-bleeding group on probing in the teeth radiographic bone level of middle 1/3, with clinical root length longer than 6mm, and with clinical crown/root ratio over 0.3(p<0.01). But there was no statistical difference in tooth mobility between bleeding group and non-bleeding group on probing in the teeth with radiographic bone level of apical 1/3, with short clinical root length less than 5mm, and with clinical crown/root ratio under 0.2(p>0.05). The results note that the tooth mobility depends on clinical root length, clinical crown/root ratio and gingival inflammation, and in the teeth with relatively good alveolar bone support gingival inflammation is one of the most important factors that affect tooth mobility.
Pressure root resorption can be observed during the eruption of permanent dentition, especially of the maxillary canines (affecting lateral incisors) and mandibular third molars (affecting mandibular second molars). Since the cause of root resorption of the adjacent affected teeth is evident, treatment simply involves extraction of the impacted tooth. However, there have been few reports on the prognosis of the remaining resorbed tooth, as dentists often choose to extract them when damage due to root resorption is observed. We report a case involving a tooth that was severely resorbed due to pressure from an adjacent impacted tooth. After extraction of the impacted tooth, the remaining tooth retained vital pulp and survived as a functional tooth.
To investigate the depth of the root concavity and root surface area of the maxillary first premolar, 40 maxillary first premolars were used. All the teeth which extracted because of advanced periodontal disease and orthodontic treatment procedure, were sectioned every 1.5mm from cementoenameljunction to the apex with hard tissue microtome. Each sectioned root was taken photograph with slide film, and projected for measuring with a calibrated digital Curvi-Meter. The root surface area, percentage of the RSA and the linear variation of the RSA were calibrated for each 1.5mm section. Linear variation of the depth of root concavity was measured on mesial and distal root surface for each section using computer-aided digitizer. The results were as follows. 1. The total mean root length of maxillary first premolar was 13.48mm. Mean buccal root length of 2-rooted tooth was 12.59mm, mean palatal root length was 12.73mm, and mean root length of single rooted tooth was 13.78mm. 2. The total mean root surface area of maxillary first premolar was $194.17mm^2$, mean root surface area for 2-rooted tooth was $205.97mm^2$ and mean root surface area for single rooted tooth was $188.49mm^2$. 3. It was 59.93% of the total root surface area that the area from CEJ to coronal 6mm. And, the coronal half of the root length accounted for approximately 71.76% of the total root surface area. 4. Most deepest concavity of the mesial root surface was 0.65mm at apical 3.0mm, 4.5mm level in maxillary first premolar. And, that of the distal root surface was 0.37mm at apical 4.5mm level. 5. All of the maxillary first premolar had mesial root surface concavity. This mesial root surface concavity appeared to be more pronounced in 2-rooted tooth than single rooted tooth.
This study describes the clinical steps taken in the treatment of a patient who had an avulsed right upper central incisor that presented with incomplete root development and chronic apical periodontitis. A 7-year-old boy was referred from a private dentist to a dental office specializing in endodontics. The tooth had remained in a dry environment for 20 minutes, and tooth replantation was performed at an emergency appointment. After clinical and radiographic examinations, root canal decontamination was performed, followed by several changes in intracanal calcium hydroxide medication. Blood clot formation was attempted, but bleeding within the root canal was insufficient; therefore, we opted for an intracanal medication change to stimulate mineralized tissue formation in the apical region. Root obturation was performed 45 days after the last change of intracanal medication, and clinical, radiographic, and tomographic follow-up examinations were performed at 3, 6, 18, and 40 months after the endodontic intervention. The increase in thickness and length of the root structure and the absence of root resorption were verified through follow-up examinations. Therefore, it was concluded that the procedures used were successful for tooth replantation.
The purpose of this study was to quantitatively evaluated experimental tooth root resorption for digital radiography. For this study, experimentally three root sites were used, and radiograms were taken with standardized apparatus. Digital imaging system were consisted of NEC PC-980l(computer), TRINITRON(monitor), SONY XC-711 CCD camera. The display monitor had a resolution of 512X512 pixels. The obtained results were as follows: 1. In the difference of the four X-ray film of the contrast correction, the contrast difference was one gray scale variation at mean value. 2. Viewing of the view box of the periapical radiographs, experimental tooth root resorption of the periapical area of the first premolar, middle of mesial surface of the first molar mesial root, middle of lingual surface of the first molar distal root were recognized by increased diameter. 3. On the analysis by histogram, the periapical area of the first premolar, the middle of mesial surface of the first molar mesial root were each recognized tooth root resorption of the 5,6,7 pixel, 2,4,5 pixel by increased diameter. 4. On the analysis by histogram, the middle of lingual surface of the first molar distal root was each recognized tooth root resorption of the none, 3,6 pixel by increased diameter.
Purpose : The purpose of this study was to examine the patient- and treatment-related etiologic factors of external root resorption. Materials and Methods : This study consisted of 163 patients who had completed orthodontic treatments and taken the pre- and post-treatment panoramic and lateral cephalometric radiographs. The length of tooth was measured from the tooth apex to the incisal edge or cusp tip on the panoramic radiograph. Overbite and overjet were measured from the pre- and post-treatment lateral cephalometric radiographs. The root resorption of each tooth and the factors of malocclusion were analyzed with an analysis of variance. A paired t test was performed to compare the mean amount of root resorption between male and female, between extraction and non-extraction cases, and between surgery and non-surgery groups. Correlation coefficients were measured to assess the relationship between the amount of root resorption and the age in which the orthodontic treatment started, the degree of changes in overbite and overjet, and the duration of treatment. Results : Maxillary central incisor was the most resorbed tooth, followed by the maxillary lateral incisor, the mandibular central incisor, and the mandibular lateral incisor. The history of tooth extraction was significantly associated with the root resorption. The duration of orthodontic treatment was positively correlated with the amount of root resorption. Conclusion : These findings show that orthodontic treatment should be carefully performed in patients who need the treatment for a long period and with a pre-treatment extraction of teeth.
Completely avulsed tooth caused by a traumatic injury needs replantation for treatment choice. But, replantated tooth usually comes with inflammatory root resorption, replacement resorption and ankylosis, moreover ankylosis cause severe functional and esthetic problems. The outcome of replantated tooth depends on the following factors; minimal damage to pulp and periodontal tissue, the length of extraoral time, the medium of the tooth stored, the level of root formation and so on. The purpose of this case report is to describe the variable resorption pattern and to discuss types that influence the occurrence of resorption.
Tooth mobility may be the decisive factor that determines whether dental treatment of any kind is undertaken. Although tooth mobility in isolation says little in itself, the finding of increased tooth mobility is of both diagnostic and prognostic importance. Only the detection of an increase or decrease in mobility makes an evaluation possible. Thus prior to treatment, we must understand the pathologic process causing the observed the tooth mobility and decide whether the pattern and degree of observed tooth mobility is reversible or irreversible. And then it must be decided whether retention and treatment or extraction and replacement. The purpose of this study was to compare tooth mobility at different time period during root planing and flap operation and to relate changes in mobility to each treatment method. Twenty-one patients (287 teeth) with chronic adult periodontitis were treated with root planing(control group) and flap operation(experimental group), and each group was divided 3 subgroups based upon initial probing pocket depth (1-3mm, 4-6mm, 7mm and more). Tooth mobility was measured with $Periotest^{(R)}$ at the day of operation, 4 days, 1 week, 2 weeks, 3 weeks, 4 weeks, 8 weeks, 12 weeks after each treatment. Tooth mobility, attachment loss, radiographic bone loss, and bleeding on probing were measured at the day of operation, 4 weeks, 8 weeks and 12 weeks after treatment. 1. In group initial probing depth was 1-3mm, tooth mobility had no significant difference after root planing and flap operation. 2 . In group initial probing depth was 4-6mm, 7mm and more, tooth mobility had decreased in 12 weeks after root planing(p<0.01). And the mobility had increased after flap operation(p<0.01) and was at peak in 1 week, and decreased at initial level in 4 weeks, below the initial level in 12 weeks(p<0.01). 3. In 1 week, significant difference in tooth mobility between control and experimental group was found(p<0.01) but, in 12 weeks no difference between two groups was found. 4. Change of immediate tooth mobility after treatment was more larger in deep pocket than in shallow one. In group with the same probing pocket depth, the change of tooth mobility in molar group was greater than that of premolar group. 5. Tooth mobility before treatment was more strongly correlated with radiographic bone loss (r=0.5325) than probing depth, attachment loss and bleeding on probing, in 12 weeks after treatment, was more strongly correlated with attachment loss($r^2$=0.4761) than probing depth and bleeding on probing. Evaluation of the treatment effect and the prognosis after root planing and flap operation were meaningful on tooth initial probing depth 4mm and more. After flap operation, evaluation of the prognosis should be performed at least in 4 weeks and in 12 weeks after treatment, no difference in tooth mobility between two groups was observed. Radiographic bone loss and attachment loss were good clinical indicators to evaluate tooth mobility.
Objectives: The maintenance of the healthy periodontal ligament cells of the root surface of donor tooth and intimate surface contact between the donor tooth and the recipient bone are the key factors for successful tooth transplantation. In order to achieve these purposes, a duplicated donor tooth model can be utilized to reduce the extra-oral time using the computer-aided rapid prototyping (CARP) technique. Materials and Methods: Briefly, a three-dimensional digital imaging and communication in medicine (DICOM) image with the real dimensions of the donor tooth was obtained from a computed tomography (CT), and a life-sized resin tooth model was fabricated. Dimensional errors between real tooth, 3D CT image model and CARP model were calculated. And extra-oral time was recorded during the autotransplantation of the teeth. Results: The average extra-oral time was 7 min 25 sec with the range of immediate to 25 min in cases which extra-oral root canal treatments were not performed while it was 9 min 15 sec when extra-oral root canal treatments were performed. The average radiographic distance between the root surface and the alveolar bone was 1.17 mm and 1.35 mm at mesial cervix and apex; they were 0.98 mm and 1.26 mm at the distal cervix and apex. When the dimensional errors between real tooth, 3D CT image model and CARP model were measured in cadavers, the average of absolute error was 0.291 mm between real teeth and CARP model. Conclusions: These data indicate that CARP may be of value in minimizing the extra-oral time and the gap between the donor tooth and the recipient alveolar bone in tooth transplantation.
Navigation of the main root canal and dealing with a dens invaginatus (DI) is a challenging task in clinical practice. Recently, the guided endodontics technique has become an alternative method for accessing root canals, surgical cavities, and calcified root canals without causing iatrogenic damage to tissue. In this case report, the use of the guided endodontics technique for two maxillary lateral incisors with multiple DIs is described. A 16-year-old female patient was referred with the chief complaint of pain and discoloured upper front teeth. Based on clinical and radiographic findings, a diagnosis of pulp necrosis and chronic periapical abscess associated with double DI (Oehler's type II) was established for the upper left lateral maxillary incisor (tooth #22). Root canal treatment and the sealing of double DI with mineral trioxide aggregate was planned for tooth #22. For tooth #12 (Oehler's type II), preventive sealing of the DI was planned. Minimally invasive access to the double DI and the main root canal of tooth #22, and to the DI of tooth #12, was achieved using the guided endodontics technique. This technique can be a valuable tool because it reduces chair-time and, more importantly, the risk of iatrogenic damage to the tooth structure.
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