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Splinting of traumatized teeth is an important step in the treatment of periodontally injured teeth and a precondition of healing of the periodontal tissues. Although it has been shown in animal experiments that replanted teeth without splinting showed analogous healing outcomes compared to splinted teeth, the placement of a splint in dental trauma situations is warranted for medico-legal reasons, for the comfort of the patient, and for the avoidance of additional trauma during periodontal healing. Ideally, the splinting of traumatized teeth should be an easy and fast procedure for the dentist. Trauma splints should be comfortable and easy to keep clean for the patient. The splint should allow some physiologic mobility to promote healing of the periodontal tissues. The widely used and recommended wire-composite splint, with material variations, meets the ideal requirements of current splinting concepts in dental traumatology. Times of using destructive tissue-coverage splints are definitely gone. They are too rigid, compromise periodontal and gingival healing, and are uncomfortable to the patient. The objective of this article is to present the current concepts in splinting of traumatized teeth. The given recommendations about splinting techniques and splinting periods are based on experimental and clinical studies.

The two objectives of the present study were: to assess the healing after periradicular surgery using the Periotest device, and to compare the recorded Periotest values with the healing category determined after a one-year follow-up using radiographic and clinical criteria. In 43 patients with periradicular surgery, Periotest values could be recorded pre- and postoperatively, as well as after six and twelve months. Cases with a successful healing, as determined at the one-year follow-up, demonstrated a continuous decrease of the Periotest values over time, whereas one-year failures showed increasing Periotest values over the study period. In control teeth, the Periotest values remained unchanged for the whole study period. It appears that the Periotest measurements correlate with the postoperative healing mode following periradicular surgery, and therefore, allow an additional assessment of the healing outcome.

The present paper describes the current treatment philosophy of dislocated or avulsed permanent teeth at our school. Splinting and medication (root canal treatment, systemic antibiotics, etc.) are targeted to minimize the initial inflammatory reaction and to reduce post-traumatic complications such as pulp necrosis and/ or external root resorption.

Endodontic surgery, and in particular periapical surgery, has seen a significant development in the last few years, mainly following the introduction of microsurgical principles and the use of magnification devices. The successful outcome of periapical surgery, however, is based on the quality of the root-end obturation that should prevent any reinfection originating from the root canal. Since amalgam as a root-end sealing material was abandoned many years ago, a great diversity of obturation techniques and materials have been described. Besides the standard root-end cavity preparation with microtips, the author today has a preference for the Retroplast-technique. The paper describes this technique in detail and reports the possibilities and limits of this obturation method.

Pulp sensitivity and vitality changes were evaluated in 69 traumatized maxillary incisors and in 38 control teeth during a follow-up period of 20 months. Examinations included thermal testing using carbon dioxide snow (CO2) and the laser Doppler flowmetry (LDF). These measurements were compared to the clinical and radiological findings. In 47.8% of the traumatized teeth and in 55.3% of the control group the three LDF measurements corresponded with the sensitivity testing using CO2 and with the clinical and radiological findings. In 31.9% of the traumatized teeth and in 7.9% of the control group the LDF-measurements differed from the CO2-measurements, but were in agreement with the other clinical and radiographic findings. The information obtained by laser Doppler flowmetry is of additional importance for the treatment planning. Since the clinical examination of traumatized teeth is sometimes inconclusive, the laser Doppler flowmetry is a further diagnostic tool but it cannot replace the radiological or clinical examination.

Diagnostic and therapeutic interventions following dental injuries are not part of the routine practice in the dental office. Quite often, these patients are emergency cases who seek treatment after normal office hours. The objective of this and the future papers is to present the current treatment concepts in dental traumatology at the School of Dental Medicine, University of Berne. The fruitful cooperation in the field of dental traumatology between the Department of Oral Surgery and Stomatology, and the Department of Conservative Dentistry (including pediatric dentistry and endodontology), is based on the interdisciplinary approach that has been established four years ago. Following discussion and evaluation of such treated cases, and considering current clinical and experimental references, the said concepts have been worked out. The present paper describes the diagnostic measures following injuries to the permanent teeth. Subsequent papers will illustrate our therapeutic concepts of injuries to the periodontal and dental hard tissues of permanent teeth.

This study evaluated periapical healing of induced apical lesions with concomitant loss of the buccal bone plate in a dog model using four foxhounds. In an initial surgery, pulp cavities of mandibular premolars were exposed to induce apical lesions. In the same session, the cortical bone covering the buccal root surfaces was surgically removed to simulate buccal bone loss. After radiographic confirmation of the development of apical lesions, sites were reentered for surgical treatment. Following apical and buccal debridement, root-end resection, and root-end filling, sites were subjected to three different treatment modalities: (1) flap readaptation (controls); (2) placement of a collagen membrane covering the apical defect and denuded root surface; or (3) placement of an anorganic bovine bone filler into the apical defect and onto the exposed buccal root surface, with additional application of a collagen membrane. Animals were sacrificed 7 months following the second surgery. Step sections were analyzed histometrically and morphometrically for periapical healing. Sites with membrane + filler showed a statistically significantly lower mean percentage of new bone formation within the former defect compared to both membrane-alone and control sites. No significant differences were found for tissue components deposited on the cut root face across treatment groups. Formation of a continuous thin layer of new cementum covering the exposed dentin surface and root-end filling material was a frequent finding. Analysis of the tissue regeneration on the buccal root aspect as well as the clinical periodontal parameters will be presented in a separate article.

A total of 129 teeth with periradicular surgeries (apicoectomies) were analyzed in a prospective clinical study. In the test group including 62 teeth, an endoscope (Tele-Otoscope with a 70 degrees viewing angle) was used as an intraoperative visualization aid to monitor the following surgical steps: root-end resection, root-end cavity preparation and retrograde root-canal obturation. In the control group including 67 teeth, intraoperative diagnostics were carried out using micromirrors. Fifty-four and 61 teeth could be re-examined after one year. Based on the clinical and radiographic findings they were categorized as success, uncertain healing or failure. In the test group with endoscopy, the success rate was 88.9%, whereas in the control group it was only 75.4%. However, statistically no significant difference was found between the two groups. Additional experimental and clinical studies will show if endoscopy will improve the success rates in periradicular surgery any further.

Tooth injuries are frequently associated with sports injuries. Most of them could be minimized or prevented by the use of a mouthguard. The present study investigated the occurrence of tooth injuries and the attitude of athletes of Bernese sports clubs towards mouthguards, by means of a questionnaire and clinical examination. A total of 172 out of 200 athletes from six sports clubs, who were contacted directly at the sports fields, returned the questionnaire. Fifty of them owned a mouthguard (= 29.1%) and 54 reported having suffered dental trauma. The majority of athletes did not wear a mouthguard, despite acknowledging its usefulness. Even after a dental injury, the rate of mouthguard-acceptance increased just marginally; only 38.9% of all injured athletes were wearing a mouthguard after dental trauma. Most of the athletes had not considered wearing a mouthguard at all. For many of them, impairment of speech and breathing and discomfort were reasons not to wear a mouthguard. Of the 54 reported athletes with dental trauma, 48 were examined clinically. The upper central incisors were by far the most frequently injured teeth. The clinical examination used an injury severity index (NIDR-Index, National Institute of Dental Research) ranging from grade 0 (no visible damage), to grade 6 (loss of tooth). The most common finding was grade 4 (injuries that were treated by reconstruction). In conclusion there is a need to optimize information for athletes concerning mouthguards and sports injuries. Providing such information is not only the responsibility of coaches and trainers, but also of dentists.

The purpose of this prospective study was to examine the influence of a 1 mm lengthening of the rough surface (TPS) of "esthetic plus"-ITI-implants on the periimplant soft and hard tissues. Twenty-one "esthetic plus" ITI-implants were inserted into the maxilla in an esthetically critical zone of 12 patients with sufficient alveolar bone. Clinical and radiographic examinations were performed after ten and 32 months. The mean DIB-score (DIB = distance between implant shoulder and first implant-bone contact) was 2.19 mm after 32 month. The average DIB-score of implant sites adjacent to natural teeth was 1.90 mm, there only 0.1 mm of the rough surface did not have bone contact. However, the average DIB-scores of implant sites adjacent to other implants (2.63 mm) or distal extension situations (2.79 mm) were much higher. This means that the coronal part of the rough surface had no radiographic bone contact with 0.83 mm (to other implants) and with 0.99 mm (to distal extension situations), what should be taken into consideration when using an "esthetic plus"-ITI-implant. As a consequence a standard ITI-implant with a smooth neck of 2.8 mm would be indicated. The results of the present study indicate, that not only the shortening of the smooth implant neck to 1.8 mm but also the adjacent structures influence the periimplant soft and hard tissues.

The present experimental study compared four dental trauma splints in 10 volunteers. The evaluated splints included a wire-composite splint (WCS), a button-bracket splint (BS), a resin splint (RS), and the newly developed titanium trauma splint (TTS). All splints were bonded to the labial surfaces of the maxillary lateral and central incisors and left in place for 1 week. After splint removal, the next splint was placed after a 1-week rest period. The sequence of splint application was randomized for each individual. The following subjective parameters were assessed using a visual analogue scale: sensitiveness of splinted teeth, irritation of the gingival margin, irritation of the lips, impairment of speech, eating and oral hygiene. The results show that the application of BS leads to a significantly higher irritation of the lips and greater impairment of speech compared to other splints (P < 0.05). The RS leads to an increased and significantly higher irritation of the gingiva (P < 0.05) owing to a significant increase in cleaning difficulties (P < 0.05). In conclusion, WCS and TTS appear to be more accepted splints according to a subjective assessment by 10 volunteers.

The present clinical study investigated the outcome of intentional replantation using Emdogain for periodontal healing following trauma-related ankylosis. Sixteen ankylosed teeth affected by replacement resorption were treated as follows: After tooth extraction, the root canal was obturated with a retrograde titanium post. Emdogain was applied to the root surface and into the extraction socket with subsequent replantation of the tooth. Evaluation parameters included horizontal and vertical Periotest scores, percussion sound and periapical radiographs. All findings were compared to those of the adjacent teeth. The mean follow-up period was 15 months (range 4-24 months). Eleven teeth showed no signs of recurrence of ankylosis: they were in full function and exhibited no pathological clinical findings. Four severely traumatized teeth demonstrated a recurrence of ankylosis after a mean period of 6 months, one tooth was lost in a second accident after 7 months. The estimated probability of 1 year without recurrence of ankylosis was P=0.66 (95% confidence interval [0.40; 0.94]). The mean survival time was 10.2 months (SD 1.1). The results indicate that treatment of replacement resorption following light to moderate trauma with replantation and Emdogain appears to prevent or delay recurrence of ankylosis in many cases.

Since the introduction of microsurgical principles in the 1990s, the field of endodontic surgery has made continuous and substantial progress. Particularly, root-end cavity preparation has been simplified and optimized by means of newly developed surgical microinstruments. However, the successful outcome of endodontic surgery depends to a large extent on accurate intraoperative diagnostics. Conventionally, micromirrors (retromirrors) and microprobes have been used for this purpose. Recently, the surgical microscope has been used to enhance visibility during dental procedures. In addition, endoscopy has been reported to provide the surgeon with outstanding vision and ease of use. This article describes the technical specifications and the diagnostic application of the endoscope during endodontic surgery.

The present study evaluated posttraumatic developmental disturbances of 74 permanent teeth in 30 children, who had been treated in our department between 1992-1996 following trauma to the deciduous dentition. The recall in early 2001 included a clinical and radiographic examination. 24 of the permanent teeth showed developmental disturbances following injuries to their primary predecessors. The most frequent malformations were enamel discoloration and enamel defects. Injuries to the primary teeth that caused the majority of developmental disturbances were intrusions and lateral luxations. These results clearly show that the odontogenesis of permanent teeth can be influenced by trauma to deciduous teeth. Therefore, follow-up examinations are highly recommended after injuries to the primary dentition.

The treatment of displacement injuries and fractures of permanent teeth is an important emergency therapy in the dental office. Due to new sport trends and various outdoor activities, the frequency of dental trauma of children and adolescents alike is steadily rising. The standard treatment of displacement or avulsion injuires of permanent teeth is repositioning or replantation with subsequent splinting. The dental trauma splint must be flexible to allow for the physiologic movement of the repositioned or replanted teeth in order to reduce the risk for ankylosis or external root resorption. Stabilization of a repositioned tooth with a flexible splint over a short time period optimises the rehabilitation of the periodontal tissues. In the literature various splinting techniques have been described. This paper presents a new splinting technique; the Titanium Trauma Splint (TTS), which is made of pure titanium and was specifically developed for the treatment of traumatically displaced or avulsed permanent teeth. The TTS-splint has certain advantages when compared to traditional splinting techniques. These advantages are beneficial both for the dentist and patient alike.

The present study evaluates and analyzes anamnestic and clinical findings of 100 consecutively referred patients with oral mucosal lesions. The mean age of the cohort was 50.5 years (range 8-91 years) with a female rate of 60 percent. A total of 9 malignant neoplasia were found among the 100 mucosal lesions, including 7 squamous cell carcinomas and 2 mucoepidermoid carcinomas. In addition, 11 cases presented with leukoplakia and 4 cases with lichen planus, both recognized as possible precancerous conditions. These figures support the essential role of the dentist with respect to initial diagnosis and prevention of oral cancer. In addition, stomatologic follow-up examinations are recommended to be performed by each and every general practitioner. In the near future, the dentist will assess oral mucosal lesions more frequently due to the increasing number of elderly patients and to the fact that elderly people present with more lesions compared to younger patients. consistent to literature data, patients with leukoplasia and squamous cell carcinoma had the highest rates of tobacco and alcohol consumption. Therefore, the dentist may also become active in giving preventive information to the patient. the results of the present study showed, that--by employing a standardized examination--a correct clinical diagnosis was identical to the final diagnosis established by laboratory techniques.

Lateral ridge augmentation has become a standard treatment option to enhance the bone volume of deficient recipient sites prior to implant placement. In order to avoid harvesting an autograft and thereby eliminating additional surgical procedures and risks, bone grafting materials and substitutes are alternative filler materials to be used for ridge augmentation. Before clinical recommendations can be made, such materials must be extensively studied in experimental models simulating relevant clinical situations. The present pilot study was conducted in three dogs. Different grafting procedures were evaluated for augmentation of lateral, extended (8 x 10 x 14 mm) and chronic bone defects in the mandibular alveolar ridge. Experimental sites received tricalcium phosphate (TCP) granules or demineralized freeze-dried bone allograft (DFDBA) particles. Barrier membranes (ePTFE) were placed for graft protection. These approaches were compared to ridge augmentation using autogenous cortico-cancellous block grafts, either with or without ePTFE-membrane application. After a healing period of six months, the sites were analyzed histologically and histomorphometrically. Autografted sites with membrane protection showed excellent healing results with a well-preserved ridge profile, whereas non-protected block grafts underwent bucco-crestal resorption, clearly limiting the treatment outcome. The tested alloplastic (TCP) and allogenic (DFDBA) filler materials presented inconsistent findings with sometimes encapsulation of particles in connective tissue, thereby reducing the crestal bone width. The present pilot study supports the use of autografts with barrier membranes for lateral ridge augmentation of extended alveolar bone defects.

Periradicular surgery has become an established treatment option in endodontic surgery. The major objective of this surgery is to obtain periradicular tissue regeneration, including the formation of a new attachment apparatus, by exclusion of any potentially noxious agent within the physical confines of the affected root. However, in a substantial number of cases, the endodontic lesion has a concomitant marginal periodontal lesion that may complicate the healing success. In periodontology, the guided tissue regeneration (GTR) principle using a barrier membrane has been extensively studied and successfully used, and thus may become an adjunct in endodontic surgery. This article presents a classification system of endodontic and periodontal lesions with respect to the application of the membrane technique and reviews the pertinent literature based upon this classification system.

Root-end cavities have traditionally been prepared by means of small round or inverted cone burs in a micro-handpiece. Since sonically or ultrasonically driven microsurgical retrotips became commercially available in the early 1990s, this new technique of retrograde root canal instrumentation has been established as an essential adjunct in periradicular surgery. At first glance, the most relevant clinical advantages are the enhanced access to root ends in limited working space and the smaller osteotomy required for surgical access because of the various angled designs and small size of the retrotips. However, a number of experimental studies comparing root-end preparations made with microsurgical tips to those made with burs have demonstrated other advantages of this new technique, such as deeper cavities that follow the original path of the root canal more closely. The more centered root-end preparation also lessens the risk of lateral perforation. In addition, the geometry of the retrotip design does not require a beveled root-end resection for surgical access thus decreasing the number of exposed dentinal tubules. A controversial issue of sonic or ultrasonic root-end preparation is the formation of cracks or microfractures, and its implication on healing success. The present paper reviews experimental and clinical studies about the use of microsurgical retrotips in periradicular surgery and discusses many issues raised in previous papers.

Today, partially edentulous patients represent the majority of patients seeking treatment with implant-supported prostheses. This chapter presents the specific aspects of the surgical handling of partially edentulous patients with either single-tooth gaps, extended edentulous spaces or distal extension situations. Due to differences in treatment objectives, a distinction is made between sites without esthetic priority (non-esthetic sites) and with esthetic priority (esthetic sites). In non-esthetic sites, the primary goal of the surgical therapy is to achieve a predictable hard and soft tissue integration of the implant to re-establish function with the implant-supported prosthesis. In esthetic sites, the goal of surgical therapy is to achieve successful tissue integration and to obtain esthetic soft tissue contours to re-establish both function and esthetics. Therefore, the surgeon must have a clear understanding of the specific needs in a given situation, and must master the necessary surgical techniques concerning a correct implant placement and a correct soft tissue handling to achieve the treatment objectives. In non-esthetic sites, a non-submerged approach is clearly preferred, thus avoiding a second-stage procedure for abutment connection. If a soft tissue correction is necessary to re-establish keratinized peri-implant mucosa, this is done at the time of implant placement with mucogingival surgery. In esthetic sites, a submerged implant placement is preferred to achieve esthetically pleasing soft tissue contours. If a soft tissue augmentation is necessary, this is done at the time of implant placement with connective tissue grafts. Thus, the second surgical procedure after 8-10 weeks of healing is reduced to a mucosaplasty like a punch biopsy, avoiding an open flap procedure. Based on favorable properties of the TPS surface, short implants (6 or 8 mm) and short healing periods of 3-4 months have been successfully utilized in partially edentulous patients in the last 14 years. The introduction of the SLA surface allows a further reduction of the healing period to 6 weeks of healing in all sites with normal bone density (class I-III). In summary, the ITI philosophy offers straightforward surgical concepts to predictably achieve the treatment objectives with the least demanding surgical protocol, reducing the related chairtime and costs for the patient and the clinician.

The basic surgical principles governing the placement of ITI implants are based on research-oriented developments in harmony with evidence-based and outcome-oriented clinical procedures. In the past 15 years, the range of implant indications has been significantly widened, and partially edentulous patients clearly represent the majority of patients seeking treatment with dental implants today. An important aspect of the successful rehabilitation of patients with ITI implants is the careful selection of implant candidates with respect to systemic and local risk factors. These factors are presented based on current knowledge. Today, solid-screw implants in various screw dimensions and neck configurations comprise the ITI Dental Implant System. These different implant types are necessary to handle the full range of implant indications, in particular in partially edentulous patients. The main clinical factors are presented for the selection of the appropriate implant type, length and diameter. These implants are utilized both in a non-submerged and in a submerged approach. The main goal of surgical therapy is low trauma and the least demanding surgical procedure for patient and clinician to optimize the cost-effectiveness of implant therapy. Hence, a non-submerged approach is preferred in all sites without esthetic priority, such as in fully edentulous patients or in posterior sites of partially edentulous patients. These indications clearly represent the majority of implant patients. In esthetic sites, a submerged approach is utilized to satisfy the specific esthetic demands. The possibility to successfully utilize short implants (6 and 8 mm) and a reduced healing period of 3 months are further advantages of ITI implants due to favorable properties of the rough TPS surface. With the introduction of the microrough SLA surface, a reduction of the healing period to 6 weeks facilitates further progress towards simplification of implant therapy. In summary, the ITI Dental Implant System represents a scientifically well-documented, complete implant system for the treatment of fully and partially edentulous patients, offering straightforward surgical concepts based on predictable treatment outcome and excellent cost-effectiveness.

Purpose: This study evaluated the outcome of periradicular surgery using a new set of retrotips for root-end cavity preparation., Patients and Methods: Forty-three patients who had 50 consecutively treated teeth with periradicular pathology were enrolled in this prospective study. After apicoectomy, root-end cavity preparation was performed, using diamond-surfaced retrotips driven by a sonic handpiece; EBA-cement was used as the root-end filling material. Healing assessment was based on clinical and radiographic criteria., Results: At the 1-year follow-up, 82% of the reexamined surgical cases presented with successful healing. Fourteen percent of the treated teeth were deemed as improved (partial healing), and 4% were classified as failures., Conclusion: The new retrotips were found to be ideal for root-end cavity preparation. They simplify the surgical approach to root ends where the working space is limited by restricted access. Root-ends prepared with this new sonoabrasive technique yielded excellent results at the 1-year follow-up examination.

This prospective clinical study evaluated bone regeneration around 20 dental implants placed in 15 patients (mean age 39.7 years). Peri-implant bone defects were augmented with autogenous bone grafts harvested intraorally from the mandible (chin or retromolar area). Augmented sites were covered with an individually trimmed micro titanium mesh which was rigidly affixed with microscrews to the residual jaw bone. Height of implant exposure (mean 6.5 mm), i.e. dehiscencies (80%) or fenestrations (20%), and graft height (mean 6.2 mm) were measured in an apico-coronal direction using a periodontal probe. At re-entry (mean interval 6.6 months) the titanium mesh and microscrews were removed and bone regeneration assessed. The mean height of the integrated bone graft was 5.8 mm corresponding to a mean bone fill of 93.5%. The overall postop healing course was excellent with only one site developing a soft tissue dehiscence with subsequent mesh exposure (complication rate 5%). This study demonstrated that a micro titanium mesh in combination with autogenous bone grafts is effective for treatment of peri-implant bone defects.

The present paper describes the clinical and radiographic healing results of 27 implants followed from 1 to 3 years after functional implant loading. Prior to implant placement, alveolar ridges with insufficient bone volume were augmented using autogenous bone grafts and a micro titanium mesh for graft stabilization. After a mean interval of 5.2 months implants were installed. Following an osseointegration period of on average 7.2 months, implants were supplied with suprastructures. The mean loading period for the 27 implants was 21 months. All implants exhibited ankylotic stability and healthy peri-implant soft tissues. The detailed analysis of clinical parameters (probing depth, level of mucosal margin, attachment level, modified plaque and sulcus bleeding indices) and radiographic measurements (crestal bone level), revealed findings similar to those at implants placed into non-augmented bone. Peri-implant bone resorption was calculated to be 1.0 mm for the 1st year after implant loading and 0.1 mm for the following year. Pain, suppuration or semilunar bone defects were absent at all implants. It was concluded that loaded dental implants which have been inserted into an augmented alveolar ridge using autogenous bone grafts and a micro titanium mesh for graft stabilization, demonstrate clinical and radiographic findings similar to those of implants placed into a pristine ridge.

This article reports the surgical technique and outcome of simultaneous bone grafting and implant placement. A new treatment philosophy different than the principle of guided bone regeneration is presented. The technique is characterized by grafting autogenous bone into a peri-implant bone defect rather than by regenerating bone in a secluded space. Stabilization of the autogenous bone graft is achieved with a micro titanium mesh. The study sample comprised 10 implant sites in six patients. All sites were successfully treated, and postoperative healing was uneventful. The autogenous bone grafts demonstrated perfect integration upon reevaluation when the implants were recovered. The micro titanium mesh proved to be highly biocompatible, exhibited excellent mechanical properties, and avoided graft displacement and contour collapse.

Regional odontodysplasia is an uncommon dental malformation with characteristic clinical and radiographic findings. Affected teeth appear discolored with irregularly shaped surfaces. Radiographically wide pulp chambers and thin poorly defined hard tissue outlines are typical features. This report describes a 9-year-old girl with recurrent and recalcitrant periapical infections as a result of unilateral mandibular odontodysplasia. With a 6-year follow-up, this is the longest documented case of regional odontodysplasia treated by tooth autotransplantation.

Clinical case reports and animal studies have demonstrated that the principle of guided bone regeneration can be applied for surgical treatment of moderate to profound peri-implant bone loss (peri-implantitis). However, the degree of bone regeneration within the peri-implant osseous defect was reported to be variable depending on different clinical factors and on the postoperative course. Most papers dealing with surgical treatment of peri-implantitis advocate the use of a non-resorbable ePTFE membrane for secluding the peri-implant bone defect enabling bone regeneration. Additionally some surgeons fill the defects with allografts or alloplasts. The present case report demonstrates another surgical approach by using autogenous cancellous bone for grafting into the peri-implant bone defect and placing a bioresorbable polylactide membrane as a matrix barrier. The successful outcome of this modified surgical approach enabled the patient to maintain the implant for prosthetic reconstruction after early but severe bone loss.

Sufficient bone volume is still considered the most important prerequisite for the osseointegration of dental implants. The TIME technique (autogenous bone grafting combined with stabilization using a titanium mesh) for localized alveolar ridge augmentation was evaluated in 20 patients who had insufficient bone volumes for the primary placement of dental implants. Different clinical recordings were evaluated at TIME stage 1 (augmentation surgery) and at TIME stage 2 (reentry surgery with mesh removal and simultaneous dental implant placement). In most patients, single- or extended-tooth gaps (up to four units) were augmented with autogenous bone harvested from the chin or retromolar area. With the exception of temporary disturbances of tooth sensibility, no morbidity at the donor sites was observed. In one patient, the stabilizing titanium micromesh had to be removed prematurely because of graft infection. At the reentry surgery, the bone grafts were found to be completely incorporated in 75% of the patients. In 15% of the patients, only minimal graft resorption was observed (less than 10% of the graft volume). Subsequently, 28 implants could be placed in 19 patients. The stabilizing titanium mesh was best suited for vertical ridge augmentations. Another feature of the mesh was the excellent tissue compatibility, with little clinical or histologic inflammation, even when the mesh had become exposed.

Disturbances of facial growth and occlusion as well as temporomandibular joint dysfunction are possible sequelae of temporomandibular joint fractures in children. In a follow-up study we examined 30 children with conservatively treated condylar fractures of the mandible (age at time of accident from 9 months to 13 years) regarding dysfunction or growth disturbances within the stomatognathic system. The mean interval between the accident and the follow-up was 4 years and 11 months. We found 6 cases with tilted occlusional planes in the 'en face' analysis, 3 of them with bilateral condylar fractures. There was only one case with a facial asymmetry. The interincisive distance was never below 35 mm. Only 3 patients, all of them with bilateral condylar fractures, had a restricted mobility of the mandible. Remodelling of the condylar head was good in 92% of the cases. Two patients with bilateral fractures showed formation of a bifid condyle without ankylosis. Deviation of the ascending ramus in the horizontal plane was observed radiographically in 21% of the cases with unilateral fractures and in 33% with bilateral fractures respectively and always in a medial direction. Measurement of the length of the Processus articularis in the orthopantomogramm showed a shortening in 70% of the cases on the fracture side. The radiographic evaluation of facial asymmetry after Ricketts and Mulick only revealed an angle difference of more than 5 degrees in some cases.

Although uncommon, anterior maxillary supernumerary teeth (mesiodentes) are the most frequent supernumerary teeth. A disturbed or delayed eruption of the adjacent permanent incisors may be due to a mesiodens and should lead to a further radiographic examination. In some cases the exact radiographic location of the mesiodens may prove difficult. The surgical removal of mesiodentes is especially difficult in extreme cranial displacement. The records of 90 patients with 113 mesiodentes are discussed with special reference to their degree of retention, topographical location, width of pericoronal space and surgical removal, and incidence of retention and malposition of the adjacent permanent incisors, respectively.

Traumata to primary teeth occur very often in small children. The highest prevalence of developmental disturbances of permanent teeth after trauma to their predecessors has been recorded after intrusive injuries of primary teeth. In the present survey 47% of the recalled children had such developmental disturbances. The majority of developmental disturbances consisted of enamel hypoplasia (59%) which included discoloration, defects or a combination of both. In some cases the clinical feature of enamel defects could be diagnosed radiographically before tooth eruption. However, the total number of all enamel discolorations was to be detected after complete tooth eruption only. The so-called pre-eruptive calciotraumatic lines on radiographs corresponded clinically to circular enamel defects or crown dilacerations. Generally, a high correlation was found between the degree of intrusion (of the primary tooth) and the frequency and severity of developmental disturbance (of the permanent tooth). No correlation was found, however, concerning the treatment of intruded primary teeth and the occurrence of developmental disturbances. Whether intruded primary teeth were removed immediately or left to spontaneous re-eruption did not affect the incidence and type of developmental disturbances.

Disturbances of facial growth, occlusion and temporomandibular joint function respectively are all possible sequelae of condylar fractures in children. In this study 30 children (age at accident from 9 months to 14 years, mean 6 years and 9 months) were reexamined who had sustained conservatively treated condylar fractures. Dysfunction and disturbances within the stomathognathic system were assessed by a clinical and radiographic examination. The mean interval between the accident and the follow-up study was 4 years and 11 months. The maximal interincisive distance was always better than 35 mm. The "en face" analysis revealed 6 cases with an inclined occlusion plane referring to the horizontal plane. Only 3 patients, all with bilateral condylar fractures, showed a restricted mandibular mobility. Remodelling of the condylar head was very good in 77% of the cases. In the frontal plane, 21% of the unilateral cases and 33% of the bilateral cases respectively had a persistent medial inclination of the condyle. The measured difference in length of the processus articularis showed the highest correlation to the previous condylar fracture. The radiological evaluation after Ricketts (1960) and Mulick (1965) to assess facial asymmetry revealed six cases (20%) with a relevant angle difference of more than 5 degrees.

The topographic relationship of the apices of the primary teeth to the permanent tooth germs explains the potential for possible developmental disturbances of the permanent teeth after injuries to their predecessors. The anatomical, histologic and clinical aspects of permanent tooth malformation following trauma to the primary teeth are described. One hundred and fourteen children with originally 255 traumatized primary teeth have been re-examined (with an average period of 5.1 years after the trauma) to assess any developmental disturbances of the corresponding permanent teeth. Twenty-three per cent of partially or completely erupted permanent teeth showed developmental disturbances. The most frequent malformation was enamel hypoplasia including enamel discoloration and/or enamel defects. The highest prevalence of developmental disturbances of permanent teeth was found after intrusive injuries of primary teeth.