Effect of non-erupted third molars on roots of approximal teeth. A radiographic, clinical and histologic study

This study was undertaken to evaluate clinically and histologically root resorption in extracted human second molars in close proximity to non-erupted third molars. The control group consisted of extracted second molars that were proximal to fully erupted third molars. Eight out of the 11 teeth in the study group presented different degrees of radiographic root resorption, nine presented clinical resorption, and all 11 had histologic evidence of root resorption. In the control group, no signs of root resorption were seen radiographically or clinically. Histologically, limited sites of resorption were identified in all teeth, which were partially repaired by cellular cementum. Histologic observation of study specimens revealed root surface resorption in 10 out of the 11 teeth, one showing replacement resorption as well. Inflammatory resorption was observed in the three most advanced cases in the study group. Reparative cementum partially lining resorbed areas was evident in all teeth with surface resorption. Within the limits of this study, radiographic identification of distal root resorption of second molars in close proximity to non-erupted third molars appears reliable. The findings may support the hypothesis that the presence of a non-erupted third molar in close proximity to the distal root of the second results in root resorption.     

Effect of mechanical treatment on healing after third molar extraction

The aim of this study was to determine the effect of subgingival scaling and root planing on healing of the distal surface of second molars following extraction of third molars. Twenty-eight patients with contralateral erupted third molars and pocket depths greater than or equal to 3 mm on the distal surface of the second molars participated in this study. Measurements of supragingival bacterial plaque, bleeding on probing, pocket depth, and relative attachment level were performed at baseline and 2 months after treatment. Extraction of contralateral third molars was carried out simultaneously. The experimental site received thorough scaling and root planing of the distal surface of the second molar, while the control site received extraction alone. Experimental sites showed significant improvement in all clinical parameters assessed compared to the control sites. In conclusion, periodontal lesions on the distal of second molars can be significantly improved following scaling and root planing after extraction of third molars.     

Comparative in vitro effectiveness of closed root debridement with fine instruments on specific areas of mandibular first molar furcations. I. Root trunk and furcation entrance

The purpose of this study was to compare curets with a small blade to slim ultrasonic inserts on their efficacy in removing artificial deposits from the root trunk and furcation entrance areas of mandibular molars using an in vitro model simulating a clinically closed root debridement approach. The study was conducted on 100 artificial mandibular first molars (50 right side and 50 left side) with anatomical roots. Root trunks, furcation entrances, and furcation areas of each molar were colored by a coat of black model paint. The teeth were fixed in a custom acrylic model and maintained in a firm position by modified acrylic occlusal splints. The root areas were covered with a heavy rubber dam imitating gingival tissue. The model was attached to a mannequin and mounted on a dental chair. Fifty molars (25 right, 25 left) were instrumented with the experimental curets and an equivalent number of molars with the ultrasonic inserts. The instrumentation was carried out by one experienced operator, spending 4 minutes on each molar. The instrumented areas were individually analyzed to determine the percentage of deposits remaining, using a computerized imaging routine system. One-way analysis of variance was conducted to test for differences between both types of instruments. Results revealed that the curets were significantly more efficient (P < 0.01) than the ultrasonic inserts in removing paint from both root trunks and furcation entrances. These findings should be corroborated in a clinical study to determine the potential value of the instruments tested during initial therapy or supportive care of involved mandibular furcations.     

Development of wisdom teeth as a criterion of age determination

The study is based on the orthopantomographic evaluation of the formation and the development of the permanent third molar (n = 938 patients with known age between 15 and 25 years). We used a modified method according to Gleiser and Hunt (1955) with 3 stages of crown formation and 7 stages of root formation. The correlation between age and the formation of the third molar is not very close. There is a deviation of +/- 4 years (97% statistical safety). The root is completed at the age of about 23 years (upper jaw: 23 years in males and females, mandible: males 23.2 years, females 23.6 years). There is a slight sexual dimorphism with an accelerated development of the third molar in males. The dentition of the molars runs parallel on both sides of the jaw. Only a small proportion (14%) of all persons has completely formed roots at the age of 21. Retination of the third molars (produced by the second molar and by the ascending branch of the mandible) causes a delay of its development.     

Intra-observer reliability regarding removal of asymptomatic third molars

OBJECTIVE: To investigate reliability of practitioners' removal decisions and judgements of risk of pathology associated with asymptomatic third molars. SUBJECTS: 10 oral surgeons and 18 family dentists from South Wales with experience ranging from 5 to 28 years. METHOD: Participants were presented with periapical radiographs of 36 asymptomatic, mandibular third molars and were informed of the age and sex of the patients and the degree of eruption of the third molars. Participants were asked to assess, using visual analogue scales, the likelihood of future pathology if the third molars were left in situ and to indicate if they should be removed or not. To assess intra-observer reliability, the 36 cases were duplicated and presented to the participants on a different occasion, a month later. The same questions were asked as on the first occasion. RESULTS: Significant correlations (Pearsons correlation coefficients) were found between initial and repeat assessments of all measures but there was little agreement about the need for removal (Kappa values: 0.54 for oral surgeons and 0.41 for the family dentists). For every item studied, changes in position on the visual analogue scale of two-thirds or more of the total length occurred from the first to the second assessment. CONCLUSION: Treatment decisions about whether or not to remove asymptomatic third molars were not made on a rational basis. Since similar conclusions were recorded in a previous Swedish study, it is inferred that until further high quality evidence of disease prediction is published, decisions to remove third molars prophylactically cannot be made reliably.     

Development and cell fate in interspecific (Mus musculus/Mus caroli) orthotopic transplants of mouse molar tooth germs detected by in situ hybridization

Interpretation of results from previous tooth germ transplantation studies is limited by the inability to distinguish between donor and host cells unequivocally. Furthermore, ectopic transplantation sites have generally been used and the relevance of this to tooth development in situ is uncertain. The aim here was to determine cell fate in orthotopic tooth germ transplants using an interspecific mouse marker system. Mandibular first molar tooth germs were dissected from Mus musculus (CD1) and Mus caroli mice (age range 15-19 day embryo) and transplanted interspecifically into the alveolar crypt of extirpated first mandibular molars in neonatal M. musculus (CD1) and M. caroli hosts. Grafts were recovered at intervals up to 4 weeks postoperatively. Paraffin wax-embedded sections were examined using routine histological techniques and in situ hybridization with a biotinylated DNA probe (pmSat5) specific for M. musculus, to distinguish between donor and host cells. Development of M. musculus tooth germs in M. caroli mandibles and vice versa was similar and transplants progressed to incipient root formation. Vascularization of transplants was chimaeric, being donor-derived in the pulp and host-derived more peripherally. The investing soft tissues comprised a mixture of donor and host cells, predominantly donor. Donor cells were also found in the soft tissue of intertrabecular spaces in the surrounding bone, but alveolar osteocytes were almost entirely host-derived. Long-term survival of grafts was limited and few donor cells were present after 2 weeks. This study provides an unequivocal demonstration of the origin of all cells present in transplanted tooth germs.     

Mal de Meleda: a report of four cases from the United Arab Emirates

Scanning electron microscopy was used to study the effect of cyclophosphamide (Cy) on molar development in 18 Sprague-Dawley rats from 15 to 48 days of age after birth. Doses of 30 mg/kg body weight of Cy dissolved in 1 ml 0.9% NaCl were given to the rats at 10 and 13 days of age. Eighteen control rats had injections of 1 ml 0.9% NaCl at the same ages. The most obvious changes in the experimental teeth were found in the developing roots of the first and second molars and in both the crown and roots of the third molar. The roots of the first and second molars were short and showed apical closure in the experimental rats. In addition to the disturbances in crown and root formation, the third molars were also significantly reduced in total size as compared with the third molars in the control rats.     

Incidence of Helicobacter pylori infection in Ghanaian patients with dyspeptic symptoms referred for upper gastrointestinal endoscopy

There is a lack of information in the United Kingdom on the prevalence of third molars in older patients. The aim of this study was therefore to define the pattern of lower third molar retention in UK dental practice attenders aged 35 years and over. A random sample of 599 eligible patients from a rural dental practice were included in the study. Information was obtained from clinical notes and panoramic radiographs. Data collected included age, gender, presence or absence of lower third molars, number of teeth present in the lower arch and eruption status. Two hundred and sixty-four (44.1 per cent) had at least one lower third molar present (mean age = 57.1 years) while 335 (55.9 per cent) had no lower third molars (mean age = 50.2 years). The data suggest that a greater proportion of men than women retain at least one lower third molar although this finding was not statistically significant. Seventy per cent of retained lower third molars reported in the study were fully erupted. Sixty per cent were vertically placed. There was an association between age and number of teeth present (chi 2 = 38.85, 4DF, P < 0.05), older patients having fewer lower teeth. These data suggest that a large number of patients can expect to keep their lower third molars beyond the age of 35 years and that in many cases a conservative "wait and see' policy for lower third molars in the early twenties is appropriate.     

Third angioplasty, and after that?

The authors studied retrospectively a series of 39 patients with a documented second restenosis after coronary angioplasty between January 1987 and November 1992, 33 of whom (31 men, 2 women) underwent a third procedure. The artery dilated was the left anterior descending (n = 17 including 9 proximal stenoses), the right coronary (n = 10), the left circumflex or its branches (n = 5) and the left main stem (n = 1). The lesions were confirmed to one vessel in 25 cases (75%) and affected two vessels in 8 cases (25%). The third angioplasty procedure was performed on a single artery in all cases. The average left ventricular ejection fraction was 60% (43%-75%). The diameter of the dilated artery was over 3.25 mm in 24% of cases (8/33). The primary success rate was 100% without any complications. The average period between the first and second angioplasties was 16 +/- 10 weeks, and between the second and third angioplasties 19 +/- 12 weeks. Angioplastic controls of the 3rd angioplasty were performed in 25 cases (75%). A third restenosis (n = 7) was treated by surgical bypass (n = 1), repeat angioplasty (n = 4), endocoronary stenting (n = 1) or medically (n = 1), with a global follow-up of 22 months (2-56 months), 2 patients underwent coronary bypass grafting, 2 have residual angina (contralateral lesion which could not be dilated), 1 had an infarct in the territory of an undilated artery, and 28 (85%) were asymptomatic. The restenosis rate after the third angioplasty procedure was 28% (7/25).(ABSTRACT TRUNCATED AT 250 WORDS)     

Dietary amino acids as new and novel agents to enhance allograft survival

Little is known about the long-term effects of fluoride-releasing materials on carious dentine in vivo. The aim was to investigate the 2-year influence of a resin-modified glass ionomer cement (RM-GIC) and amalgam on the bacteriological counts of carious dentine that remained under class I restorations. To enable a split-mouth design, 33 molar pairs in 33 patients (mean age 15.1 years, SD 1.4) were selected, based on clinically and radiographically diagnosed occlusal dentine caries. The enamel of the carious molars was removed, and the carious dentine was sampled under aseptic conditions just beneath the dentinoenamel junction. The molars were alternately restored with RM-GIC or amalgam without further removal of carious dentine. The samples were processed for microbiological determination of total viable counts (TVC), mutans streptococci (MS), and lactobacilli (LB). The molar pairs of 25 patients were reevaluated after 2 years using the same clinical techniques and were permanently restored after complete caries removal. Both materials showed a substantial decrease in numbers of TVC and LB of the carious dentine after the 2-year period. Compared to amalgam, the decrease in the numbers of LB was significantly more pronounced for RM-GIC. No microorganisms were detected in only 11 molars (6 RM-GIC and 5 amalgam) after the 2-year period. Based on this study, we suggest that complete removal of carious dentine is still the best conservative treatment, irrespective of the restorative material used.     

Guided tissue regeneration in Class II furcation involved maxillary molars: a controlled study of 8 split-mouth cases

The purpose of this study was to clinically evaluate the effectiveness of polytetrafluoroethylene membranes in the healing of interproximal Class II furcation defects in maxillary molars using a surgical treatment technique based on the principles of guided tissue regeneration. Eight subjects with similar bilateral Class II furcation lesions on the mesial aspect of maxillary first molars participated in this study. Patients received initial therapy consisting of oral hygiene instructions, scaling and root planing, and occlusal adjustment if necessary. Clinical parameters evaluated included plaque index, sulcular bleeding index, probing depth, attachment level, gingival recession, and open horizontal and vertical furcation fill. An acrylic occlusal stent was used to assure reproducibility of measurements. Experimental sites received a polytetrafluoroethylene membrane following surgical exposure of the furcation. Control sites were treated in the exact same manner but without a membrane. Membranes were removed at 6 weeks after the first surgery. Reentry surgeries were performed at 9 months. Postsurgical results showed a significant improvement in probing depth, attachment level, and open horizontal furcation fill for both groups when compared to baseline values, with experimental sites performing significantly better than controls. Control sites showed a slight loss in open vertical furcation fill while experimental sites remained unchanged. This study suggests that guided tissue regeneration using polytetrafluoroethylene membranes is of some but limited value in the treatment of maxillary molar interpoximal Class II furcation lesions.     

Scanning electron microscopic evaluation of the cleanliness of a new ultrasonic root end preparation

Recently introduced ultrasonic instrumentation techniques for root end preparation have revolutionized the field of endodontic surgery. The specially designed tips offer improved access to the root end and create more conservative root and preparations while decreasing the amount of retained debris. This study compared the cleanliness of root end preparations made using ultrasonic instrumentation with that of those prepared in a traditional manner using a microhandpiece bur. We used 10 extracted maxillary human premolars and molars. After cleaning, shaping, and obturation of the root canals, a 3 mm root end resection perpendicular to the long axis of the root was performed with a carbide fissure bur. The roots were randomly divided into two groups and root end preparations were made using the two aforementioned techniques. The roots were longitudinally split and sputter-coated with gold for scanning electron microscopic study. Three independent dentists used a standardized grading system to evaluate the cleanliness of the root end preparations. The ultrasonic preparation had significantly less superficial debris and a thinner smear layer than the microhandpiece preparation (p < 0.05). There were no significant differences between the canal and isthmus portions of the root end preparations within each group in either superficial debris or smear layer. This indicates that cleaner surfaces for root end cavities are created using ultrasonic retrotips than using microhandpiece burs.     

Further characterization of alpha 2-macroglobulin binding properties of Actinomyces pyogenes

OBJECTIVE: To investigate and compare agreement within two groups of dental practitioners, family dentists and oral surgeons, in their decisions regarding removal of asymptomatic mandibular third molars. SUBJECTS: Ten oral surgeons and 18 family dentists from South Wales with experience ranging from 5 to 28 years. METHODOLOGY: Participants were presented with periapical radiographs of 36 asymptomatic, mandibular third molars and were informed of the age and gender of the patients and the degree of eruption of the third molars. Participants were asked to indicate whether they thought that the third molar should be removed or not. The degree of agreement between participants was measured by kappa indices for multiple raters. RESULTS: The kappa indices were 0.14 for the oral surgeons and 0.09 for the family dentists, indicating poor agreement beyond chance. Although in most cases the participants decided not to remove the third molar, they did so inconsistently, that is, they did not make this decision on the same cases. There were also differences in the inclination of the participants to suggest removal of the 36 third molars. CONCLUSION: Poor inter-observer agreement suggested that treatment decisions regarding asymptomatic third molars are based more on subjective beliefs and habitual practices than on rational decision making.     

Molar polymorphisms and the timing of dentition mineralization

The chronological age, skeletal age, and morphological age at the time of mineralization of 14 stages of the permanent teeth of 121 boys and 111 girls of the serial experimental sample of the Burlington Growth Centre were contrasted according to whether or not the children had 4- or 5-cusped mandibular permanent first molars, and whether or not they had agenesis of one or more third molars. In the boys with 4-cusped mandibular first molars, the mineralization of the teeth occurred at significantly earlier chronological and skeletal ages when they were significantly shorter in stature. Tooth mineralization was not consistently earlier in the girls with 4-cusped molars, but these girls tended to be taller and heavier than those with 5-cusped molars. In contrast, in both sexes with agenesis of third molars, the mineralization of the teeth was significantly delayed according to chronological, skeletal and morphological evaluation. The change in timing of mineralization was greatest for the second premolars and second molars, and least for the first molars.     

Effect of recombinant human granulocyte colony-stimulating factor on efficacy of radiation therapy in tumor-bearing rats

The effect of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on radiation-induced neutropenia and on growth of transplanted tumors treated by irradiation was investigated using tumor-bearing rats as a model for radiation therapy. In a preliminary study using normal rats, neutropenia induced by upper hemi-body irradiation at 3 Gy/day 5 times a week for 3 weeks was prevented by consecutive subcutaneous injections of rhG-CSF at 100 micrograms/kg/day. Rats bearing Walker-256, a mammary tumor, were scheduled to receive upper hemibody irradiation at 3 Gy/day for 15 times in 3 weeks if white blood cell (WBC) counts were maintained above 3,000/microliters. In control tumor-bearing rats not receiving rhG-CSF, irradiation was often withheld because of the decrease in WBC counts below 3,000/microliters. In contrast, a decrease in WBC counts below 3,000/microliters was rarely found in tumor-bearing rats injected daily with rhG-CSF. The average number of radiation treatments in control rats and rats treated with rhG-CSF was about 8 and 14, respectively, out of the scheduled 15 treatments in 3 weeks. Treatment with rhG-CSF made it possible to complete the radiation therapy regimen and thus inhibit the growth of the transplanted tumor more effectively. These results suggest that rhG-CSF may be useful to ensure radiation therapy on schedule in cancer patients.     

Effect of heterochronic parabiosis on liver microsomal enzyme oxidation

Third molars have been associated with a host of pathologies and there are risks involved with their surgical removal. They also have the highest incidence of congenital absence of all the permanent teeth. The aim of this study was to determine the prevalence and distribution of congenitally missing third molars in local Chinese patients. The orthopantomographic radiographs of 786 Singaporean Chinese patients aged 12 to 16 years were examined. It was found that 562 (71.5%) of the children had all 4 third molars. Varying degrees of third molar agenesis were noted in the other 224 (28.5%) children. Of these, 43 (5.5%) showed total absence of third molars. There was no significant difference in agenesis between the right and left sides and no sexual predilection was noted. However, more third molars were missing from the maxilla compared to the mandible, the ratio being 3:2.     

Residents'' corner. Answer to case of the month #58. Megacystis-microcolon-intestinal hypoperistalsis syndrome

The aim of this study was to compare the predictive value of umbilical artery Doppler velocimetry in women in the supine position with that in women in the complete left lateral position as a screening test for abnormal obstetric outcomes. Umbilical artery resistance index (RI) was measured at 27-29 weeks and 35-37 weeks in 202 pregnant women. The measurements were performed with the mother in the supine position in 100 cases (supine group), and in the complete left lateral position in 102 cases (lateral group). Predictive values of the tests for abnormal outcomes (small for gestational age, fetal distress, pregnancy-induced hypertension) were compared between both groups. When abnormal RIs were defined as being greater than the 90th centile in the supine group, the sensitivities for any of the abnormal outcomes at 27-29 weeks were 18% in the supine group and 6% in the lateral group; the positive predictive values were 30% and 25%, respectively. For measurement at 35-37 weeks, the sensitivity and positive predictive value were 29% and 45%, respectively in the supine group, and 0% in both cases in the lateral group. When abnormal RIs were defined as being greater than the 90th centile in the lateral group, the sensitivities at 27-29 weeks were 41% in the supine group and 6% in the lateral group; the positive predictive values were 44% and 8%, respectively. At 35-37 weeks, the sensitivity and positive predictive value were 53% and 43% in the supine group, and 6% and 8% in the lateral group. Umbilical artery Doppler velocimetry when the mother was in the complete left lateral position was of little value as a screening test. However, when the mother is in the supine position, it may serve as a kind of stress test and disclose latent obstetric abnormalities in certain cases.     

Guided tissue regeneration in the treatment of degree III furcation defects in maxillary molars

11 subjects with generalized periodontitis and advanced lesions in the maxillary molar regions, including bilateral mesial-distal, but not buccal, degree III furcation defects in the 1st and/or 2nd molars, were recruited for the present clinical trial. The patients were given oral hygiene instruction and full-mouth scaling and root planing. A re-examination was performed after 3 months of healing, after which the furcation involved molars were randomly selected for a GTR or conservative treatment modality. An informed consent form was signed by each participating patient. The GTR procedure involved the elevation of mucoperiostal flaps, root surface debridement, and the placement of an e-PFTE membrane at the 2 entrances of the furcation defect. The flaps were repositioned and secured. The contralateral molar was treated in an identical manner but without the placement of the teflon membrane. The patients received amoxicillin (1g x 2/day for 8 days), were placed on chlorhexidine mouth rinsing and were recalled for prophylaxis 1x every 2 weeks. The teflon membranes were removed at a 2nd stage procedure after 6 weeks. All subjects were re-examined 6 months after the regenerative procedure, and in addition, all sites were evaluated following a reentry procedure. The final examination and measurements made during the reentry procedure documented that, although some reduction in probing pocket depth and some gain in probing attachment had occurred at both test and control sites, none of the furcation defects had closed, but retained the characteristics of a degree-III furcation involvement.     

Tooth replantation in germ-free and conventional rats

The purpose of the present study was to evaluate the influence of bacterial infection on the pulpal and periodontal tissues in replanted teeth using germ-free and conventional rats. Forty maxillary and mandibular first molars from ten 6-week-old germ-free male Wistar rats were used. The animals and all materials were maintained in a germ-free environment inside vinyl isolators throughout the experimental periods. Twenty conventional male Wistar rats served as controls. The first molars were intentionally replanted immediately after extraction. At 3 days, and 1, 2, 4 and 8 weeks after replantation, animals were sacrificed and the replanted teeth were histopathologically evaluated. Diversity of pulp tissue response was notable in conventional rats, which initially showed various degrees of neutrophil infiltration and then displayed different types of response, including revascularization with reparative dentin formation and complete necrosis. Pulpal responses of germ-free rats were less variable, being characterized by an almost complete lack of neutrophil infiltration and a high frequency of bone-like tissue ingrowth. Typical inflammatory resorption was detected only in conventional rats, whereas a higher incidence of ankylosis was notable in germ-free rats. The present results may corroborate the concept that bacterial infection is a major cause of serious healing complications following tooth replantation, such as pulp necrosis and inflammatory root resorption. The difficulty in optimally controlling bacterial infection seems to be highly relevant to the complexity and unpredictability of the outcome of this procedure. It should also be emphasized that extensive mechanical damage to the periodontal tissues may trigger the development of unfavorable healing complications as ankylosis, even under strictly aseptic conditions.     

Root resorptions in upper first premolars after application of continuous intrusive forces. Intra-individual study

A scanning electron microscopy study of possible root resorptions and their localization after application of continuous forces of different magnitudes was conducted. Twelve upper first premolars, indicated for extraction, were previously intruded with constant forces. The teeth were divided into 3 groups: 1. non-moved control teeth, 2. continuous force application of 50 cN for 4 weeks, 3. continuous force application of 100 cN for 4 weeks. Specially designed NiTi-SE-stainless steel springs were utilized to exert the actual forces. After experimental tooth movement, the extracted teeth were dehydrated, metal-coated and examined by scanning electron microscopy. The intruded teeth showed resorptive areas consisting of lacunae (concavities) in the mineralized root surface. The teeth moved with 50 cN showed in the apical third several, in the medial third few, and in the cervical third no resorptive areas. In the case of the teeth moved with 100 cN, we observed resorptive areas in most of the apical third--including the apex contour-, several in the medial third, and none in the cervical third. In the control group no resorptions were observed. Thus, our results suggest that intrusion of human teeth with continuous forces induces root resorption, depending on the magnitude of force applied.