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Tewari N, Lauridsen E, Atif M, Srivastav S, Tsilingaridis G, Haldar P, Andersson L. Risk of pulp necrosis and related complications in the permanent anterior teeth with lateral luxation: A systematic review and meta-analysis. Dent Traumatol 2024. [PMID: 38576393 DOI: 10.1111/edt.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 04/06/2024]
Abstract
This systematic review aimed to evaluate the evidence related to the occurrence of pulp necrosis and related complications in permanent anterior teeth with lateral luxation. It was envisaged to address the ambiguity related to the recommendation for pulp extirpation in teeth with mature root apex. An a priori protocol was formulated as per the best practices of evidence-based medicine and registered in PROSPERO. A comprehensive search was performed electronically in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane on July 10,2023 without any restriction of language or year of publication. The screening of titles and abstracts and later the full-text articles were performed. Later, the data extraction was performed by using a self-designed sheet, risk of bias (ROB) assessment was done, meta-analysis was performed, and the GRADE approach was used to assess the quality of evidence. The qualitative synthesis was performed on 13 studies done from 1985 to 2020 in hospital settings. There was variability in the minimum and total observation periods, sample sizes, and characteristics of the sample population. The overall pooled prevalence of pulp necrosis was found to be 57% (95% CI: 42, 72%). It was 12% (95% CI: 8%, 18%, I2 = 0%) in immature teeth, and 58% (95% CI: 42, 73%, I2 = 86%) in mature teeth. The pooled prevalence of EIRR was found to be 11% (95% CI: 4, 27%, I2 = 95%) with greater risk in teeth with mature root apex (RR: 1.26, 95% CI: 1.12, 1.42, I2 = 0%). The ROB was moderate or high in nine studies and the GRADE of evidence was very low in 14 of 15 outcomes. There are greater chances of pulp necrosis in teeth with lateral luxation, especially with mature apex. However, it can still be less than 60% in most cases with the prevalence of EIRR less than 20%. Hence, an absolute recommendation for endodontic intervention in mature teeth with lateral luxation must be interpreted with slight caution.
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Affiliation(s)
- Nitesh Tewari
- Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Eva Lauridsen
- Dental Trauma Guide Teamet Kæbekirurgisk Afdeling, Rigshospitalet, Copenhagen, Denmark
| | - Mohammad Atif
- Department of Pediatric Dentistry, ZA Ahmed Dental College, Aligarh Muslim University, Aligarh, India
| | - Sukeshana Srivastav
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Denmark
| | - Georgios Tsilingaridis
- Division of Orthodontics and Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center of Pediatric Oral Health, Stockholm, Sweden
| | - Partha Haldar
- Centre of Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Lars Andersson
- Department of Oral & Maxillofacial Surgery, Malmo University, Sweden
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Coste SC, Rodrigues MAF, Chaves JFM, Lima TCDS, Colosimo EA, Bastos JV. A retrospective cohort study of pulp prognosis in luxated permanent teeth: a competing risk analysis. Clin Oral Investig 2024; 28:187. [PMID: 38430349 DOI: 10.1007/s00784-024-05574-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
AIM The present retrospective cohort study aimed to evaluate luxated permanent teeth for pulp prognosis and risk factors. METHODOLOGY Case records and radiographs of 224 patients, involving 427 luxated permanent teeth, referred for treatment at the Dental Trauma Center-School of Dentistry, Universidade Federal de Minas Gerais, (DTC-SD-UFMG) from 2014 to 2022, were assessed for pulp prognosis classified as vitality, necrosis and pulp canal obliteration (PCO). A competing risk survival analysis estimated the hazards of the three outcomes, and the effect of demographic, clinical and treatment variables was tested using a cause specific Cox regression model. RESULTS Pulp vitality was found in163 teeth (38.2%), pulp necrosis in 120 teeth (28.1%) and 55 teeth (12.9%) developed PCO. Pulp vitality decreased in the presence of concomitant crown fractures (HR 0.38 95% CI [0.2-0.8] p = 0.006). The risk of pulp necrosis (HR 0.62 95% CI [0.4-0.96] p = 0.03) was lower in cases with open apices but increased with concomitant crown fractures (HR 4.0 95% CI [2.6-6.1] p = 0.001) and intrusions (HR 2.3 95% CI [1.2-4.1] p = 0.007). Lateral or extrusive luxations (HR 3.0 95% CI [1.3-6.9] p = 0.001) and open apices (HR 2.4 95% CI [1.2-4.7] p = 0.01) showed higher rates of PCO. CONCLUSION Type of luxation, the diameter of the apical foramen, and the presence of concomitant crown fractures were main determinants of pulp prognosis after luxation injuries in permanent teeth. CLINICAL RELEVANCE Pulp prognosis after tooth luxation is dependent on the presence and direction of tooth displacement together with infection control. CLINICAL TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Sylvia Cury Coste
- Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas Gerais, R. Prof. Moacir Gomes de Freitas, 688, Pampulha, Belo Horizonte/MG, 31270-901, Brazil.
| | - Márcio Augusto Ferreira Rodrigues
- Statistics Department, Institute of Exact Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Brazil
- Institute of Mathematics & Statistics, Universidade Federal de Goiás, Goiânia, 74690-900, Brazil
| | - Júlia Ferreira Maciel Chaves
- Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas Gerais, R. Prof. Moacir Gomes de Freitas, 688, Pampulha, Belo Horizonte/MG, 31270-901, Brazil
| | - Thiago César da Silva Lima
- Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas Gerais, R. Prof. Moacir Gomes de Freitas, 688, Pampulha, Belo Horizonte/MG, 31270-901, Brazil
| | - Enrico Antônio Colosimo
- Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas Gerais, R. Prof. Moacir Gomes de Freitas, 688, Pampulha, Belo Horizonte/MG, 31270-901, Brazil
| | - Juliana Vilela Bastos
- Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas Gerais, R. Prof. Moacir Gomes de Freitas, 688, Pampulha, Belo Horizonte/MG, 31270-901, Brazil
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Parvini P, Lermen Y, Sader R, Schwarz F, Obreja K. Traumatic dental injuries over an 8-year period at a German dental center: a retrospective overview and cross-sectional analysis. Int J Implant Dent 2023; 9:40. [PMID: 37910228 PMCID: PMC10620362 DOI: 10.1186/s40729-023-00506-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND/AIM The aim of this study was to analyze a population of patients who had suffered from traumatic dental injuries (TDIs) by using different patient-, trauma- and treatment-related parameters. MATERIAL AND METHODS All dental records of patients ≥ 3 years old who had presented at the dental emergency service between Jan 1, 2009 and Dec 31, 2016 for the treatment of dental trauma were analyzed. A total of 2758 patients were invited for a recall examination at the Department for Dental Surgery and Implantology, ZZMK Carolinum, Goethe University Frankfurt, Germany; of these, 269 patients attended their recall appointments. RESULTS The enrolled patient population consisted of 1718 males and 1040 females, with a mean age of 19.63 years (median 12.00 ± 17.354 years). A total of 4909 injured teeth were assessed, with a mean of 1.78 injured teeth per patient (median 2.00 ± 1.279). Males were found to be more frequently affected by TDIs compared to females (1.65:1). The majority of these injuries occurred in the first two decades of life (66.1%; n = 1824). The majority of the patients presented for initial treatment within 24 h of their accident (95.7%). The most frequent TDIs were isolated luxation injuries 49.4% (n = 2426) and isolated crown fractures 30% (n = 1472). Combination injuries were diagnosed in 20.6% of the cases (n = 1011). CONCLUSIONS Based on the findings of the present analysis, it can be concluded that males were more frequently affected by TDIs than females. Most patients had suffered from TDI before they had turned 10 years of age. Overall, the enamel-dentin fracture was found to be the most frequent injury, followed by concussions and lateral luxations.
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Affiliation(s)
- Puria Parvini
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, ZZMK Carolinum, Theodor-Stern-Kai 07, H.29, 60590, Frankfurt, Germany.
| | - Yanislava Lermen
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, ZZMK Carolinum, Theodor-Stern-Kai 07, H.29, 60590, Frankfurt, Germany
| | - Robert Sader
- Clinic for Cranio-Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, ZZMK Carolinum, Theodor-Stern-Kai 07, H.29, 60590, Frankfurt, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, ZZMK Carolinum, Theodor-Stern-Kai 07, H.29, 60590, Frankfurt, Germany
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Vera J, Thepris-Charaf J, Hernández-Ramírez A, García JG, Romero M, Vazquez-Carcaño M, Arias A. Prevalence of pulp canal obliteration and periapical pathology in human anterior teeth: A three-dimensional analysis based on CBCT scans. AUST ENDOD J 2023; 49:351-357. [PMID: 35877115 DOI: 10.1111/aej.12669] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
This study aimed to determine the prevalence of pulp canal obliteration (PCO) and its association with periapical pathology (Hypodense areas) in cone-beam computed tomography (CBCT) scans of anterior teeth. A total of 2161 CBCT scans from patients 18 years or older taken between 2000 and 2020 were selected. Patient-, tooth- and scan-related data were registered. Two calibrated evaluators recorded the number of teeth with PCO ≥4 mm in the cervical third of the roots and the presence or absence of periapical hypodensities (PH). The length of the root canal that was calcified was also determined. Logistic regression analysis was used to determine whether any of the recorded factors influenced the presence of PCO and the presence of periapical pathology in teeth presenting with PCO. The only factor significantly related to the presence of PCO was patient age. The prevalence of PH in teeth exhibiting PCO was 10%.
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Affiliation(s)
- Jorge Vera
- Endodontics Department, University of Missouri, Kansas City, Missouri, USA
- Endodontics Department, Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico
| | | | | | | | - Mónica Romero
- Endodontics Department, University of Missouri, Kansas City, Missouri, USA
- Endodontics Department, Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico
| | | | - Ana Arias
- Facultad de Odontología, Universidad Complutense de Madrid, Madrid, Spain
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Connert T, Weiger R, Krastl G. Present status and future directions - Guided endodontics. Int Endod J 2022; 55 Suppl 4:995-1002. [PMID: 35075661 PMCID: PMC9790195 DOI: 10.1111/iej.13687] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/18/2022] [Indexed: 12/30/2022]
Abstract
Luxation injuries and other stimuli may lead to a pulp canal obliteration (PCO). Even though the apposition of tertiary dentine is a sign of a vital pulp, in some cases root canal treatment is indicated in the long term due to apical periodontitis or pulpitis. Depending on the extent of PCO, root canal treatment may be challenging even for experienced and well-equipped endodontic specialists. The 'guided endodontics' (GE) technique was introduced 6 years ago as an alternative to conventional access cavity preparation for teeth with PCO and apical pathosis or irreversible pulpitis. Using three-dimensional radiological imaging such as cone-beam computed tomography and a digital surface scan, an optimal access to the orifice of the calcified root canal can be planned virtually with appropriate software. GE is implemented either with the help of templates analogous to guided implantology (= static navigation) or by means of dynamic navigation based on a camera-marker system. GE has emerged as a field of research in the last 6 years with very promising laboratory-based results regarding the accuracy of guided endodontic access cavities for both static and dynamic navigation. Clinical implementation seems to provide favourable results, but the evidence is mainly based on numerous case reports and a few case series. This narrative review aims to provide an update on the present status of GE and to identify relevant research areas that could contribute to further improvements of this technique.
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Affiliation(s)
- Thomas Connert
- Department of Periodontology, Endodontology and CariologyUniversity Center for Dental Medicine Basel UZBUniversity of BaselBaselSwitzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and CariologyUniversity Center for Dental Medicine Basel UZBUniversity of BaselBaselSwitzerland
| | - Gabriel Krastl
- Department of Conservative Dentistry and PeriodontologyUniversity Hospital of WürzburgWürzburgGermany
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Kallel I, Lagha M, Moussaoui E, Douki N. Lateral luxation: Is root resorption an unavoidable complication? Clin Case Rep 2022; 10:e05880. [PMID: 35600017 PMCID: PMC9117713 DOI: 10.1002/ccr3.5880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/05/2022] Open
Abstract
Lateral luxation is defined as a traumatic displacement of a tooth in any direction other than axially. A laterally luxated tooth is often immobile because of its bony lock. It produces a high metallic sound during percussion. Pulp sensibility testing is likely to be negative during the initial follow‐up. However, the tooth should be monitored until a definitive pulp diagnosis is made. Treatment includes local anesthesia, suturing soft tissue injuries, manual repositioning of the luxated tooth, and stabilization with a flexible splint for 4 weeks. Given the risk of pulp necrosis following lateral luxation, particularly in teeth with radiographically closed apices and severe displacement, an immediate (prophylactic) root canal treatment is recommended. The objective of this work was to report and discuss the management of a case of lateral luxation involving a permanent tooth treated by reduction, followed by contention with 0.4 steel wire and composite resin, and endodontic treatment, and which was complicated by root resorption 3 months later. We also highlighted the possible complications following lateral luxation, especially root resorption. The key clinical message of this case report is to detail the management of lateral luxation and to highlight the importance of clinical and radiological follow‐up in order to detect the possible complications, particularly root resorption.
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Affiliation(s)
- Ines Kallel
- Department of Dental Medicine Hospital Sahloul Sousse Tunisia
- Faculty of Dental Medicine University of Monastir Tunisia
- Laboratory of Research in Oral Health and Maxillo Facial Rehabilitation (LR12ES11) University of Monastir Tunisia
| | - Malek Lagha
- Faculty of Dental Medicine University of Monastir Tunisia
- Laboratory of Research in Oral Health and Maxillo Facial Rehabilitation (LR12ES11) University of Monastir Tunisia
| | - Eya Moussaoui
- Department of Dental Medicine Hospital Sahloul Sousse Tunisia
- Faculty of Dental Medicine University of Monastir Tunisia
- Laboratory of Research in Oral Health and Maxillo Facial Rehabilitation (LR12ES11) University of Monastir Tunisia
| | - Nabiha Douki
- Department of Dental Medicine Hospital Sahloul Sousse Tunisia
- Faculty of Dental Medicine University of Monastir Tunisia
- Laboratory of Research in Oral Health and Maxillo Facial Rehabilitation (LR12ES11) University of Monastir Tunisia
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Dentoalveolar Trauma of Children and Adolescents. Pediatr Dent 2022. [DOI: 10.1007/978-3-030-78003-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Sakly EH. Management of extrusive luxation of upper incisors in young permanent teeth: a case report. Pan Afr Med J 2021; 40:144. [PMID: 34925679 PMCID: PMC8654872 DOI: 10.11604/pamj.2021.40.144.30656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/03/2021] [Indexed: 11/14/2022] Open
Abstract
This case report documents the clinical approach adopted for two permanent maxillary incisors with extrusive luxation in a 16-year-old boy. The proposed procedures involved reposition of both teeth, by digital pressure and stabilized by using semi-rigid splint for 2 weeks. Endodontic therapy was performed. Clinical and radiographic follow-up examinations were conducted at 6-month intervals for two years. Assessment revealed the absence of pulpal and periapical disease and the restoration of the maxillary incisors to a state of health and normal function. A long-term clinical and radiological follow-up is needed to prevent and precociously detect possible complications that may occur following a extrusive luxation.
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Affiliation(s)
- Emna Hidoussi Sakly
- Department of Restorative Dentistry-Endodontics, Oral Health and Oro-Facial Rehabilitation Laboratory Research, Faculty of Dental Medicine of Monastir, University of Monastir, Tunisia
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Evaluation of Clinical and Radiographic Findings among Patients with Traumatic Dental Injuries Seeking Delayed Treatment. Int J Dent 2021; 2021:9549508. [PMID: 34471410 PMCID: PMC8405333 DOI: 10.1155/2021/9549508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/09/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Time elapsed between trauma and treatment greatly influences the prognosis of traumatic dental injuries (TDIs). The aim of this study was to analyze clinical and radiographic findings related to complications of TDIs among patients seeking delayed treatment of such injuries. Materials and Methods 123 permanent teeth with a history of previous TDIs were included in the study. Clinical findings analyzed were the type of fracture, type and number of injured teeth, crown discoloration, and pulpal status of the injured tooth (pulpal diagnosis). The radiographic findings analyzed included pulp canal obliteration (PCO), root resorption (RR), and periapical radiolucency (PR). Statistical analysis included descriptive analysis. Results Tooth discoloration was the most common presenting complaint (53.65%), while fall (48.78%) was the most frequent cause of trauma. The range of time duration between trauma and presentation for treatment was 5 months to 30 years (average time 12.82 years). Pulp necrosis (PN) was the most common complication (90.24%). Almost half of the teeth with PN had fracture injury and discoloration along with a high frequency of PR (78.37%). Even teeth with a normal appearance were found to have a high incidence of PN (76.92%) and PR (53.84%). The crown discoloration was the second most frequent finding (48.78%). Many teeth (41.66%) with vital pulp were also discolored. Most of the teeth (79.31%) with yellowish discoloration and all teeth with brownish discoloration were nonvital. A high frequency of PN (90%) and PR (78.33%) was found in teeth with discoloration. PR was the most common radiographic finding (69.10%), while PCO and RR were observed in 17.88% and 21.13% of teeth, respectively. Conclusion The findings of this study support the fact that delayed treatment of TDIs leads to increased complications. PN was the most common complication followed by tooth discoloration, RR, and PCO among patients seeking delayed treatment after TDIs.
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Joos M, Joos R, Berli C, Filippi A. Photographic assessment of simulated dental luxation injuries. Dent Traumatol 2021; 37:601-607. [PMID: 33780149 DOI: 10.1111/edt.12674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Dental photographs are a valid means for documentation of dental luxation injuries. The aim of the study was to evaluate the utility of two photographs from different perspectives in the assessment of dental luxation injuries compared to one perspective only. MATERIALS AND METHODS Photographs of simulated dental luxation injuries were shown to experts in dental traumatology and other dentists who had to estimate the displacement in the vertical and horizontal dimensions. The overall error of estimation as a result of both vertical displacement and horizontal displacement was calculated and statistically analyzed. RESULTS The mean overall error of estimation was 0.43 mm and 0.75 mm for experts and dentists, respectively. If two (frontal and occlusal) perspectives were available, the overall error was lower than when only one perspective was available (p < .001). Experts had a lower overall error compared to dentists (p < .015). CONCLUSION Two photographs from two perspectives allowed better interpretation of dental luxation injuries.
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Affiliation(s)
- Marc Joos
- Department of Oral Surgery and Center of Dental Traumatology, University Center for Dental Medicine Basel (UZB), Basel, Switzerland
| | - Roland Joos
- Institute of Optometry, University of Applied Sciences (FHNW), Olten, Switzerland
| | - Constantin Berli
- Department of Oral Surgery and Center of Dental Traumatology, University Center for Dental Medicine Basel (UZB), Basel, Switzerland
| | - Andreas Filippi
- Department of Oral Surgery and Center of Dental Traumatology, University Center for Dental Medicine Basel (UZB), Basel, Switzerland
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Spinas E, Pipi L, Mezzena S, Giannetti L. Use of Orthodontic Methods in the Treatment of Dental Luxations: A Scoping Review. Dent J (Basel) 2021; 9:18. [PMID: 33557060 PMCID: PMC7913869 DOI: 10.3390/dj9020018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 01/08/2023] Open
Abstract
(1) Background: Treating dental luxation injuries is challenging for the clinician. Dental luxations account for 18-33% of injuries to permanent teeth and can be addressed using different therapeutic approaches. The present work was conducted with two aims: (i) to evaluate, through a scoping review, current knowledge of the orthodontic methods (repositioning and stabilization splinting) that can be used at the time of the trauma, and (ii) to investigate the frequency and type of pulp consequences arising after these traumatic injuries. (2) Methods: The literature search was conducted in the period June 2020-December 2020 using the PubMed/MEDLINE, SCOPUS and Web of Science databases. The research questions were formulated according to the PICO (Population, Intervention, Comparison, Outcomes) method and considered the following aspects: type of luxation injury and stage of root development; use of orthodontic repositioning and splinting techniques; frequency and type of pulp consequences; and compliance of treatments with international guidelines. (3) Results: The initial screening of the databases, using the selected search keywords, yielded a total of 587 articles, just 8 fully met the inclusion criteria. Closer analysis of these 8 publications revealed that they would not produce clear meta-analytical data. This made it necessary to limit the data collected to the following six items: number and type of injuries, initial therapeutic intervention, duration of follow-up, number, and type of different pulp consequences. (4) Conclusions: While orthodontic techniques are commonly used to treat dental intrusions, in the case of extrusive and lateral luxation injuries, they are less frequently used and the orthodontic approach is generally confined to the stabilization phase. Among the various possible pulp consequences, many authors consider only pulp canal obliteration (PCO) and pulp necrosis (PN), often tending to overlook physiological healing (pulp survival) and the possible development of PN after PCO. There is therefore a clear need for new, high-quality clinical studies of this topic based on systematic and standardized data collection.
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Affiliation(s)
- Enrico Spinas
- Department of Surgical Sciences, Sports Dental Research Center, University of Cagliari, Via Ospedale, 40-09124 Cagliari, Italy;
| | - Laura Pipi
- Department of Surgical Sciences, Sports Dental Research Center, University of Cagliari, Via Ospedale, 40-09124 Cagliari, Italy;
| | - Silvia Mezzena
- Department of Conservative Dentistry and Endodontics, School of Dentistry, University of Cagliari, Via Ospedale, 40-09124 Cagliari, Italy;
| | - Luca Giannetti
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Via del Pozzo, 71-41124 Modena, Italy;
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Krug R, Volland J, Reich S, Soliman S, Connert T, Krastl G. Guided endodontic treatment of multiple teeth with dentin dysplasia: a case report. Head Face Med 2020; 16:27. [PMID: 33203420 PMCID: PMC7672920 DOI: 10.1186/s13005-020-00240-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background To report the outcome of guided endodontic treatment (GET) of a case of dentin dysplasia with pulp canal calcification (PCC) and apical periodontitis based on the use of a 3D-printed template designed by merging cone-beam computed tomography (CBCT) and surface scan data. Case presentation A 12-year old female with radicular dentin dysplasia type I (DD-1) presented for endodontic treatment. Radiography revealed PCC in all teeth and apical radiolucency in seven teeth (12, 15, 26, 31, 32, 36 and 46). Tooth 36 had the most acute symptoms and was thus treated first by conventional access cavity preparation and root canal detection. Despite meticulous technique, the distal and mesiolingual canals were perforated. The perforations were immediately repaired with mineral trioxide aggregate, and the decision was made to switch to guided endodontic treatment for the remaining 6 teeth. CBCT and intraoral surface scans were acquired and matched using coDiagnostix planning software (Dental Wings Inc.), the respective drill positions for root canal location were determined, and templates were virtually designed and 3D-printed. The template was positioned on the respective tooth, and a customized drill was used to penetrate the calcified part of the root canal and perform minimally invasive access cavity preparation up to the apical region. All root canals were rapidly and successfully located with the templates. At 1-year follow-up, clear signs of apical healing were present in all treated teeth. Conclusions In patients with dentin dysplasia, conventional endodontic therapy is challenging. GET considerably facilitates the root canal treatment of teeth affected by dentin dysplasia.
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Affiliation(s)
- Ralf Krug
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Pleicherwall 2, 97070, Würzburg, Germany.
| | - Julian Volland
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Sebastian Reich
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Sebastian Soliman
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Thomas Connert
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Mattenstraße 40, 4058, Basel, Switzerland
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
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Accuracy and Efficiency of a Dynamic Navigation System for Locating Calcified Canals. J Endod 2020; 46:1719-1725. [DOI: 10.1016/j.joen.2020.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022]
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14
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Hegde SG, Tawani G, Warhadpande M, Raut A, Dakshindas D, Wankhade S. Guided endodontic therapy: Management of pulp canal obliteration in the maxillary central incisor. J Conserv Dent 2020; 22:607-611. [PMID: 33088075 PMCID: PMC7542072 DOI: 10.4103/jcd.jcd_21_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/27/2020] [Accepted: 07/10/2020] [Indexed: 11/12/2022] Open
Abstract
This is a case report of the management of pulp canal obliteration of maxillary central incisor using guided endodontic therapy. Patient reported with discolored and proclined 11. Intraoral periapical (IOPA) Radiographs and cone-beam computed tomography (CBCT) showed periapical radiolucency. The canal was obliterated till the middle third and was patent in the apical 7 mm. Root canal treatment (RCT) was planned using guided endodontics. Information of CBCT and digital surface scan were integrated using Blue Sky Bio software. A transparent three-dimensional (3D) model of the tooth and stent, designed with a sleeve for insertion of bur, was 3D-printed using clear resin. After orientation was found satisfactory on the 3D model, access opening was initiated with the orientation of round bur through the stent. IOPAs were taken after preparation of every 3 mm. The canal was located in the apical third. Cleaning and shaping were performed, and RCT completed successfully. Guided endodontic therapy is useful in the management of calcifications in anterior teeth.
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Affiliation(s)
- Shubha G Hegde
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Nagpur, India
| | - Gopal Tawani
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College, DMIMS (Deemed to be University), Nagpur, India
| | - Manjusha Warhadpande
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Nagpur, India
| | - Abhijeet Raut
- Department of Mechanical Engineering, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Darshan Dakshindas
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Nagpur, India
| | - Sattyam Wankhade
- Department of Prosthodontics and Crown and Bridge, Government Dental College and Hospital, Nagpur, India
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Moccelini BS, Alencar NAD, Magno MB, Bolan M, Maia LC, Cardoso M. Is there an association between crown discoloration and pulp necrosis in traumatized per in vitro manent teeth? A meta-analysis. Braz Oral Res 2020; 34:e103. [PMID: 32901727 DOI: 10.1590/1807-3107bor-2020.vol34.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/15/2020] [Indexed: 11/21/2022] Open
Abstract
The present study aimed to identify the scientific evidence regarding the association between crown discoloration and pulp necrosis in traumatized permanent teeth. A systematic literature search was conducted in the PubMed/Medline, Lilacs/BBO, Scopus, Web of Science, Cochrane Library databases, and grey literature. Quality assessment and bias control were carried out according to the Fowkes and Fulton guidelines. Meta-analysis was performed, and the odds ratio was calculated with a 95% confidence interval. The quality assessment of the evidence was determined for the meta-analysis outcomes using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. From 2,702 studies identified, five articles met the inclusion criteria. One among these showed no methodological soundness and was excluded from the meta-analysis, and the remaining four studies were included in the meta-analysis. The total number of traumatized permanent teeth evaluated in the meta-analysis was 367. The results showed a positive association between crown discoloration and pulp necrosis in permanent teeth. Teeth with crown discoloration showed 23 times more chance to present pulp necrosis than teeth without crown discoloration (OR 23.82 [1.25, 452.87]; p = 0.03), with a very low certainty of evidence. There is a significant association between crown discoloration and pulp necrosis of traumatized permanent teeth. Due to the very low strength of evidence according to GRADE, this result should be viewed with caution.
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Affiliation(s)
- Bárbara Suelen Moccelini
- Universidade Federal de Santa Catarina - UFSC, School of Dentistry, Department of Pediatric Dentistry, Florianópolis, SC, Brazil
| | - Nashalie Andrade de Alencar
- Universidade Federal de Santa Catarina - UFSC, School of Dentistry, Department of Pediatric Dentistry, Florianópolis, SC, Brazil
| | - Marcela Baraúna Magno
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Rio de Janeiro, RJ, Brazil
| | - Michele Bolan
- Universidade Federal de Santa Catarina - UFSC, School of Dentistry, Department of Pediatric Dentistry, Florianópolis, SC, Brazil
| | - Lucianne Cople Maia
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Rio de Janeiro, RJ, Brazil
| | - Mariane Cardoso
- Universidade Federal de Santa Catarina - UFSC, School of Dentistry, Department of Pediatric Dentistry, Florianópolis, SC, Brazil
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Jain SD, Carrico CK, Bermanis I. 3-Dimensional Accuracy of Dynamic Navigation Technology in Locating Calcified Canals. J Endod 2020; 46:839-845. [DOI: 10.1016/j.joen.2020.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/23/2020] [Accepted: 03/10/2020] [Indexed: 12/13/2022]
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Clark D, Levin L. Prognosis and complications of mature teeth after lateral luxation: A systematic review. J Am Dent Assoc 2019; 150:649-655. [PMID: 31176453 DOI: 10.1016/j.adaj.2019.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Dental trauma injuries are frequent in children and adolescents and can result in a sequela of future complications. Lateral luxation injuries are diagnosed when a tooth becomes displaced in a position other than axial and is often associated with alveolar bone fracture. Although the tooth is not immediately lost, pulp canal obliteration or pulpal necrosis can occur. The objective of this systematic review was to gather existing data on lateral luxation injuries to mature teeth to evaluate their overall prognosis and reported complications. TYPES OF STUDIES REVIEWED The authors conducted a systematic search of the literature using MEDLINE, PubMed, Embase, and Cochrane databases in February 2019. They hand searched reference lists to identify additional literature. The authors included prospective and retrospective observational studies in the search. They screened a total of 291 articles, downloaded 28 articles, and included 4 articles in the study. RESULTS The most frequent complication reported for mature teeth with lateral luxation was pulpal necrosis (44.2%). Less frequent findings included surface resorption (14.0%), inflammatory resorption (8.5%), pulp canal obliteration (8.1%), and replacement resorption (0.9%). The included studies were cohort studies, which resulted in great heterogeneity, and the authors could not attempt a meta-analysis. CONCLUSIONS AND PRACTICAL IMPLICATIONS A large number of permanent teeth that experience lateral luxation are at risk of developing pulpal necrosis and other complications. Careful follow-up is required for these patients to treat complications as early as possible. Furthermore, the authors of this systematic review emphasize the importance of consistent reporting of dental trauma outcomes.
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18
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Bastos JV, Côrtes MIDS. Pulp canal obliteration after traumatic injuries in permanent teeth - scientific fact or fiction? Braz Oral Res 2018; 32:e75. [PMID: 30365616 DOI: 10.1590/1807-3107bor-2018.vol32.0075] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 06/07/2018] [Indexed: 01/01/2023] Open
Abstract
Pulp canal obliteration (PCO) is a frequent finding associated with pulpal revascularization after luxation injuries of young permanent teeth. The underlying mechanisms of PCO are still unclear, and no experimental scientific evidence is available, except the results of a single histopathological study. The lack of sound knowledge concerning this process gives rise to controversies, including the most suitable denomination. More than a mere semantic question, the denomination is an important issue, because it reflects the nature of this process, and directly impacts the treatment plan decision. The hypothesis that accelerated dentin deposition is related to the loss of neural control over odontoblastic secretory activity is well accepted, but demands further supportive studies. PCO is seen radiographically as a rapid narrowing of pulp canal space, whereas common clinical features are yellow crown discoloration and a lower or non-response to sensibility tests. Late development of pulp necrosis and periapical disease are rare complications after PCO, rendering prophylactic endodontic intervention useless. Indeed, yellowish or gray crown discoloration may pose a challenge to clinicians, and may demand endodontic intervention to help restore aesthetics. This literature review was conducted to discuss currently available information concerning PCO after traumatic dental injuries (TDI), and was gathered according to three topics: I) physiopathology of PCO after TDI; II) frequency and predictors of pulpal healing induced by PCO; and III) clinical findings related to PCO. Review articles, original studies and case reports were included aiming to support clinical decisions during the follow-up of teeth with PCO, and highlight future research strategies.
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Affiliation(s)
- Juliana Vilela Bastos
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Restorative Dentistry, Belo Horizonte, MG, Brazil
| | - Maria Ilma de Souza Côrtes
- Pontifícia Universidade Católica de Minas Gerais - PUC-MG, Department of Dentistry, Belo Horizonte, MG, Brazil
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Diangelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR, Malmgren B, Moule AJ, Pohl Y, Tsukiboshi M. Guidelines for the Management of Traumatic Dental Injuries: 1. Fractures and Luxations of Permanent Teeth. Dent Traumatol 2018; 39:401-411. [PMID: 22230724 DOI: 10.1111/j.1600-9657.2011.01103.x] [Citation(s) in RCA: 272] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.
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Affiliation(s)
- Anthony J Diangelis
- Department of Dentistry, Hennepin County Medical Center and University of Minnesota School of Dentistry, Minneapolis, MN, USA;, Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, USA.
| | - Jens O Andreasen
- Center of Rare Oral Diseases, Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Rigshopitalet, Denmark
| | - Kurt A Ebeleseder
- Department of Conservative Dentistry, Medical University Graz, Graz, Austria
| | - David J Kenny
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Martin Trope
- Department of Endodontics, School of Dentistry, University of Pennsylvania, Philadelphia, PA, USA
| | - Asgeir Sigurdsson
- Department of Endodontics, UNC School of Dentistry, Chapel Hill, NC, USA
| | - Lars Andersson
- Department of Surgical Sciences, Faculty of Dentistry, Health Sciences Center Kuwait University, Kuwait City, Kuwait
| | | | - Marie Therese Flores
- Pediatric Dentistry, Faculty of Dentistry, Universidad de Valparaiso, Valparaiso, Chile
| | - Morris Lamar Hicks
- Department of Endodontics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | | | - Barbro Malmgren
- Department of Clinical Sciences Intervention and Technology, Division of Pediatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Alex J Moule
- Private Practice, University of Queensland, Brisbane, Australia
| | - Yango Pohl
- Department of Oral Surgery, University of Bonn, Bonn, Germany
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20
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Clark D, Levin L. Prognosis and complications of immature teeth following lateral luxation: A systematic review. Dent Traumatol 2018; 34:215-220. [PMID: 29719935 DOI: 10.1111/edt.12407] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2018] [Indexed: 02/28/2024]
Abstract
BACKGROUND/AIMS Lateral luxation injuries are a type of traumatic dental injury in which the tooth becomes displaced in the palatal/lingual or labial direction. This injury is common among children and can result in pulp canal obliteration or pulp necrosis. The objective of this systematic review was to gather existing data on lateral luxation injuries to immature teeth to evaluate their overall prognosis. METHODS A systematic search was conducted using Medline, Pubmed, Scopus, Lilacs, EMBASE and Cochrane databases in October 2017. Reference lists were also hand-searched to identify additional literature. Prospective and retrospective observational studies were included. A total of 502 articles were screened and six articles were included in the study. RESULTS Pulp canal obliteration was the most frequent complication of immature teeth with lateral luxation (31.3%). This was followed by pulp necrosis (17.5%), inflammatory resorption (5.7%), and surface resorption (3.2%). Due to the heterogeneity of the studies, a meta-analysis was not attempted. There was great variation in the reported outcomes among the studies. CONCLUSION Accurate prognosis evaluation of traumatic dental injuries is difficult due to the nature of current studies being retrospective or prospective cohort studies. Lateral luxation is a common traumatic dental injury and has life-long concerns for a patient. It is important for future studies to report on the same outcomes to increase the quality of evidence regarding prognosis and treatment interventions, not only for lateral luxation injuries, but for all traumatic dental injuries.
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Affiliation(s)
- Danielle Clark
- Faculty of Medicine and Dentistry, Division of Periodontology, University of Alberta, Edmonton, AB, Canada
| | - Liran Levin
- Faculty of Medicine and Dentistry, Division of Periodontology, University of Alberta, Edmonton, AB, Canada
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21
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Guided Endodontic Access in Maxillary Molars Using Cone-beam Computed Tomography and Computer-aided Design/Computer-aided Manufacturing System: A Case Report. J Endod 2018; 44:875-879. [DOI: 10.1016/j.joen.2018.02.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/26/2018] [Accepted: 02/06/2018] [Indexed: 11/23/2022]
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22
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Connert T, Zehnder MS, Weiger R, Kühl S, Krastl G. Microguided Endodontics: Accuracy of a Miniaturized Technique for Apically Extended Access Cavity Preparation in Anterior Teeth. J Endod 2017; 43:787-790. [DOI: 10.1016/j.joen.2016.12.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/21/2016] [Accepted: 12/10/2016] [Indexed: 12/18/2022]
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23
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Lima TFR, Silva EJNLD, Gomes BPFDA, Almeida JFAD, Zaia AA, Soares ADJ. Relationship between Initial Attendance after Dental Trauma and Development of External Inflammatory Root Resorption. Braz Dent J 2017; 28:201-205. [DOI: 10.1590/0103-6440201701299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/28/2017] [Indexed: 11/22/2022] Open
Abstract
Abstract This clinical study aimed to evaluate the relationship of the delay between dental trauma and the initial attendance to the development of external inflammatory root resorption in permanent teeth affected by severe luxation. Sixty-seven patients, aged between 11 and 56 years, presenting 133 injured teeth with closed apex (56 extrusive luxation, 69 lateral luxation and 8 intrusive luxation) were followed up for a minimum of 24 months. The time elapsed between dental trauma and the initial attendance was recorded. The presence of necrotic pulp and external inflammatory resorption for each type of trauma was verified. Fisher’s exact test was used to verify the influence of the initial attendance date at the Dental Trauma Center and the development of inflammatory resorption (p<0.05). The odds ratio was used to check the risk of developing external inflammatory resorption due to delay in seeking treatment. Pulp necrosis was observed in 105 teeth (78.9%) and external inflammatory resorption was detected in 17.8% cases of extrusive luxation (10 teeth), 15.9% of lateral luxation (11 teeth) and 25% of intrusive luxation (2 teeth). For lateral luxation, extended delay between the date of injury and initial attendance influenced the occurrence of external inflammatory resorption (p=0.0174). Patients who began treatment 45 days after the injury were 3.4 times more likely to develop external inflammatory resorption than patients who sought treatment after the trauma. Treatment late after the occurrence of dental trauma can impair the prognosis and result in the development of external inflammatory resorption in luxated teeth.
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24
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Gould TE, Piland SG, Caswell SV, Ranalli D, Mills S, Ferrara MS, Courson R. National Athletic Trainers' Association Position Statement: Preventing and Managing Sport-Related Dental and Oral Injuries. J Athl Train 2016; 51:821-839. [PMID: 27875057 DOI: 10.4085/1062-6050-51.8.01] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To provide athletic trainers, health care professionals, and all those responsible for the care of athletes with clinical recommendations for preventing and managing sport-related dental and oral injuries. BACKGROUND Participation in competitive sports continues to grow at both the interscholastic and intercollegiate levels. Therefore, exposure to, and the incidence of athletic-related injury, including orofacial injury, will also likely increase. At the time of this writing, the leading governing agencies for interscholastic (National Federation of State High School Associations) and intercollegiate (National Collegiate Athletic Association) sports require only protective orofacial equipment (eg, mouthguards) for 5 and 4, respectively, of their sanctioned sports. Although orofacial injuries represent a small percentage of all sport-related injuries, the financial burden associated with these injuries (eg, tooth avulsion) can exceed $15 000 over an adult life. Therefore, effective management of sport-related dental injuries is critical to the long-term financial, physical, and emotional health of people who have experienced dental trauma. RECOMMENDATIONS Based upon the current evidence regarding sport-related orofacial injury, we provide recommendations related to planning considerations, education, and mouthguard efficacy, material, fabrication, and care considerations. Additionally, suggested best practices for managing sport-related dental injury are also given for athletic trainers and other health care professionals.
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Affiliation(s)
- Trenton E Gould
- School of Kinesiology, The University of Southern Mississippi, Hattiesburg
| | - Scott G Piland
- School of Kinesiology, The University of Southern Mississippi, Hattiesburg
| | - Shane V Caswell
- Athletic Training Program, George Mason University, Manassas, VA
| | | | | | - Michael S Ferrara
- College of Health and Human Services, University of New Hampshire, Durham
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Lin S, Pilosof N, Karawani M, Wigler R, Kaufman AY, Teich ST. Occurrence and timing of complications following traumatic dental injuries: A retrospective study in a dental trauma department. J Clin Exp Dent 2016; 8:e429-e436. [PMID: 27703612 PMCID: PMC5045691 DOI: 10.4317/jced.53022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/17/2016] [Indexed: 11/20/2022] Open
Abstract
Background This study explores the pattern of complications occurrence resulting from traumatic dental injuries, the relation of this pattern to the number of years from the time of the injury to its first diagnosis, and other contributing characteristics such as root development and trauma characteristic. Material and Methods Patients’ data treated following dental trauma from 2002 to 2014 were classified and grouped according to age, gender, tooth type, injury type, diagnosis and the time that elapsed between the traumatic event and the diagnosis of complications (TIC). The distribution function of the quantitative parameters was determined with the Kolmogorov-Smirnov test. Fisher exact test was used to test differences between categorical parameters. Results The review identified 166 patients (114 male and 52 female), with a total of 287 traumatized teeth, and a mean of 1.8 injured teeth per incident. Maxillary teeth were involved significantly more often in traumatic dental injuries. The follow-up period range (TIC) had a mean of 2.99 years. The most frequent complication was pulp necrosis (34.2%).
The most frequent complication related to avulsion was ankylotic root resorption (50%) diagnosed after a median TIC of 1.18 years. Open apices at the occurrence of trauma were observed in 52 teeth. Of these, 54.9% experienced pulp necrosis and 9.8% inflammatory root resorption with a median TIC of 1.63 years.
Teeth that experienced multiple traumatic events showed significantly more late pulp necrosis compared to teeth that experienced a single traumatic injury (61.9% vs. 25.3%, respectively, p<0.0001). Conclusions Follow-up periods should be based on the type of traumatic dental injury and the severity of the potential complications for the tooth. Current recommendations for follow-up after traumatic dental injury should be revised to reflect the need for more frequent and overall prolonged follow-up. Key words:Dental trauma, avulsion, open apex, pulp necrosis, root resorption, follow-up, complications.
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Affiliation(s)
- Shaul Lin
- DMD, Endodontics and Dental Trauma Department, School of Graduate Dentistry, Rambam Medical Center, Haifa, Israel; DMD, Faculty of Medicine at the Technion Institute of Technology, Haifa, Israel
| | - Nir Pilosof
- DMD, Endodontics and Dental Trauma Department, School of Graduate Dentistry, Rambam Medical Center, Haifa, Israel
| | - Munir Karawani
- DMD, Endodontics and Dental Trauma Department, School of Graduate Dentistry, Rambam Medical Center, Haifa, Israel
| | - Ronald Wigler
- DMD, Endodontics and Dental Trauma Department, School of Graduate Dentistry, Rambam Medical Center, Haifa, Israel
| | - Arieh Y Kaufman
- DMD, Endodontics and Dental Trauma Department, School of Graduate Dentistry, Rambam Medical Center, Haifa, Israel
| | - Sorin T Teich
- DMD, MBA, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
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26
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Heithersay GS. Life cycles of traumatized teeth: long-term observations from a cohort of dental trauma victims - series 2. Aust Dent J 2016; 61:317-28. [DOI: 10.1111/adj.12430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- GS Heithersay
- Discipline of Endodontology; School of Dentistry; The University of Adelaide; South Australia Australia
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27
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Kiefner P, Connert T, ElAyouti A, Weiger R. Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three-year follow-up. Gerodontology 2016; 34:164-170. [PMID: 27296318 DOI: 10.1111/ger.12238] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Determination of accessibility, time needed and outcome of endodontic treatment of teeth with calcified root canals in a sample of elderly participants in a private practice limited to endodontics. BACKGROUND Due to demographic changes, gerodontology is becoming more and more important, also in the field of endodontology. Elderly patients can show up with severe calcifications of root canals. Root canal treatment, when needed, can be very challenging in these cases. Only few data exist about the treatment of calcified root canals and its outcome, especially in an elderly population. MATERIALS AND METHODS Forty-one participants (median age: 72 years) needing a root canal treatment were included. The total number of treated teeth was 41 with 114 negotiated root canals. A specialist limited to endodontics performed the treatment in a private practice. Outcome was assessed by applying the periapical index score on the basis of recall radiographs provided by the referring dentists. Likewise, time required to localise the root canals was measured. RESULTS All root canals have been detected using the operating microscope, and full working length could be established in 90% of the cases. Success rate was 80% after an observation time of 3 years. In three of five teeth, root canals could be localised within 15 min. CONCLUSION Calcified root canals of older people treated in this study were all accessible within a maximum of 60 min. The success rate after a follow-up of 3 years was 80%.
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Affiliation(s)
- Peter Kiefner
- Private practice, Stuttgart, Germany.,Department of Conservative Dentistry and Periodontology, University Hospital of Würzburg, Würzburg, Germany
| | - Thomas Connert
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Basel, Switzerland
| | - Ashraf ElAyouti
- Department of Conservative Dentistry, University of Tuebingen, Tuebingen, Germany
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Basel, Switzerland
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28
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Lam R. Epidemiology and outcomes of traumatic dental injuries: a review of the literature. Aust Dent J 2016; 61 Suppl 1:4-20. [DOI: 10.1111/adj.12395] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R Lam
- International Research Collaborative - Oral Health and Equity, School of Anatomy, Physiology and Human Biology; The University of Western Australia; Western Australia Australia
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Krastl G, Zehnder MS, Connert T, Weiger R, Kühl S. Guided Endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology. Dent Traumatol 2015; 32:240-246. [DOI: 10.1111/edt.12235] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Gabriel Krastl
- Department of Conservative Dentistry and Periodontology; Center of Dental Traumatology; University of Würzburg; Würzburg Germany
| | - Marc S. Zehnder
- Department of Periodontology, Endodontology and Cariology; Center of Dental Traumatology; University of Basel; Basel Switzerland
| | - Thomas Connert
- Department of Periodontology, Endodontology and Cariology; Center of Dental Traumatology; University of Basel; Basel Switzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology; Center of Dental Traumatology; University of Basel; Basel Switzerland
| | - Sebastian Kühl
- Department of Oral Surgery, Oral Radiology and Oral Medicine, Center of Dental Traumatology; University of Basel; Basel Switzerland
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30
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Zehnder MS, Connert T, Weiger R, Krastl G, Kühl S. Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location. Int Endod J 2015; 49:966-72. [DOI: 10.1111/iej.12544] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/05/2015] [Indexed: 01/10/2023]
Affiliation(s)
- M. S. Zehnder
- Department of Periodontology, Endodontology and Cariology; University of Basel; Basel Switzerland
| | - T. Connert
- Department of Periodontology, Endodontology and Cariology; University of Basel; Basel Switzerland
| | - R. Weiger
- Department of Periodontology, Endodontology and Cariology; University of Basel; Basel Switzerland
| | - G. Krastl
- Department of Operative Dentistry and Periodontology; University of Würzburg; Würzburg Germany
| | - S. Kühl
- Department of Oral Surgery Oral Radiology and Oral Medicine; University of Basel; Basel Switzerland
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31
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Andreasen FM, Kahler B. Pulpal Response after Acute Dental Injury in the Permanent Dentition: Clinical Implications—A Review. J Endod 2015; 41:299-308. [DOI: 10.1016/j.joen.2014.11.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/09/2014] [Accepted: 11/27/2014] [Indexed: 12/28/2022]
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Rocha Lima TF, Nagata JY, de Souza-Filho FJ, de Jesus Soares A. Post-traumatic complications of severe luxations and replanted teeth. J Contemp Dent Pract 2015; 16:13-19. [PMID: 25876944 DOI: 10.5005/jp-journals-10024-1628] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The aim of this study was to evaluate the main post-traumatic complications of severe luxation and replanted teeth using clinical and radiographic analyses. MATERIALS AND METHODS Eighty-three patients aged between 7 and 55 years old presenting 180 traumatized teeth that suffered extrusive luxation (n=67), lateral luxation (n=69), intrusive luxation (n=10) and tooth avulsion (n=34) followed by replantation were evaluated. The follow-up period was 24 months. The complications examined were: pulp canal obliteration, pulp necrosis and root resorption (infammatory and replacement). Furthermore, the relationship between time elapsed before receiving dental attendance and development of infammatory resorption was observed. RESULTS Pulp necrosis was the main complication, occurring in 147 teeth (82.7%). All of the teeth that suffered intrusive luxation and tooth avulsion were diagnosed with pulp necrosis, with significant difference in comparison with another traumas (p<0.001/Fisher's exact test). Infammatory root resorption was observed in 20.5% of the cases and replacement resorption was more related to tooth replantation (94.1%), showing significant prevalence among tooth luxations (p<0.001/Fisher's exact test). In addition, it was noted that patients who seek treatment 9 weeks after the trauma episode presented 10 times more chance of developing infammatory resorption when compared with patients who seek treatment soon after dental trauma (Odds ratio test). CONCLUSION It may be concluded that pulp necrosis was the main post-traumatic complication observed in traumatized teeth and that delay in seeking treatment may damage the prognosis of severe luxation and replanted teeth. CLINICAL SIGNIFICANCE Clinical studies describing the main complications that may affect traumatized teeth present great relevance to make the population aware of the importance of seeking immediate treatment and to alert the professional to the need for follow-up. When traumatic injuries are diagnosed and treated early, post-traumatic complications may be controlled, allowing conservation of the tooth in oral cavity.
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Affiliation(s)
- Thiago Farias Rocha Lima
- Professor Department of Restorative Dentistry, Endodontics Area Federal University of Paraíba, João Pessoa, Paraiba, Brazil Phone: 982226564, e-mail:
| | | | - Francisco José de Souza-Filho
- Department of Restorative Dentistry, Endodontics Area Piracicaba Dental School, State University of Campinas Piracicaba, Brazil
| | - Adriana de Jesus Soares
- Department of Restorative Dentistry, Endodontics Area Piracicaba Dental School, State University of Campinas Piracicaba, Brazil
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Soares TRC, Luiz RR, Risso PA, Maia LC. Healing complications of traumatized permanent teeth in pediatric patients: a longitudinal study. Int J Paediatr Dent 2014; 24:380-6. [PMID: 24251824 DOI: 10.1111/ipd.12082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Traumatic dental injuries (TDI) can affect soft and hard dental tissues and supporting structures in different ways and severity. AIM This study describes the complications associated with health in traumatized permanent teeth (TPT) over a 12-month period and assesses the relationships between TDI, involved tissues, and root development (RD). DESIGN The study enrolled 294 patients with 548 TPT. Data were collected on the TDI, RD, and the healing complication (HC) and when they were examined (03, 06, and 12 months). Frequencies are described and analyzed using the chi-squared test, relative risk (RR), and Mantel-Haenszel analysis (P≤0.05). RESULTS Healing complications were present in 201 (36.68%) teeth and were more frequently diagnosed 3 months (63.68%) after the TDI. Pulp necrosis was the most common HC (38.3%), and it was significantly associated with avulsion (P=0.023). Teeth with complete RD showed a tendency of developing HC over time, independent of TDI (P=0.05). HC in teeth with complete RD related to support tissue trauma (P=0.005) and avulsion (P<0.001) appeared more frequently after 3 months. CONCLUSION Healing complications are more common in teeth that have suffered trauma in supporting tissues and avulsion, especially in teeth with complete RD. The HC occur more frequently in the first 3 months, and a necrotic pulp was the most common complication.
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Affiliation(s)
- Thais R C Soares
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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34
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Periodontal healing complications following extrusive and lateral luxation in the permanent dentition: a longitudinal cohort study. Dent Traumatol 2012; 28:394-402. [DOI: 10.1111/edt.12000] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2012] [Indexed: 11/26/2022]
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Bücher K, Neumann C, Thiering E, Hickel R, Kühnisch J. Complications and survival rates of teeth after dental trauma over a 5-year period. Clin Oral Investig 2012; 17:1311-8. [DOI: 10.1007/s00784-012-0817-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/30/2012] [Indexed: 12/20/2022]
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36
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Lauridsen E, Hermann NV, Gerds TA, Ahrensburg SS, Kreiborg S, Andreasen JO. Combination injuries 3. The risk of pulp necrosis in permanent teeth with extrusion or lateral luxation and concomitant crown fractures without pulp exposure. Dent Traumatol 2012; 28:379-85. [DOI: 10.1111/j.1600-9657.2011.01100.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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37
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Turkistani J, Hanno A. Recent trends in the management of dentoalveolar traumatic injuries to primary and young permanent teeth. Dent Traumatol 2011; 27:46-54. [DOI: 10.1111/j.1600-9657.2010.00950.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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38
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Wriedt S, Martin M, Al-Nawas B, Wehrbein H. Long-term Effects of Traumatic Injuries to Incisors and Periodontal Tissues during Childhood. J Orofac Orthop 2010; 71:318-29. [DOI: 10.1007/s00056-010-9940-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 07/30/2010] [Indexed: 11/24/2022]
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Hecova H, Tzigkounakis V, Merglova V, Netolicky J. A retrospective study of 889 injured permanent teeth. Dent Traumatol 2010; 26:466-75. [PMID: 20946344 DOI: 10.1111/j.1600-9657.2010.00924.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of this study was to investigate pre-injury factors, causes of dental injuries and healing complications after traumatic injuries to permanent teeth. The analysed sample comprised 889 permanent teeth of 384 patients, who were treated in the Dentistry Department in Faculty Hospital in Pilsen. Enamel-dentin fractures [233 teeth (26.2%)] and lateral luxations [207 teeth (23.3%)] were the most frequent injuries. The age of the patients at the time of injury varied between 7 and 65 years. Predominantly, children were affected [587 injured teeth (66.0%)]. The most frequent causes of injuries in patients older than 11 years were various sport activities, predominantly bicycling. Pulp necrosis was observed in 239 teeth (26.9%). It was the most frequent post-traumatic complication in all types of dental traumas. Teeth with a completed root formation demonstrated a higher prevalence of pulp necrosis than teeth with an incomplete root formation in all types of luxation injuries. External root resorption was observed in 144 teeth. The rate of inflammatory resorption differed between the various types of luxation injuries (extrusive luxation 5.6%, lateral luxation 11.6%, intrusive luxation 33.3%). Following avulsion and replantation, active inflammatory resorptions were diagnosed in 13 (26.5%) of 49 replanted teeth and ankylosis/replacement resorptions were observed in 21 (42.9%) of 49 replanted teeth. After avulsion, primarily, immature teeth were affected by these complications. Within the observation period of 5 years, 39 teeth (4.4%) had to be removed (16 teeth with root fractures, 19 avulsed and replanted teeth, 3 luxated teeth, 1 tooth with crown-root fracture).
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Affiliation(s)
- Hana Hecova
- Dentistry Department, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Czech Republic.
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40
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De Rossi M, De Rossi A, Queiroz AMD, Nelson Filho P. Management of a complex dentoalveolar trauma: a case report. Braz Dent J 2009; 20:259-62. [PMID: 19784475 DOI: 10.1590/s0103-64402009000300016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This paper describes the case of a 12-year-old male patient who presented a severe lateral luxation of the maxillary central incisors due to a bicycle fall. Treatment involved suture of the soft tissues lacerations, and repositioning and splinting of the injured teeth, followed by endodontic treatment and periodontal surgery. After a 2-year follow-up, clinical and radiographic evaluation revealed that the incisors presented satisfactory esthetic and functional demands.
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Affiliation(s)
- Moara De Rossi
- Department of Pediatric Dentistry, State University of Campinas, Piracicaba, SP, Brazil.
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Abstract
Treatment of traumatized teeth generally occurs in two phases: short-term emergency treatment and stabilization followed by endodontic management and review. These authors recently reviewed the endodontic considerations in the treatment of traumatized permanent anterior teeth, and in this article review the early management of traumatized permanent teeth. Preoperative assessment and emergency management are emphasized, as is the treatment of immature teeth for which continued development of the root system must be encouraged. Factors influencing long-term prognosis are discussed and the influence of various management strategies evaluated.
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Affiliation(s)
- Alex J Moule
- School of Dentistry, University of Queensland, 141 Queen Street, Brisbane 4000, Queensland, Australia.
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42
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Pelka M, Berthold C, van Waes H. Late reposition of a lateral luxated maxillary incisor with an immature apex. Dent Traumatol 2009; 25:550-4. [PMID: 19754701 DOI: 10.1111/j.1600-9657.2009.00814.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Here we describe an unusual trauma case. A recently erupted permanent upper-right incisor sustained a lateral luxation when a 5-year-old girl on a playground climbing net dropped off, catching the right upper incisor in the net. The tooth was laterally luxated in vestibular direction, and no other signs of injury occurred. A dental practitioner could not reposition the bony locked tooth. Four days later, the girl came to our clinic, and we performed an incomplete repositioning of the tooth and made a flexible splint. Controls were made at 1, 6, and 12 weeks and at 6, 12, 18, and 24 months later. The 24-month follow-up clinical examination revealed the patient to be asymptomatic and the tooth to be completely functional, and the recall radiograph showed further apical root growth. The implications of a late incomplete reposition of laterally luxated permanent teeth with immature apices are discussed.
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Affiliation(s)
- Matthias Pelka
- Dental Clinic 1, Operative Dentistry and Periodontology, University of Erlangen-Nuremberg, Erlangen, Germany.
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43
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Ferrazzini Pozzi EC, von Arx T. Pulp and periodontal healing of laterally luxated permanent teeth: results after 4 years. Dent Traumatol 2008; 24:658-62. [DOI: 10.1111/j.1600-9657.2008.00687.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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44
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Kırzıoğlu Z, Özay Ertürk MS, Altun AC. Recurrent trauma histories of two ‘unlucky teeth’: 42-month follow-up. Dent Traumatol 2008; 24:e42-6. [DOI: 10.1111/j.1600-9657.2008.00637.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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45
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Yeng T, Parashos P. Dentists’ management of dental injuries and dental trauma in Australia: a review. Dent Traumatol 2008; 24:268-71. [DOI: 10.1111/j.1600-9657.2007.00543.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Andreasen JO. Doubtful new treatment guidelines for luxated permanent teeth proposed. Dent Traumatol 2008; 24:262-3; author reply 263-4; discussion 264-5. [DOI: 10.1111/j.1600-9657.2007.00664.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Casas MJ, Krimbalis PP, Morris AR, Behdinan K, Kenny DJ. An experimentally calibrated finite element study of maxillary trauma. Dent Traumatol 2007; 23:273-7. [PMID: 17803483 DOI: 10.1111/j.1600-9657.2006.00460.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A baseball injury to an instrumented human cadaver maxillae was simulated with a regulation (142 g) baseball traveling at 14 m s(-1). Measurements of strain were obtained with three-axis strain gauge rosettes located at the medial palate and both canine fossae. A three-dimensional finite element (FE) model of a dentate human maxilla was constructed from computed tomography scans of the skull of an adolescent. This three-dimensional mathematical model of the maxilla was deemed geometrically accurate by convergence testing when the model's degrees of freedom approximated 74 000. The simulated load case involved a transient dynamic impact to the medial maxilla with boundary conditions imposed at skeletal buttresses of the model. The model was calibrated through direct comparison with the displacements and principal strains gathered from experimental and epidemiological data. The comparison of experimental and calculated principal strains as a result of the simulated impacts revealed a 1.7-11.4% difference.
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Affiliation(s)
- Michael J Casas
- Department of Research, Bloorview MacMillan Children's Centre, Toronto, ON, Canada.
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48
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Abstract
Despite the many journal articles and reviews that have been published regarding the treatment of trauma to teeth, the endodontic management of these injuries is often still not fully understood. The purpose of this review is to establish clear and up-to-date guidelines for practitioners who are faced with treating dental injuries on a day-to-day basis, based on an assessment of current available scientific information relating to the endodontic management of these injuries. Treatment is discussed under the headings: infractions, uncomplicated crown fractures, complicated crown fractures, crown-root fractures, root fractures, luxation injuries, avulsion, root resorption, pulp canal obliteration and open-apex teeth. Emphasis is placed on the treatment of traumatized immature teeth where maintenance of pulp blood supply is important to encourage continued development of the root system. Only the treatment of traumatized permanent anterior teeth is reviewed. Information contained in this article is based on a review of the literature on dental trauma which involved a MEDLINE search using the key words "dental trauma" and the individual topics listed above. The guidelines produced by the International Association of Dental Traumatology, the American Academy of Pediatric Dentistry and the American Association of Endodontists were also reviewed and the recommendations contained in this paper are in concert with the major recommendations of these bodies.
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49
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Day PF, Duggal MS. The role for 'reminders' in dental traumatology: 3. The minimum data set that should be recorded for each type of dento-alveolar trauma - a review of existing evidence. Dent Traumatol 2006; 22:258-64. [PMID: 16942556 DOI: 10.1111/j.1600-9657.2006.00439.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to establish the prognostic factors recorded at the time of diagnosis or initial treatment that affect pulp and periodontal healing and tooth survival. A search strategy and quality assessment method was established to review the literature. The significant factors identified are listed for each type of dento-alveolar injury. These factors identified are the gold standard against which quality assessments of dento-alveolar trauma records can be compared and all new computer or paper-based methods for recording any type of dento-alveolar trauma should aim to record this minimum information.
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Affiliation(s)
- Peter F Day
- Division of Child Dental Health, Leeds Dental Institute, Leeds, UK.
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50
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Abstract
Tooth retention has increased significantly in older adults, and dentists are now challenged by the need to preserve critical teeth. There will be a need to consider endodontic therapy, and this paper describes how successful endodontics can be provided for elderly patients. Strategic treatment planning is essential, and preservation of key teeth will facilitate satisfactory oral function for elderly patients. These teeth may be important in achieving and maintaining an intact anterior dental arch, for removable partial denture retention or preservation of alveolar bone. In some cases, this can only be achieved if endodontic procedures are undertaken. When infection of a root canal is present, there is no reason why good quality endodontic therapy should not work in a healthy elderly patient. Elimination of infection can be challenging in narrow root canals, and a systematic approach for improving access into and negotiating these canals is outlined.
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Affiliation(s)
- P Finbarr Allen
- Department of Restorative Dentistry, University Dental School and Hospital, Wilton, Cork, Ireland.
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