Dissertations / Theses on the topic 'Ankylotic'

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária
A anquilose alvéolo-dentária é definida como a fusão da cimento e/ou dentina com o osso alveolar, provocando a perda do ligamento periodontal através da consequente substituição por tecido ósseo. A sua etiologia não está bem esclarecida, mas existem hipóteses que procuram explicar a sua origem, considerando fatores como distúrbios do metabolismo local, traumáticos e genéticos. A sua prevalência é cerca de dez vezes maior nos dentes decíduos do que nos dentes permanentes, duas vezes mais frequente na mandíbula do que na maxila, podendo ser uni ou bilateral e abranger ambos os sexos. O diagnóstico precoce é fundamental, para diminuir as suas consequências nos processos de crescimento e desenvolvimento alvéolo-dentário. Apesar do exame histológico ser o mais preciso, é o menos utlizado. O exame radiográfico apresenta limitações quando a anquilose atinge menos de 20% da superfície radicular e não se localiza por mesial ou distal das raízes. Apesar de ser através do exame clínico que esta anomalia se deteta com mais facilidade, para alguns autores, a resistência oferecida pelo dente à movimentação ortodôntica representa um único diagnóstico praticamente definitivo. O plano de tratamento depende se o dente anquilosado é decíduo ou permanente, da existência ou não de sucessores permanentes, do tempo de início da anomalia, da época do diagnóstico, do padrão de erupção e severidade da infra-oclusão, e da relação dos dentes anquilosados com os adjacentes e antagonistas. A nível da discussão foi possível averiguar que há uma grande diferença de opiniões entre autores relativamente a vários parâmetros como teorias etiológicas, prevalência e tipos de tratamento. A possibilidade de poder vir a responder, através de revisão bibliográfia, às dificuldades de diagnóstico e implicações clínicas da anquilose alvéolo-dentária, foi determinante para este trabalho. Para a sua concretização, procedeu-se a uma pesquisa manual na biblioteca da Universidade Fernando Pessoa e na biblioteca da Faculdade de Medicina Dentária da Universidade do Porto. Paralelamente, realizou-se uma pesquisa na Web através do motor de busca “Google”, e nas bases de dados “MEDLINE/Pubmed” e “BOn”. Não foi feita qualquer restrição temporal tendo-se, apenas, incluído na pesquisa livros, metanálises, artigos de revisão e artigos de descrição de casos clínicos, escritos em língua inglesa, portuguesa e espanhola. Durante a pesquisa apenas se encontraram fontes de informação de 1964 a 2014. The alveolar tooth ankylosis is defined as the fusion of cement and / or dentin with the alveolar bone, causing loss of the periodontal ligament by subsequent replacement by bone tissue. The etiology remains unclear, although there are theories that attempt to explain its origin, considering factors such as local metabolism disturbances, traumatic and genetic factors. It’s prevalence is about ten times higher in primary teeth than in permanent teeth, twice as frequent in the mandible than in the maxilla, may be unilateral or bilateral including both sexes. Early diagnosis is essential to reduce its impact on the processes of growth and alveolar dental development. Although the histological examination is the most accurate, it is the less used. Radiographic examination has restrictions when ankylosis reaches less than 20% of the root surface and is not located by mesial or distal root. Although this anomaly is more easily detected through clinical examination, some authors argue that the resistance offered by the orthodontic tooth movement is virtually a single definitive diagnosis. The treatment plan depends on whether the tooth is ankylosed deciduous or permanent, the existence of permanent successors, the start time of the anomaly, the time of diagnosis, the eruption pattern and severity of infra-occlusion, and the relationship of the teeth ankylosed with the adjacent and antagonists ones. In the discussion it was possible to verify that there is a great difference of opinions among authors with respect to several parameters such as etiological theories, prevalence and types of treatment. The possibility of being able to respond, through bibliography review to the difficulties of diagnose and clinical implications of the alveolar-dental ankylosis, was crucial to this work. For it’s realization, we proceeded to a manual search on Fernando Pessoa University library and on the College of Dental Medicine, University of Porto, library. In parallel, we performed a Web search using the search engine "Google" and a search on "MEDLINE / Pubmed" and "B-On" databases. No time restriction was done and the search has only included books, meta-analyzes, review articles, and articles describing clinical cases, written in English, Portuguese and Spanish. During the search only information sources from 1964 to 2014 were found.

Syfte: Syftet med studien var att utvärdera risken för ankylos för exartikulerade (utslagna) permanenta tänder förvarade i saliv föregångna av olika torrförvaringstider innan replantation.Material och metod: Patientdata med replanterade permanenta tänder som förvarats i saliv före replantation valdes ut från en databas vid Köpenhamns Universitetssjukhus. Parodontal läkning med avseende på ankylos analyserades.Resultat: I studien inkluderades sjuttiofyra patienter (54 pojkar och 20 flickor) med 89 exartikulerade och replanterade tänder som alla hade förvarats i saliv före replantation. Den tid som de exartikulerade tänderna hade förvarats i saliv varierade från 1 minut till 150 minuter, med en genomsnittlig förvaringstid på 35 minuter. Cirka 40 % av de salivförvarade tänderna uppvisade läkning utan ankylos. Torrförvaring 5 minuter eller mindre före förvaring i saliv resulterade i ankylos hos 40% av tänderna men när torrförvaring översteg 5 minuter före förvaring i saliv sågs ankylos hos 80%. Tänder med slutet apex var signifikant mer påverkade av ankylos än tänder med öppet apex. Ankylos ökade med ökad förvaringstid i saliv.Slutsats: Att förvara en tand i saliv innan replantation minskar risken för ankylos jämfört med att förvara tanden torrt. Tänder med öppet apex har bättre prognos än tänder med slutet apex. Tillfällig förvaring av tanden i saliv bör uppmuntras om tanden inte omedelbart kan replanteras eller om ett lämpligt förvaringsmedel som till exempel mjölk eller fysiologisk koksaltlösning inte finns tillgängligt direkt vid olycksplatsen.Nyckelord: ankylos, exartikulerad tand, förvaringsmedium, replantation, saliv.
Purpose: The aim of the study was to evaluate the risk of ankylosis for avulsed human teeth stored in saliva preceded by various dry storage condition prior to replantation.Material and methods: Data from patients with replanted permanent teeth stored in saliva prior to replantation were selected from a database at Copenhagen University Hospital. Periodontal healing related to ankylosis was analyzed.Results: Seventy-four patients (54 male and 20 female) with 89 avulsed and replanted teeth, which all had been placed in saliva prior to replantation, were retrieved. The time the avulsed teeth were placed in saliva ranged from 1 to 150 minutes (mean time 35 minutes). Around 40 % of the saliva stored teeth showed healing without ankylosis. Dry storage for 5 minutes or less before saliva storage resulted in ankylosis in 40% of the teeth but when dry storage exceeded 5 minutes prior to storage in saliva, ankylosis was seen in 80%. Teeth with mature root development were significantly more often affected by ankylosis than teeth with immature root development. Ankylosis increased with increased storage time in saliva.Conclusion: Storing a tooth in saliva prior to replantation decreases the risk of ankylosis compared with dry storage. Immature teeth have a better prognosis than mature teeth. Temporary storage in saliva should be encouraged if an avulsed permanent tooth cannot be immediately replanted or a suitable storage medium such as milk or saline are not immediately available at the place of accident.Keywords: ankylosis, replantation, saliva, storage medium, tooth avulsion.

Orientador: Wilson Roberto Poi
Banca: Idelmo Rangel Garcia Júnior
Banca: Daniele Botticelli
Banca: Hugo Alexandre de Souza
Banca: Maurício Zardo
Resumo: O objetivo deste trabalho foi analisar o reparo ósseo peri-implantar de implantes instalados sobre raízes dentárias reimplantadas tardiamente, apresentando processo de anquilose e reabsorção por substituição. Foram utilizados os terceiros e quartos pré-molares inferiores de 4 cães machos (Beagle). Os dentes foram seccionados, e as raízes mesiais extraídas e mantidas durante 1 hora em temperatura ambiente. Após a remoção do ligamento periodontal necrótico e tratamento endodôntico, imergiram-se em fluoreto de sódio por 5 minutos e reimplantou a porção no alvéolo esplintando nas porções distais. Nestas foram realizadas pulpotomia e restauração. Decorridos 30 dias, as porções mesiais tiveram suas coroas seccionadas. Após 5 meses, cinco implantes foram instalados em osso reparado, grupo I, (Controle); nove foram instalados nos alvéolos frescos pós-exodônticos das porções distais (Grupo II - Imediato) e doze implantes foram instalados sobre as raízes mesiais em processo de reabsorção radicular externa (Grupo III - experimental). Decorridos 120 dias, os resultados foram analisados pelo contato osso implante da superfície do implante sem roscas e das três primeiras roscas. Foi avaliada, também, a área de tecido ósseo presente nos espaços internos das três primeiras roscas e da área espelho correspondente. O contato osso implante foi de 55% no grupo controle, 48% no imediato e 40% no grupo experimental. A área de tecido ósseo foi, respectivamente, 71%, 61% e 55%, e a área espelho de tecido ósseo foi de 62%, 60% e 58%. Conclui-se que o reparo ósseo perimplantar de implantes instalados sobre raízes apresentou um pequeno em relação aos outros dois grupos.
Abstract: The purpose of this study was to analyze the peri-implant bone repair of dental implants placed on delayed reimplated roots, with process of ankylosis and reabsorption by substitution. The lower third and fourth pre-molar of four male dogs (Beagle) was used. The teeth were cut, and the mesial roots were extracted and kept out for 1 hour at ambient temperature. After removal of necrotic periodontal ligament and endodontic treatment, the root was immersed in sodium fluoride for 5 minutes. Then it was reimplanted in the correspondent alveolar bone and splinted in distal portion. A pulpotomy and a crown restoration were conducted on the distal portion. After 30 days, the mesial portions had their crowns cut (decoronation).Moreover, 5 months later, five implants were installed in bone repair, Group I (Control), and nine were installed in the fresh socket of the distal portions, which were extracted (Group II - Immediate). Finally, twelve implants were installed on the mesial roots, with process of external resorption (Group III - experimental). After 120 days, the results were analyzed by bone implant contact, from the surface of the implant without threads to the first three threads. It was also evaluated the area of the bone tissue located in the internal spaces of the first three threads and the corresponding mirror area. The bone implant contact was 55% in the control group, 48% in the immediate group and 40% in the experimental group. The area of bone tissue in the internal threads area was respectively 71%, 61% and 55%, and the mirror area of bone tissue had the following results: 62%, 60% and 58%. It was concluded that peri-implant bone repair of the implant put on the roots with an external resorption showed delay compared to the other two groups.
Doutor

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O objetivo deste trabalho foi analisar o reparo ósseo peri-implantar de implantes instalados sobre raízes dentárias reimplantadas tardiamente, apresentando processo de anquilose e reabsorção por substituição. Foram utilizados os terceiros e quartos pré-molares inferiores de 4 cães machos (Beagle). Os dentes foram seccionados, e as raízes mesiais extraídas e mantidas durante 1 hora em temperatura ambiente. Após a remoção do ligamento periodontal necrótico e tratamento endodôntico, imergiram-se em fluoreto de sódio por 5 minutos e reimplantou a porção no alvéolo esplintando nas porções distais. Nestas foram realizadas pulpotomia e restauração. Decorridos 30 dias, as porções mesiais tiveram suas coroas seccionadas. Após 5 meses, cinco implantes foram instalados em osso reparado, grupo I, (Controle); nove foram instalados nos alvéolos frescos pós-exodônticos das porções distais (Grupo II – Imediato) e doze implantes foram instalados sobre as raízes mesiais em processo de reabsorção radicular externa (Grupo III – experimental). Decorridos 120 dias, os resultados foram analisados pelo contato osso implante da superfície do implante sem roscas e das três primeiras roscas. Foi avaliada, também, a área de tecido ósseo presente nos espaços internos das três primeiras roscas e da área espelho correspondente. O contato osso implante foi de 55% no grupo controle, 48% no imediato e 40% no grupo experimental. A área de tecido ósseo foi, respectivamente, 71%, 61% e 55%, e a área espelho de tecido ósseo foi de 62%, 60% e 58%. Conclui-se que o reparo ósseo perimplantar de implantes instalados sobre raízes apresentou um pequeno em relação aos outros dois grupos.
The purpose of this study was to analyze the peri-implant bone repair of dental implants placed on delayed reimplated roots, with process of ankylosis and reabsorption by substitution. The lower third and fourth pre-molar of four male dogs (Beagle) was used. The teeth were cut, and the mesial roots were extracted and kept out for 1 hour at ambient temperature. After removal of necrotic periodontal ligament and endodontic treatment, the root was immersed in sodium fluoride for 5 minutes. Then it was reimplanted in the correspondent alveolar bone and splinted in distal portion. A pulpotomy and a crown restoration were conducted on the distal portion. After 30 days, the mesial portions had their crowns cut (decoronation).Moreover, 5 months later, five implants were installed in bone repair, Group I (Control), and nine were installed in the fresh socket of the distal portions, which were extracted (Group II - Immediate). Finally, twelve implants were installed on the mesial roots, with process of external resorption (Group III - experimental). After 120 days, the results were analyzed by bone implant contact, from the surface of the implant without threads to the first three threads. It was also evaluated the area of the bone tissue located in the internal spaces of the first three threads and the corresponding mirror area. The bone implant contact was 55% in the control group, 48% in the immediate group and 40% in the experimental group. The area of bone tissue in the internal threads area was respectively 71%, 61% and 55%, and the mirror area of bone tissue had the following results: 62%, 60% and 58%. It was concluded that peri-implant bone repair of the implant put on the roots with an external resorption showed delay compared to the other two groups.

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Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
Dental ankylosis is the fusion of dental tissue (dentin and cementum) to alveolar bone without the presence of the periodontal ligament (PDL), which can progress to replacement resorption. Cone-beam computed tomography (CBCT) has been prescribed for the evaluation of unerupted teeth, and ankylosis is an important characteristic to be observed in the analysis of these teeth. The objective of this research was to establish diagnostic criteria, using pixel intensity in CBCT and associate with clinical and demographic factors. The pixel intensity value was performed by two analyzes. The first (analyze 1) evaluated the mean pixel intensity in different regions of the dento-alveolar complex in normal and ankylosis areas. The second (analyze 2) was observed the variation of pixel intensity values in two normal areas and one of ankylosis. Data were analyzed statistically by means of absolute and relative frequency measurements; odds ratio, Chi-square. The t-test was used to compare the means of pixel intensity. One hundred and fifty-seven CBCT exams of individuals with unerupeted or partially erupted teeth with suspected ankylosis were evaluated, totaling 206 teeth. Fifty-seven teeth (27.6%) had a presumptive diagnosis of ankylosis and were evaluated using pixel intensity value. In analysis 1, it was observed that the values of alveolar bone in the normal and ankylosis areas, practically have the same variability of pixel intensity value (t-test = 0.07). When comparing the density of normal PDL with the ankylosis area, a higher density is observed (t-test p <0.001). When compared to the alveolar bone interface with PDL and alveolar bone with ankylosis area, it is observed that the intensity of the pixels in the ankylosis region is greater than in the normal area (t-test p <0.001). In analysis 2, it was observed that there was a marked reduction of pixel intensity value in the PDL area, which did not occur in the ankylosis areas. Considering the clinical and demographic factors, the occurrence in individuals over 20 years old was 72.5%, and less or equal to 20 years was 27.5% (odds ratio 1.8 95% CI 0.87-3.73), and 77.2% (n = 44) were in the upper arch. The mesioangular inclination was observed in 49.1% (n = 28), and the association between impaction and dental ankylosis was not observed (p = 0.44 Chi-square). The cervical and middle thirds of root were the most affected, 38.6% and 35.1%, respectively. It was possible to observe ankylosis in 22 teeth (38.6%) in three multiplanar reconstructions. In summary, the results suggest that the CBCT examination allows the diagnosis of ankylosis and the analysis of the pixel intensity values and their variability are an important digital tool for the interpretation and diagnosis process.
Anquilose dentária constitui uma desordem, em que ocorre a fusão total ou parcial do cemento ou dentina ao osso alveolar, pela ausência do ligamento periodontal (LPD), podendo evoluir para a reabsorção por substituição. O exame de tomografia computadorizada por feixe cônico (TCFC) tem sido prescrito para a avaliação de dentes não irrompidos, sendo a anquilose uma característica importante a ser observada na análise desses dentes. O objetivo desta pesquisa foi estabelecer critérios de diagnóstico, utilizando intensidade de pixel em TCFC e associar com fatores clínicos e demográficos. A análise de intensidade de pixel foi realizada por meio de duas análises. A primeira (análise 1) avaliou a média de intensidade de pixel em diferentes regiões do complexo dento-alveolar em áreas normais e de anquilose. A segunda (análise 2) observou a variação dos valores de intensidade de pixel em duas áreas normais e uma de anquilose. Os dados foram analisados estatisticamente por meio de medidas de análise de frequência absoluta e relativa; odds ratio, Qui-quadrado. O teste-t foi utilizado para comparação das médias de intensidade de pixel. Cento e cinquenta e sete exames TCFC de indivíduos com dentes não irrompidos ou parcialmente irrompidos e com suspeita de anquilose, foram avaliados, totalizando 206 dentes. Cinquenta e sete dentes (27,6%) possuíam diagnóstico presuntivo de anquilose, e foram avaliados por meio da intensidade de pixel. Na análise 1, observou-se que os valores de osso alveolar na área normal e de anquilose, possuem praticamente a mesma variabilidade de intensidade de cinza (Teste-t p=0,07). Quando comparado a densidade do LPD normal com a área de anquilose, observa-se uma maior densidade (Teste-t p<0,001). Quando comparado a interface osso alveolar com LPD e osso alveolar com área de anquilose, observase que a intensidade dos pixels na região da anquilose é maior do que da área normal (Teste-t p<0,001). Na análise 2, observou-se que havia uma redução acentuada da intensidade de pixel na área do LPD, o que não ocorreu nas áreas de anquilose. Considerando os fatores clínicos e demográficos, a ocorrência em pacientes acima de 20 anos foi de 72,5%, e menor ou igual a 20 anos foi de 27,5% (Odds ratio 1,8 IC95% 0,87-3,73), sendo que 77,2% (n=44) foi localizada na arcada superior. A inclinação mesioangular foi observada em 49,1% (n=28), e não foi constatada a associação entre impacção e anquilose dentária (p=0,44 Quiquadrado). Os terços cervical e médio radiculares foram os mais acometidos, 38,6% e 35,1%, respectivamente. Foi possível observar anquilose em 22 dentes (38,6%), em três reconstruções multiplanares. Em síntese, os resultados sugerem que o exame de TCFC permite o diagnóstico de anquilose e a análise dos valores de pixel e sua variabilidade, constituem uma ferramenta auxiliar importante para o processo de interpretação e diagnóstico.

The presented diploma thesis deals with the elemental composition of hard tissues – human and murine jaws studied by laser-induced plasma spectroscopy (LIBS). Samples of human teeth contained a disease called ankylosis and the difference in elemental composition of healthy and diseased tissue was observed to localize ankylosis in the tooth. When evaluating the map of the spatial distribution of phosphorus and calcium, a decrease in the concentration of these elements in the ankylosis infected area was observed. Furthermore, murine jaws containing lead were analyzed. When assessing the spatial distribution of lead in tissue, it was found that lead was incorporated in murine teeth in the enamel at the tip of the incisor and molars. In conclusion, LIBS method achieved good results considering the detection of the elemental distribution of hard tissues. It enables to differentiate parts of the tooth in terms of elemental composition and tissue hardness and also to detect changes in the matrix caused by a disease or bioaccumulation of heavy metals.

O tratamento preconizado para dentes permanentes avulsionados devido a traumatismos dentários em crianças é o reimplante dental. Entretanto, sabe-se que o sucesso após o reimplante depende, especialmente, do tempo em que o dente permanece fora do alvéolo e do meio de conservação no qual o dente é armazenado. Nesse sentido, para que se tenha sucesso após o reimplante faz-se necessário que o dente seja imediatamente reimplantado e/ou seja mantido em um meio capaz de manter a vitalidade das células da superfície radicular. Se isso não for possível, o tratamento da superfície radicular deverá ser instituído com o objetivo de prevenir a reabsorção radicular. Dessa maneira, esta pesquisa teve como primeiro objetivo avaliar a influência de diferentes meios de conservação para dentes avulsionados, por meio de uma revisão sistemática, com a finalidade de estabelecer se há um consenso sobre o meio mais adequado para conservação capaz de prevenir sequelas como anquilose e reabsorção dentária. A seguir, o segundo objetivo desse estudo foi testar o Denosumab, um anticorpo monoclonal anti-RANKL, como substância para o tratamento tópico da superfície radicular, a fim de evitar a anquilose e a reabsorção dentária por substituição. Para tanto, foram utilizados 36 incisivos superiores direitos de ratos submetidos à extração cirúrgica, manutenção em meio extra-alveolar seco por 60 minutos e posterior reimplante. No grupo I, controle positivo, foi realizado o reimplante tardio sem tratamento de superfície; nos grupos II e III, grupos experimentais, previamente ao reimplante tardio foi realizado o tratamento da superfície radicular com solução de Denosumab a 60 mg/mL e a 30 mg/mL, respectivamente, por 10 minutos. Os canais radiculares dos animais dos três grupos foram preenchidos com pasta à base de hidróxido de cálcio, via retrógrada, e em seguida os dentes foram reimplantados. Decorridos 15 e 60 dias do reimplante, os animais foram submetidos à eutanásia e as peças, contendo dente e osso, foram removidas para o processamento histotécnico. A seguir cortes histológicos foram realizados, corados por hematoxilina e eosina (HE), para descrição das características da superfície dentária e do ligamento periodontal e para mensuração do comprimento (perímetro) da anquilose e/ou reabsorção por substituição e das áreas de reabsorção dentária, em microscopia de luz e, para mensuração da área do ligamento periodontal, em microscopia de fluorescência. Espécimes sequenciais foram analisados por meio de coloração de Brown & Brenn modificada para identificação de micro-organismos e imunohistoquímica para identificação dos marcadores RANKL, OPG e Periostina (PRT). As análises foram realizadas de forma descritiva e quantitativa. Dados quantitativos foram submetidos à analise estatística por meio do teste paramétrico ANOVA de uma via e pós-teste de Tukey e dos testes não-paramétricos de qui-quadrado e exato de Fisher, com nível de significância de 5%. Ao final da revisão sistemática da literatura pudemos concluir que não há evidência para estabelecer qual o melhor meio de conservação para dentes avulsionados. Dentre os meios que foram encontrados estão a água de coco, água da torneira, leite de soja, leite integral, solução salina, saliva, própolis, soro fisiológico, solução Euro-Collins, solução salina balanceada de Hanks (HBSS) e Viaspan®. Ainda que esta revisão tenha sido conduzida em modelo animal experimental, a baixa qualidade dos estudos bem como a sua heterogeneidade indicam que a extrapolação para humanos deva ser cautelosa. No estudo experimental em modelo animal, o tratamento de superfície com Denosumab a 60 mg/mL preveniu a anquilose, a reabsorção por substituição e a reabsorção dentária, após 60 dias, comparado com o grupo sem tratamento. A coloração de Brown & Brenn evidenciou uma menor contaminação nos tecidos mineralizados quando do tratamento de superfície com Denosumab, independente da concentração utilizada. Com relação à imunohistoquímica, o tratamento com Denosumab inibiu a síntese de RANKL sem modular OPG. A Periostina foi observada no ligamento periodontal dos dentes reimplantados. Porém, essa marcação estava ausente nas áreas de anquilose, em ambos os períodos experimentais, indicando que durante o processo de anquilose a síntese de periostina é inibida, o que resulta na fusão do osso à superfície radicular.
The treatment of choise for permanent dental avulsion is replantation. However, it is known that the success of the repair after replantation depend especially the extracellular and the storage medium in which is stored the tooth. Accordingly, in order to have success after replantation is necessary that the tooth is replanted immediately and/or to be kept in a medium capable of maintaining the cell´s vitality of the root surface. If that is not possible, treatment of the radicular surface should be done in order to prevent radicular resorption. Thus, the firstly aim was to perfom a systematic review to evaluate the in vivo effectiveness of different storage media for avulsed teeth. So, the second aim of this study is to test the substance as Denosumab, a monoclonal antibody, for the topical treatment of the root surface in order to prevent dental ankylosis and replacement resorption. For this, we used 36 rat incisors rights, extracted and replanted, and divided into: group I, positive control, delayed replantation without root surface treatment; groups II and III , experimental groups, delayed replantation without root surface treatmen with Denosumab 60 mg/mL and 30 mg/mL, respectively, for 10 minutes. The canals were filling with calcium hydroxide and the teeth were replanted. After periods of 15 and 60 days of the replantation, the animals will be euthanized. Then, samples are removed and processed for microscopic analysis. Histological sections were performed, stained with hematoxylin and eosin, to describe the characteristics of the dental surface and the periodontal ligament and to measure the length of ankylosis, replacement resorption and dental resorption by conventional microscopy, and for the measure the area of periodontal ligament, by fluorescence microscopy. Sequential specimens were analyzed by Brown & Brenn, for localization of bacteria; and markek by immunohistochemistryfor RANKL, OPG and Periostin (PRT). The analysis were displayed qualitatively or quantitatively. Data were subjected to statistical analysis by oneway ANOVA and the Tukey post-test and by chi-square and Fisher\'s exact tests. The significance level was set at 5%. The systematic review does not provide enough evidence to determine the best storage medium to achieve successful tooth replantation. This systematic review has identified many storage media that have been used to preserve avulsed teeth, including coconut water, tap water, soy milk, whole milk, saline solution, saliva, propolis, physiologic saline, Euro-Collins solution, HBSS, and Viaspan®. Although this review was conducted in an experimental animal model, a poor quality of the studies as well as their heterogeneity indicates that a human extrapolation should be cautious. In the experimental study in animal model, root surface treatment with Denosumab 60 mg/mL prevented ankylosis, replacement resorption, and tooth resorption, 60 days after replantation, compared with the untreated group. Brown & Brenn staining showed a lower contamination in the mineralized tissues in the Denosumab surface treatment group, regardless of the concentration used. As for immunohistochemistry, Denosumab inhibited the synthesis of RANKL without modulating OPG. Periostin was observed in periodontal ligament of tooth replanted. However, this labeling was absent in the ankylosis areas, in both experimental periods, indicating that during the ankylosis process, the periostin synthesis is inhibited, resulting in the fusion between bone and root surface.

The current study investigated the expression Runx2 and VEGF in the pulp, periodontal ligament and alveolar bone following hypothermal insult. Methods and Materials: Materials from a previous study performed by Tan (2011) were used for this research. The upper right first molars of fifteen eight-week-old male Sprague-Dawley rats were subjected to a single ten minute application of dry ice. The contralateral molar acted as an internal control. The animals were randomly divided into five groups of three and killed 0, 4, 7, 14 and 28 days post hypothermal insult. A further three Sprague-Dawley rats acted as an external control and were humanely killed on day 0 with no hypothermal insult. The maxilla was dissected out, fixed and embedded in paraffin. Coronal sections were cut to include the control and experimental teeth at 5-micron intervals through the furcation region. Sections were then stained with haematoxylin and eosin (H and E) and Runx2 and VEGF immunostains. Sections were scanned via a Nanozoomer Slide Scanner 2.0 series and viewed on a personal computer (MacBook Pro with 13 inch screen) using the Nanozoomer Digital Pathology (NDP) software. Semiquantitative counting was performed at a magnification of x20 via the ImageJ software. Data was analysed using SAS 9.3 (SAS Institute Inc., Cary, NC, USA). The level of significance was set at p<0.05.
Thesis (D.Clin.Dent.) -- University of Adelaide, School of Dentistry, 2013

This study used Backscattered electron imaging (BSE) and X-ray Microanalysis to qualitatively and quantitatively investigate morphology and elemental composition of ankylotic adaptation in the periodontium following hypothermic insult to their maxillary first molars. This method has been shown in previous studies to induce aseptic root resorption along with ankylotic changes within the periodontal ligament (PDL). A secondary objective was to assess the pulpal changes that occurred concurrent with the changes in the periodontium. Twenty-eight eight week old Sprague Dawley rats were divided into four groups of seven animals corresponding to one of four observation periods i.e.: t₁= 7 days, t₂= 14 days, t₃= 21 days, t₄ = 28 days. At t=0 days, six animals in each group received a thermal insult as a continuous 20 minute application of dry ice (CO₂ at -81⁰C) to the crowns of their upper right maxillary molar. The untreated left molars were used as controls. The remaining rat within each group did not receive the dry ice. All rats were given two sequential bone labels, calcein 5mg/kg and alizarin red 30mg/kg, administered intraperitoneally 8 days apart. The timing of the labels was such that all rats were euthanased 2 days after the last label. Following sacrifice, the maxillae were dissected out, fixed in ethanol and embedded in methylmethacrylate. Ten microns thick, undecalcified maxillary first molar coronal sections through the furcation were obtained. For every 3 out of 10 sections: the first was left unstained and undecalcified; the second stained with Von Kossa/haematoxylin & eosin; and the third decalcified and stained with haematoxylin & eosin. Unstained sections were viewed under fluorescence, while transmitted light microscopy was used for the other sections. Following initial analysis, the unstained, undecalcified sections were de-coverslipped and carbon coated. These sections were investigated with scanning electron microscopy and Energy Dispersive X-ray Spectrometry (EDS). Quantitative spot analysis and element mapping was performed on alveolar bone, ankylotic areas, cementum and dentine. A linear mixed effects model was employed to investigate any interaction between the four tissues of interest. A focal pattern of ankylosis was observed at days 14 and 21 in three rats. No ankylosis was observed in the control teeth. SEM revealed a focal type of ankylosis with central nodules of mineralized tissue forming within the PDL. Bridging between bone and dentine occurred with fine trabeculae which extended from the central mineralized nodule. Bridging was progressive and was more extensive at day 21 compared to day 14. At day 28, no ankylosis was observed. EDS analysis revealed that the ankylotic tissue was composed of major constituents Calcium and Phosphorous along with trace elements of Mg and Na. This was comparable to the surrounding alveolar bone, cementum and dentine. There was no statistically significant difference in the Ca/P ratios, Mg when ankylotic material was compared to bone. There was a trend towards elevated Na levels in ankylosis but this was not statistically significant relative to bone. Mg in dentine was lower than for all the other tissues and Na was higher in dentine when compared to bone and cementum. In the pulp, hypothermic injury demonstrated alteration of the odontoblast layer, reduction in cellularity, vascular alterations and tertiary dentin formation. At the 28 day observation period, the cellular and vascular changes had returned to levels comparable to the control teeth, indicating successful pulpal healing and regeneration. Marked tertiary dentine deposition was also observed at days 14, 21 and 28. Pulp chambers were visibly smaller due to tertiary dentine formation, however no pulp necrosis was observed. Thus the aseptic root resorption model, using a continuous 20 minute application of dry ice, suggested the occurrence of reversible pulpal tissue alterations compatible with an inflammatory repair process. The observation of ankylosis initiating as centralised nodules within the PDL suggest that the origins may be a consequence of osteogenic potential from PDL stem cells. The null hypothesis that a single, prolonged thermal insult on a rat molar does not have an effect on mineralized tissue formation and that ankylotic tissue is similar to bone was rejected. ABSTRACT There is a presumption that the ankylotic region formed after periodontal ligament (PDL) injury represents an unremarkable bony repair process. Essentially, the injury triggers an osteogenic repair response and the ankylotic tissue merely represents alveolar bone. There is uncertainty whether the oestogenic event is predominantly osteoblast driven, cementoblast directed, or a consequence of osteogenic potential from PDL stem cells. In this study, twenty-eight Sprague Dawley rats were divided into four groups of six animals, corresponding to one of four observation periods, and received a thermal insult as a continuous 20 minute application of dry ice to the crowns of their upper right maxillary molar. The appearance of ankylotic tissues was examined using backscattered electron images using a scanning electron microscope (SEM) equipped with an Energy Dispersive X-ray Analyser (EDS). The Ca, P, and trace elements contents were determined by EDS from four different hard tissue regions: ankylosis; bone; dentine and cementum, and the Ca/P ratios were calculated. Ankylosis was observed at days 14 and 21 in 3 rats and was not seen at day 28. No ankylosis was observed in the control teeth. BSE imaging revealed a focal type of ankylosis with central nodules of mineralized tissue forming within the PDL. The morphological features of ankylotic tissue differed to that of alveolar bone and dentine. Bridging between bone and dentine occurred with fine trabeculae which extended from the central mineralized nodule. EDS analysis showed that the ankylotic tissue was composed of major constituents Ca and P along with trace elements of Mg and Na. This was comparable to the surrounding alveolar bone, cementum and dentine. There was no statistically significant difference in the Ca/P ratios, Mg, and Na between ankylotic material and bone. Statistically significant differences was evident in Mg content between ankylotic material compared to dentine and cementum. Na content was higher in dentine than in ankylotic material. The results of this study indicate that, histochemically, ankylotic material is similar to bone. However, the appearance of ankylotic material as centralised foci with a morphology different from bone suggest that ankylosis may originate from an osteoblastic phenotype originating within PDL.
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Thesis (D.Clin.Dent.) -- University of Adelaide, School of Denstistry, 2010

The first objective of my work was to use the ank/ank (progressive ankylosis) mutant mice, which have a deficiency in inorganic pyrophosphate transport, to address the role of Ank in joint ankylosis. I observed the presence of hypertrophic chondrocytes in the uncalcified ank/ank mice articular cartilage. This novel phenotype is likely due to a dysregulation of chondrocyte maturation as these chondrocytes expressed hypertrophic chondrocyte markers (collagen type X and tissue non-specific alkaline phosphatase). I also showed by immunohistochemical staining that beta-catenin expression was upregulated and localized in the nuclei of articular ank/ank chondrocytes, suggesting activation of Wnt/beta-catenin signaling in these chondrocytes. The second objective was to use ank/ank mice as an informative model for understanding ankylosis mechanisms in human ankylosing spondylitis (AS) patients, as WNT/beta-catenin signaling plays an important role in ankylosis in AS patients. We attempted rescue of joint ankylosis in ank/ank mice by gene transfer of noggin, an antagonist of BMP signaling. Paradoxically, noggin-treated ank/ank mice had accelerated ankylosis, as evidenced by joint pathology and IHC staining of beta-catenin showed more intense signals in the spinal chondrocytes of the treated mice. As noggin and sclerostin (an antagonist of beta-catenin signaling) form a mutually inhibitory complex, we hypothesize that the formation of this complex results in relieving suppression of both beta-catenin and BMP signaling, leading to more severe ankylosis in ank/ank mice. By quantitative molecular imaging, I have demonstrated that ankylosis in these mutant mice developed simultaneously in distal and axial joint, instead of being a centripetal process. In summary, I have made three original observations in the ank/ank mice: the hypertrophic chondrocyte phenotype; activation of beta-catenin signaling and the simultaneous development of ankylosis in distal and axial joints. These mutant mice serve as valuable model for pre-clinical studies which enable modeling and testing of novel anti-ankylosis treatments.

Background: Dentoalveolar ankylosis may occur spontaneously or as a sequela to dental trauma and results in an area of bone fusing to the tooth (Kurol 1981). Infra-occlusion following dentoalveolar ankylosis results in a number of significant orthodontic sequelae. These include overeruption of the opposing tooth, tipping of adjacent teeth towards the ankylosed tooth, a loss of arch length, space loss and a shift of the dental midline (Messer and Cline 1980; Andlaw 1974; Ponduri et al. 2009). Vertical alveolar growth may also be hindered (Kjaer et al. 2008). The understanding of the biological processes behind the formation and repair of the ankylotic lesion is incomplete. Following dental trauma, the periodontal ligament (PDL) may be the source of the cells that repopulate a tooth root defect that determine whether ankylosis occurs (Erausquin and Devoto 1970; Lin et al. 2000; Melcher 1970; Line et al. 1974). When the PDL space is repopulated by cells from a source outside the true PDL tissues (such as the alveolar bone) healing may occur by way of dentoalveolar ankylosis. Research in the field of bone biology has recently focused on the role of the osteocyte. This cell, with its unique location embedded in bone, may have an essential role in bone metabolism. Osteocytes produce sclerostin, a protein that inhibits bone formation. There is also evidence that the osteocyte may be a major source of receptor activator of NF-κβ (RANKL) which is essential for osteoclastogenesis. This project aims to investigate the expression of RANKL and sclerostin in a rat model of dentoalveolar ankylosis induced by a hypothermal insult. The null hypothesis is that an applied cold insult and subsequent ankylosis does not affect the expression of RANKL and sclerostin within the dentoalveolar complex. Methods: Dentoalveolar ankylosis was induced in fifteen, eight week old, male, Sprague-Dawley rats (5 groups of 3 rats each) by application of dry ice to the upper right first molar tooth. An additional 3 rats served as untreated controls and the experimental rats were sacrificed at days 0, 4, 7, 14 and 28. Immunohistochemical detection of RANKL and sclerostin was performed and the number of RANKL and sclerostin positive and negative cells as well as the number of empty lacunae representing dead osteocytes were calculated and compared between groups. Results: The cold insult resulted in dentoalveolar ankylosis, with the periodontal ligament (PDL) almost completely replaced by bone in the furcation region of the root 14 days after injury with regeneration of the PDL evident after 28 days. Resorption of the ankylotic bone and cementum was evident in the furcation region. There was also a statistically significant increase in the number of empty lacunae due to osteocyte death that coincides with the incidence of maximal ankylosis. RANKL was detected in bone marrow stromal cells, osteoblasts and bone lining cells, osteoclasts, endothelial-like cells lining vessels, epithelial cells, odontoblasts and periodontal fibroblasts. However, clear staining in osteocytes was not evident. Epithelial rests of Malassez showed strong expression of RANKL. When ankylosis was present, there was a statistically significant difference in sclerostin expression between the areas of bone closest to, and farthest away, from the furcation area. There was a non-statistically significant trend towards reduced sclerostin expression at days 7 and 14 followed by a slight increase in expression at day 28. The slight increase in sclerostin expression at day 28 may indicate the establishment of a healing response. In considering these results, it should be noted that this experiment uses a model of ankylosis in which the ankylotic lesion develops following a thermal insult. The factors that initiate ankylosis in a clinical situation are incompletely understood and may differ from this model. Conclusions: Whilst RANKL was not detected in osteocytes in this model of ankyloses there was strong expression of RANKL by ERM in the PDL and a significant change in sclerostin expression near the area of ankylosis. This may contribute evidence that RANKL, sclerostin and the osteocyte might have a role in influencing the regeneration of the PDL following dentoalveolar ankylosis. The null hypothesis that an applied cold insult and subsequent ankylosis does not affect the expression of RANKL and sclerostin within the dentoalveolar complex is rejected.
Thesis (D.Clin.Dent.) (Research by Publication) -- University of Adelaide, School of Dentistry, 2015.

Yes
Objective: To better understand the pathogenesis of DISH, identifying early or pre-DISH lesions in the spine and investigating the relationship between spinal and extra-spinal manifestations of DISH. Material: 44 skeletonized individuals with DISH from the WM Bass Donated Skeletal Collection. Methods: For each vertebra, location, extension, point of origin and appearance of vertebral outgrowths were recorded. The size of the enthesophytes at the olecranon process, patella and calcaneal tuberosity was measured with digital callipers. Results: At either end of the DISH-ankylosed segment, isolated vertical outgrowths arising from the central third of the anterior aspect of the vertebral body can usually be observed. These bone outgrowths show a well-organized external cortical layer, an internal structure of trabecular bone and usually are unaccompanied by or show minimal associated endplate degeneration. Analysis of the relationship between spinal and extra-spinal manifestations (ESM) suggests great inter-individual variability. No correlation between any ESM and the stage of spinal DISH was found. Conclusions: Small isolated outgrowths represent the earliest stages of the spinal manifestations of DISH. The use of ESM as an indicator of DISH should be undertaken with great caution until the relationship between these two features is understood. Significance: Improved accuracy of paleopathological diagnostic criteria of DISH. Limitations: Small sample comprised of only individuals with DISH. Future research: micro-CT analysis to investigate the internal structure of the spinal lesions. Analysis of extra-spinal enthesophytes in individuals with and without DISH to understand their pathogenesis and association with the spinal lesions in individuals with DISH.
Institute of Life Sciences Research Studentship awarded by the University of Bradford, Bradford, UK.

No tratamento de molares decíduos anquilosados, o diagnóstico precoce, o tratamento adequado e o acompanhamento completo são muito importantes. A infra-oclusão devido a anquilose, quando não tratada, pode ter um impacto negativo no desenvolvimento oclusal normal da criança, originando problemas. O objetivo do presente estudo foi determinar as opções terapêuticas em molares decíduos anquilosados Foi realizada uma pesquisa bibliográfica no motor de busca “Google”, e nas bases de dados “Medline/Pubmed”, “B-On” e “Researchgate”, sem limitação temporal, e foram incluídos estudos do tipo meta-análises, artigos de revisão e artigos de descrição de casos clínicos, redigidos na língua inglesa, portuguesa e francesa. Após a leitura dos artigos, foram considerados 47 artigos para a realização desta revisão.
In the treatment of ankylosed primary molars, early diagnosis, adequate treatment and complete follow-up are very important. Infra-occlusion due to ankylosis, if left untreated, can have a negative impact on the child's normal occlusal development, causing problems. The aim of the present study was to determine the therapeutic options for ankylosed primary molars. A bibliographic search was carried out in the search engine “Google”, and in the databases “Medline/Pubmed”, “B-On” and “Researchgate”, without temporal limitation, and studies of the meta-analysis type, review articles and description articles of clinical cases, written in English, Portuguese and French. After reading the articles, 47 articles were considered for this review.

The process of tooth eruption involves complex interactions between genetic, epigenetic and environmental factors. ‘Infraocclusion’ refers to a tooth that is positioned below the normal plane of occlusion. This study aims to determine the frequency of occurrence of infraocclusion in the primary molars and to find out whether there are associations between infraocclusion and several variables. Further, it is planned to clarify the roles of genetic, epigenetic and environmental factors in contributing to observed variation in infraocclusion, and to estimate the frequency of occurrence of some selected dental anomalies in association with infraocclusion. Orthopantomographs of 1,454 healthy singleton Finnish boys and girls aged between 9-10 years, and study models of 320 Australian twin pairs aged between 8-10 years were examined. Adobe Photoshop CS5 computer software was used to construct reference lines (from the mesial marginal ridge of the mandibular first permanent molar to the cusp tip of the primary canine or the mesioincisal edge of the permanent lateral incisor). The distances between reference points were measured (in mm) for both samples and categorised into non-infraoccluded, mild, moderate, and severe. Genetic modelling was also used to quantify the contribution of genetic and environmental factors to observed variation. The orthopantomographs were examined for the presence of associated dental anomalies. Dental age and tooth size assessment were carried out in individuals showing infraocclusion. Descriptive statistics, including mean values, standard deviations and percentage frequencies, were used to summarise data within groups and comparisons between groups were made using t-tests and chi-square analyses. The overall prevalence of infraocclusion was 22% in singletons, and 27 % in twins. The primary mandibular first molar was the most commonly affected tooth (21% in singletons and 28% in twins compared with 6% and 18% for the mandibular second molar in singletons and twins respectively). Genetic modelling indicated a strong genetic contribution (~94%) to observed variation in the primary mandibular first molar, while common and unique environmental factors contributed to infraocclusion of the primary mandibular second molar. Investigation of MZ twin pairs revealed differences in the expression of infraocclusion within some twin pairs, for example, mirror imaging. These findings reflect epigenetic events and/or environmental disturbances that have occurred during the developmental process. Analysis of dental anomalies in singletons revealed a significant association of ectopic canines and the lateral incisor complex with infraocclusion. Individuals showing infraocclusion displayed delayed dental development and evidence of reduced primary tooth size. The findings showed that genetic factors play a major role in contributing to infraocclusion of the primary mandibular first molar, whereas environmental factors contribute more to variation in infraocclusion of the second molar. These environmental factors could occur in the prenatal or early postnatal stages of life and may disrupt the network of epithelial rests of Malassez, leading to localised areas of ankylosis. A possible pleiotropic effect was reflected by the presence of associated dental anomalies with infraocclusion. These findings are significant in improving understanding of the basic biological mechanisms and associated features of infraocclusion, and should assist clinicians in providing proper counselling, early diagnoses, prevention and treatment planning for affected individuals.
Thesis (Ph.D.) -- University of Adelaide, School of Dentistry, 2013

The current study investigated the distribution of periodontal epithelial cells and nerve fibres within the furcations of rat maxillary molar teeth subjected to hypothermic injury. The upper right first molars of 30 Sprague-Dawley rats were subjected to a single 20 minute application of dry ice in order to produce aseptic necrosis within the periodontal ligament, while the contralateral first molar served as an untreated control. Five animals were each sacrificed via cardiac perfusion after 7, 10, 14, 18, 21 and 28 days respectively and the maxillae were dissected out. After fixation in paraformaldehyde and processing, the tissues were embedded in paraffin wax and cut into 7µm serial coronal sections through the furcation region. Consecutive sections were then stained with H&E, cytokeratin AE1/AE3 and PGP 9.5 immunostains. Light microscopic examination of the H&E stained sections revealed that ankylosis had not developed in all of the experimental teeth, and in some of the observation groups fewer teeth were ankylosed than unaffected. The morphology of the ankylotic areas appeared to change with time, initially consisting of fine bony trabeculae, then progressing to solid bone occupying the entire furcation before becoming less solid again by the latest observation periods. Root resorption was often seen adjacent to areas of ankylosis, but the cementum of the tooth root at the point of ankylotic union was usually intact and free of resorption. Changes within the pulp chambers of the experimental teeth were also noted, with reduction in cellularity and tissue disorganisation initially, then increasing cellularity and formation of a cementum-like material on the chamber walls later. Cytokeratin AE1/AE3 immunostaining successfully identified epithelial cells within the periodontal ligament and their distribution around control teeth was similar to previous reports. Counting of these cells revealed lower numbers around experimental teeth, with the lowest counts around experimental teeth which had developed ankylosis. No change in the epithelial cell counts was detected over time, and these cells did not appear to regenerate after necrosis regardless of whether or not ankylosis developed. Statistical analysis indicated that the probability of ankylosis decreased as the number of epithelial cells increased. The PGP 9.5 immunostain identified periodontal nerve fibres, but the use of this stain was quite technique sensitive. The furcations of the molar teeth were noted to have relatively sparse innervation, with most of the visible nerve fibres being closely associated with blood vessels and located in the outer two-thirds of the ligament. Counting of the nerve fibres revealed fewer fibres around experimental teeth compared to control teeth, especially in the part of the ligament closest to the tooth root. There was no relationship detected between nerve count and time or between nerve and epithelial cell counts. Resorption was found to be more prevalent in experimental teeth, and the probability of resorption in a given tooth decreased as the epithelial cell count increased. The findings of this study suggest that the epithelial cells within the periodontal ligament have a protective function in the prevention of dentoalveolar ankylosis and resorption. Evidence of an intimate interrelationship between periodontal nerve fibre and epithelial cell numbers could not be confirmed. The null hypothesis that epithelial cell rests of Malassez do not provide a protective function against ankylosis and external root resorption was rejected, and the null hypothesis that nerve fibres and epithelial cells are not inter-dependent was retained.
http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1297409
Thesis (D.Clin.Dent.) -- School of Dentistry, 2007

This study used vital bone markers to investigate mineralized tissue adaptation in the periodontium of rats after a hypothermic insult to their maxillary first molars. This hypothermic insult has been shown in previous studies to induce aseptic root resorption with variable effects on ankylosis. A secondary objective was to assess the pulpal changes that occurred concurrent with the changes in the periodontium. Four groups of 7, eight-week old male Sprague Dawley rats were assigned to be euthanased at the day 7, 14, 21 and 28 observation periods. At day 0, 4 groups of 6 rats were subject to a single 20 minute application of dry ice on their maxillary right first molar. The remaining 1 rat within each group did not receive the dry ice. All rats were given 2 sequential bone labels, calcein 5mg/kg and alizarin red 30mg/kg, administered intraperitoneally 8 days apart. The timing of the labels was such that all rats were euthanased 2 days after the last label. The rat maxillae were fixed in ethanol and embedded undecalcified in methylmethacrylate. Ten micrometre coronal sections were obtained through the furcation of the first molars with three of each group of ten consecutive sections being unstained, stained with von Kossa/ hematoxylin and eosin counterstain, or decalcified and stained with hematoxylin and eosin, respectively. Unstained sections were viewed under fluorescence, while transmitted light microscopy was used for the other sections. Mineral apposition rates along the bone, root and pulpal surfaces as well as periodontal ligament width were measured using histomorphometry. Semiquantitative measurements of the resorptive surfaces within the periodontium were also noted. Multivariate and negative binomial regression statistical analyses were used to identify influencing variables. A focal pattern of ankylosis was observed at days 14 and 21 in 3 rats and was not seen at day 28. In both the treated and control teeth, appositional activity was greatest along bone and least along the root surface. Mineral tissue apposition rates along the bone and root surface displayed an initial spike during day 14 but declined to levels of the control teeth by day 28. A longer time lag was observed with appositional activity in the pulp which also displayed a declining trend towards the control teeth values by day 28. Resorption levels along the root surface continued to remain significantly (p<0.0001) elevated. The significantly (p<0.0001) wider periodontal ligament width in the treated molars showed a declining trend towards that of the control teeth by day 28. There was a temporary disturbance of mineralized tissue adaptation on the bone and root surfaces with a recovery of cellular vitality within the periodontium and pulp and a trend towards homeostasis of the periodontal ligament width. The null hypotheses that a single prolonged thermal insult on a rat has no effect on mineralized tissue adaptation within the periodontium and pulp chamber and that the periodontal ligament width within the interradicular region does not change in response to thermal trauma induced by the present study were rejected.
http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1345386
Thesis (D.Clin.Dent) - University of Adelaide, School of Dentistry, 2008

This study used vital bone markers to investigate mineralized tissue adaptation in the periodontium of rats after a hypothermic insult to their maxillary first molars. This hypothermic insult has been shown in previous studies to induce aseptic root resorption with variable effects on ankylosis. A secondary objective was to assess the pulpal changes that occurred concurrent with the changes in the periodontium. Four groups of 7, eight-week old male Sprague Dawley rats were assigned to be euthanased at the day 7, 14, 21 and 28 observation periods. At day 0, 4 groups of 6 rats were subject to a single 20 minute application of dry ice on their maxillary right first molar. The remaining 1 rat within each group did not receive the dry ice. All rats were given 2 sequential bone labels, calcein 5mg/kg and alizarin red 30mg/kg, administered intraperitoneally 8 days apart. The timing of the labels was such that all rats were euthanased 2 days after the last label. The rat maxillae were fixed in ethanol and embedded undecalcified in methylmethacrylate. Ten micrometre coronal sections were obtained through the furcation of the first molars with three of each group of ten consecutive sections being unstained, stained with von Kossa/ hematoxylin and eosin counterstain, or decalcified and stained with hematoxylin and eosin, respectively. Unstained sections were viewed under fluorescence, while transmitted light microscopy was used for the other sections. Mineral apposition rates along the bone, root and pulpal surfaces as well as periodontal ligament width were measured using histomorphometry. Semiquantitative measurements of the resorptive surfaces within the periodontium were also noted. Multivariate and negative binomial regression statistical analyses were used to identify influencing variables. A focal pattern of ankylosis was observed at days 14 and 21 in 3 rats and was not seen at day 28. In both the treated and control teeth, appositional activity was greatest along bone and least along the root surface. Mineral tissue apposition rates along the bone and root surface displayed an initial spike during day 14 but declined to levels of the control teeth by day 28. A longer time lag was observed with appositional activity in the pulp which also displayed a declining trend towards the control teeth values by day 28. Resorption levels along the root surface continued to remain significantly (p<0.0001) elevated. The significantly (p<0.0001) wider periodontal ligament width in the treated molars showed a declining trend towards that of the control teeth by day 28. There was a temporary disturbance of mineralized tissue adaptation on the bone and root surfaces with a recovery of cellular vitality within the periodontium and pulp and a trend towards homeostasis of the periodontal ligament width. The null hypotheses that a single prolonged thermal insult on a rat has no effect on mineralized tissue adaptation within the periodontium and pulp chamber and that the periodontal ligament width within the interradicular region does not change in response to thermal trauma induced by the present study were rejected.
Thesis (D.Clin.Dent) - University of Adelaide, School of Dentistry, 2008

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Science in Dentistry in the department of Maxillo-Facial and Oral Surgery, 2018
Introduction: Temporomandibular joint (TMJ) ankylosis may be defined as the fusion of joint surfaces with bony or fibrous tissue which causes limitations on the functional activities of the oral cavity. Surgical treatment includes gap arthroplasty (GA), interpositional Arthroplasty (IA) and joint reconstruction using costochondral graft (CCG), iliac crest, clavicular, fibular, and metatarsal or alloplastic prosthesis and distraction osteogenesis. Aim and objectives: The aim of this retrospective study was to compare outcomes of GA with CCG. The objectives were to identify factors that are associated with surgical outcomes, to identify the age group that is commonly affected and to compare the mean maximum interincisal opening (MIO) in two surgical procedures. Materials and Methods: This retrospective study evaluated outcomes of 40 patients who were treated with GA and CCG between February 2007 and December 2016. The data were analysed and classified into pre-operative, intra-operative and post-operative stages. The outcomes were evaluated by calculating an achieved MIO (final MIO – preoperative MIO), and post-operative change in MIO (Op MIO - final MIO) and the final MIO, which refers to the last recorded MIO. Results: Forty patients met the criteria for this study, twenty-seven were males and thirteen were females, the age range was 2 to 55 years. Trauma was the main cause of ankylosis with (62%) (n=26), followed by congenital defects with (27.5%) (n=11) and infection with (7.5%) (n=3). The mean of the final MIO of GA and with CCG was 30 mm (SD= 7.31) and 29.47 mm (SD= 6.79) respectively. The mean of A-MIO for GA and with CCG was 22.76 mm (SD= 8.61) and 24.1 mm (SD= 7.16) respectively, while the Pop-MIO for GA and with CCG was -3.85 mm (SD= 10.11) and -2.10 mm (SD= 7.49) respectively. The results showed no statistically significant difference (P > 0.05) in the mean MIO between two groups under GA v and CCG. In addition, it showed no association between the complications, age, gender and aetiology that were investigated by using logistic regression. Conclusion: The findings of this study suggest that there is no difference in surgical outcomes between GA and IA with CCG, and the most common age groups that was affected was third stage 20-29 years (42.5%), with no association between factors and surgical outcomes.
XL2018

碩士
臺北醫學大學
牙醫學系碩博士班
101
Aim: The aim of this review was to assess clinical outcomes of autotransplanted teeth with complete root formation and the effects of various influencing factors. Materials and Methods: A systematic literature search was performed for publications to February 2013. Treatment outcomes were estimated by multilevel Poisson regression analysis. Results: Twenty-six studies were included. The estimated failure rate was 2.0% (95% confidence interval (CI) 1.2%~3.2%); estimated 1-year survival rate was 98.0% (95% CI 96.8%~98.8%); estimated 5-year survival rate was 90.5% (95% CI 84.9%~94.1%); estimated infection-related root resorption rate was 2.1% (95% CI 1.1%~4.0%); and estimated ankylosis rate was 1.2% (95% CI 0.5%~3.2%). The estimated failure rate was higher in studies without a systemic antibiotic regimen, with only suture splinting, with wire splinting for ≤ 14 days, and with posterior donor teeth. The estimated infection-related root resorption rate was higher in studies without a systemic antibiotic regimen, with endodontic treatment initiated after 14 days postoperatively, and with anterior donor teeth. The estimated ankylosis rate was higher in studies with wire splinting and anterior donor teeth. Conclusions: Results showed that outcomes and prognoses of autotransplanted teeth with complete root formation were highly predictable. Several factors seemed to influence the outcome of tooth autotransplantation.

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária
A anquilose da articulação temporomandibular (ATM) é uma patologia rara com diversas etiologias mas que afeta não só as características físicas e psicológicas como, também compromete a qualidade de vida do portador. O médico dentista possui um papel importante na identificação e no correto encaminhamento dos pacientes com anquilose da ATM. Assim, nesta revisão narrativa da literatura pretendeu-se abordar a classificação, fisiopatologia, epidemiologia, diagnóstico e opções de tratamento desta condição patológica. A anquilose da ATM pode ocorrer na infância ou na idade adulta, tendo repercussões diferentes ao nível craniofacial. Na criança, a anquilose da ATM pode comprometer não só a função mandibular mas também o crescimento facial. O diagnóstico atendendo às características clínicas e suportado pela realização de exames auxiliares de diagnóstico adequados, é fundamental para a decisão da abordagem terapêutica Existem diversos tratamentos e materiais que podem ser utilizados no tratamento da anquilose da ATM. A sua escolha depende dos fatores relacionados com o paciente (tipo de anquilose, idade, capacidade em suportar a colheita de material autólogo ou em receber o material aloplástico) e com o cirurgião ( experiência e escolha ), no entanto, nenhum é considerado ideal. Após a cirurgia é importante que o paciente realize os exercícios de fisioterapia adequados, melhorando os resultados obtidos em cirurgia e prevenindo a recidiva ou outras complicações pós-cirúrgicas. Muitas vezes, o médico dentista pode ser chamado à equipa de tratamento multidisciplinar com vista a minimizar a má oclusão dentária instalada.
The temporomandibular joint (TMJ) ankylosis is a rare pathology with many etiologies that affects not only physical and psychology characteristics, but also compromises the quality of life of the holder. The dentist has an important role to identify and correct the forwarding of patients with TMJ ankylosis. This narrative literature review is intended to address the classification, physiopathology, epidemiology, etiology, diagnostic and treatment options of this pathology. The TMJ ankylosis may occur during childhood or in adulthood, having different consequences on a craniofacial level. For children, TMJ ankyloses can compromise not only the jaw function but also the facial growth. The diagnostic using clinical characteristics and supported by the use of auxiliary diagnostic exams, is the key factor to decide the therapeutic approach. There are several treatments and materials which can be used for the treatment of TMJ ankylosis. The choice depends on factors related to the patient (ankyloses type, age, capacity to support harvest of autologous material or receive alloplastic material) and to the surgeon (experience and choice), however, none of them are considered optimal. After surgery it is important that the patient does physiotherapy exercises, improving the results obtained in surgery and preventing relapse or other post-surgery complications. Many times, the dentist can be associated to the multidisciplinary team in order to minimize dental malocclusion.

A anquilose alvéolo-dentária é uma anomalia de erupção que consiste na fusão anatómica anormal do cemento radicular com o tecido ósseo, sem interposição do ligamento periodontal. O tratamento da anquilose vai depender, se o dente afetado é decíduo ou permanente. Existem seis modalidades de tratamento dos dentes permanentes anquilosados: não intervir, remoção cirúrgica, aumento da coroa com material restaurador, osteotomia localizada, osteotomia segmentar interalveolar e tratamento ortodôntico. O tratamento dos dentes permanentes anquilosados é influenciado pelo grau de severidade e pelo dente afetado. Os incisivos permanentes superiores, por estarem envolvidos mais frequentemente em situações de trauma são os dentes mais atingidos por anquilose na dentição permanente.
The Dental Alveolus Ankylosis is an abnormal dental tooth eruption that consists in an abnormal anatomic fusion of radicular cement with the bone tissue, without the interposition of the periodontal ligament. The treatment of the ankylosis will depend of the tooth being deciduous or permanent. There are six modalities in the treatment of permanents ankylosis teeth: not intervene; surgery removal; enhance of the dental crown with restorative material; localized osteotomy; interalveolar segmental osteotomy and orthodontic treatment. The treatment of permanents ankylosis teeth is influenced by the severity and by witch tooth is affected. Because Permanent Superior Incisors are more frequently involved in traumatic situation, they are the teeth more likely to have permanents ankylosis.

A articulação temporomandibular (ATM) apresenta-se como uma das mais complexas e diferenciadas dentre as articulações do corpo humano. As alterações ocorridas nessa articulação levam à ocorrência de algumas patologias, como a anquilose da ATM. Tal patologia se caracteriza pela fusão do côndilo mandibular e a base do crânio, por meio de tecido fibroso ou tecido ósseo, limitando os movimentos mandibulares e a abertura bucal, o que ocasiona severas consequências que envolve, desde a fala, até o estado psicológico do indivíduo. Sua classificação varia de acordo com a gravidade do caso e, dentre os fatores etiológicos mais comuns, o trauma e as infecções se apresentam como pioneiros para essa condição. Por ser assintomática e devido às particularidades anatômicas da ATM, além do exame clínico, os exames de imagem são utilizados para diagnóstico mais preciso e tomadas de decisões. Existem uma variedade de técnicas e muitas controvérsias em relação ao método padrão para o tratamento dessa patologia, não havendo, portanto, um consenso entre os pesquisadores e, por meio deste trabalho, pode-se evidenciar as inúmeras pesquisas que vêm sendo realizadas sobre o tema. Todavia, independentemente da técnica a ser utilizada, o principal propósito para o tratamento é a liberação da mandíbula e o restabelecimento de suas funcionalidades. Para o pós-operatório, o tratamento fisioterápico é um fator imprescindível para minimizar algumas sequelas e prevenção à reanquilose. Diante do exposto, através de uma revisão de literatura, o objetivo desta pesquisa é analisar e descrever sobre os conceitos e experiências relatadas por vários pesquisadores sobre os processos que envolvem a anquilose da ATM, incluindo algumas considerações anatômicas, causas, características, diagnósticos e tratamento, bem como outras informações relevantes ao tema proposto.
The temporomandibular joint (TMJ) is presented as one of the most complex and differentiated among the joints of the human body. The changes that lead to the occurrence of some joint deseases, such as TMJ ankylosis. This disease is characterized by the fusion of the mandibular condyle and skull base through fibrous tissue or bone tissue, limiting jaw movements and mouth opening, which leads to severe consequences from speech to the psychological state of the individual. Your rating will vary with the severity of the case and among the most common etiologic factors, trauma and infections present themselves as pioneers for this condition. Because it is asymptomatic and due to anatomical TMJ, in addition to clinical examination, imaging tests are used for more accurate diagnosis and decision making. There are a variety of techniques and many controversies regarding the standard method for the treatment of this pathology, and there is therefore a consensus among researchers, and, through this work, we can highlight the many researches that have been done on the subject. However, regardless of the technique being used, the main purpose is to treat the release of the jaw and restore functionality. For post-operative physical therapy is an important factor for minimizing some consequences and prevention reanquilose. Given the above, through a literature review, the objective of this research is to analyze and describe the concepts and experiences reported by several researchers about the processes involving the TMJ ankylosis, including some anatomic considerations, causes, characteristics, diagnosis and treatment as well as other information relevant to the subject.

O presente trabalho tem como objetivo principal elucidar as evidências disponíveis sobre a infra-oclusão de molares decíduos, desde a sua etiologia, diagnóstico, entender as suas implicações clínicas, assim como as diferentes hipóteses de tratamento. A metodologia utilizada para a elaboração deste trabalho recorreu à análise de artigos pesquisados nos motores de buscar online e na biblioteca. No decorrer deste trabalho, verificou-se que os molares decíduos são mais afetados do que os permanentes, sendo os inferiores os mais recorrentes. As formas de tratamento vão desde a mais conservadora até à exodontia do elemento dentário.
The present study has as main objective to elucidate the available evidence on the infraocclusion of deciduous molars, since its etiology, diagnosis, understanding its clinical implications, as well the diferent hypotheses of treatment. The methodology used for the elaboration of this work resorted to the analysis of articles searched in the engines of search online and library. During this work, it was verified that the deciduous molars are more affected than the permanent ones, the lower ones being the most recurrent ones. The forms of treatment range from the most conservative to the exodontia of the dental element.

Estudos epidemiológicos têm revelado que os traumatismos abrangem 10-35% da população. A avulsão dentária representa aproximadamente 0,5-3% das lesões traumáticas na dentição permanente, ocorrendo mais frequentemente em pacientes dos 7 aos 11 anos. Entre as lesões, a avulsão dentária é considerada um dos tipos mais graves, pois consiste no total deslocamento do dente para fora do seu alvéolo, provocando rutura do epitélio gengival, danos à polpa e ao ligamento periodontal. Torna-se necessário saber, quando, como e onde ocorreu o acidente traumático. Uma boa avaliação das queixas do paciente, a realização de exames intraorais, extra orais e radiográficos ajudam o médico dentista na elaboração de um correto diagnóstico e consequentemente um bom prognóstico. Diferentes tipos de meios aquosos têm sido investigados como a melhor forma de preservação das células do L.P de dentes avulsionados e consequentemente de um melhor prognóstico. Existem muitas soluções que foram propostas e/ou testadas como meio de armazenamento para dentes avulsionados, a exemplo: Solução Salina Balanceada de Hank (HBSS), Viaspan®, água da torneira, saliva, leite bovino, própolis, soro fisiológico e solução para lentes de contacto. A fim de combater ou minimizar problemas, como a anquilose, reabsorção radicular inflamatória externa ou perda precoce do elemento dentário, tornou-se importante à comunidade médica a elaboração de protocolos e medidas preventivas para dentes com rizogénese completa e incompleta que sofreram trauma por avulsão. Foi utilizado uma pesquisa metodologia de natureza bibliográfica, com recurso a artigos científicos e obras relacionados com o tema.
Epidemiological studies have shown that trauma cover 10-35% of the population. Tooth avulsion is approximately 0.5-3% of traumatic injuries in the permanent dentition, occurring more frequently in patients from 7 to 11 years. Among injuries, tooth avulsion is considered one of the most serious types, because consist in the total displacement or avulsion of the tooth out of its socket, causing disruption of the gingival epithelium, damage to the pulp and periodontal ligament. It is necessary to know when, how and where was the traumatic accident. A good assessment of the patient's complaints; the conducting of intraoral; extra oral and radiographic examinations help the dentist in the development of a correct diagnosis and therefore a good prognosis. Different types of aqueous storage have been investigated as the best way to preserve the L.P cells of avulsed teeth and consequently a better prognosis. Many solutions have been proposed and / or tested as a storage medium for avulsed teeth example: Hank's Balanced Salt Solution (HBSS); Viaspan®; tap water, saliva, bovine milk, propolis, saline solution and contact lenses solution. In order to combat or minimize problems as and ankylosis, external inflammatory root resorption or early tooth loss, it has become important to the medical community to develop protocols and preventive measures for teeth with complete and incomplete root formation that have suffered trauma avulsion. The methodology that was used in this dissertation was bibliographical, using scientific articles and books and related to the topic.