1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Šimunović L, Špiljak B, Vranić L, Negovetić Vranić D. Treatment priorities and arrival time of traumatic dental injuries-An 8-year retrospective study. Dent Traumatol 2024; 40:11-21. [PMID: 37750007 DOI: 10.1111/edt.12889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND/AIM Most of the previous studies in the available literature discussed the time of arrival in general to the healthcare system, while a minority studied the relationship between the type of trauma and arrival. The aim of this retrospective study is to assess the arrival time of traumatic dental injuries (TDIs) depending on the urgency of treatment according to Andreasen. MATERIALS AND METHODS This 8-year retrospective study was carried out at the Department of Pediatric Dentistry at the University Dental Clinic in Zagreb, Croatia. Andreasen's classification was used to define the kind of TDI as well as to divide them by the need for urgent treatment or treatment priorities in three groups: acute, subacute, and delayed. RESULTS The sample consisted of 1040 children (59% male and 41% female) with a median age of 7. Each year, the age group most affected by TDIs was 6-12 years old. While there is a general increase in the prevalence of TDIs overall, there is a decline in TDIs among children aged 6-12 and an increase among preschoolers and adolescents (below 6 and above 12 years old). Throughout the years, 52.73% red/acute and 41.16% yellow/subacute TDIs were not treated on time due to delayed arrival. More patients from Zagreb come in the first 24 h, while more patients from outside Zagreb come to the clinic a month or more after their injuries. Patients which suffered TDI accompanied with soft-tissue injury arrived sooner. CONCLUSIONS It is necessary to introduce monitoring and education of patients under the age of 6 and over 12, as well as their parents/caregivers. New programs should be implemented and new referent centers that specialize in treating TDIs outside of Zagreb should be established.
Collapse
Affiliation(s)
- Luka Šimunović
- Department of Orthodontics, School of Dental Medicine Zagreb, University of Zagreb, Zagreb, Croatia
| | - Bruno Špiljak
- School of Dental Medicine Zagreb, University of Zagreb, Zagreb, Croatia
| | - Lara Vranić
- Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | | |
Collapse
|
4
|
Gurzhiy OV, Kolomiiets SV, Kulay OO. INJURY OF TEMPORARY AND PERMANENT TEETH IN CHILDREN: THERAPUTIC APPROACH. BULLETIN OF PROBLEMS BIOLOGY AND MEDICINE 2022. [DOI: 10.29254/2077-4214-2022-4-167-35-43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
5
|
Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, Ree M, Connert T, Widbiller M, Tjäderhane L, Dummer PMH, Galler K. Endodontic management of traumatized permanent teeth: a comprehensive review. Int Endod J 2021; 54:1221-1245. [PMID: 33683731 DOI: 10.1111/iej.13508] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
The pulp plays a key role in the treatment of traumatic dental injuries (TDIs) and is strongly associated with the outcome, particularly in severe cases. A correct pulp diagnosis is essential as it forms the basis for developing the appropriate management strategy. However, many TDIs are complex, and their treatment requires a profound knowledge of the physiological and pathological responses of the affected tissues. This comprehensive review will look at the dentine-pulp complex and its interaction with the surrounding tissues following TDIs. The literature up to 2020 was reviewed based on several searches on PubMed and the Cochrane Library using relevant terms. In addition to the recently revised guidelines of the International Association of Dental Traumatology, this article aims to provide background information with a focus on endodontic aspects and to gather evidence on which a clinician can make decisions on the choice of the appropriate endodontic approach for traumatized permanent teeth.
Collapse
Affiliation(s)
- G Krastl
- Department of Conservative Dentistry and Periodontology, Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | - R Weiger
- Department of Periodontology, Endodontology and Cardiology, University School of Dental Medicine, Basel, Switzerland.,Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland
| | - A Filippi
- Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland.,Department of Oral Surgery, University School of Dental Medicine, Basel, Switzerland
| | - H Van Waes
- Department of Paediatric Dentistry, Clinic for Orthodontics and Paediatric Dentistry, University of Zürich, Zürich, Switzerland
| | - K Ebeleseder
- University Clinic of Dental Medicine and Oral Health, Medical University Graz, Graz, Austria
| | - M Ree
- Private Practice, Purmerend, Netherlands
| | - T Connert
- Department of Periodontology, Endodontology and Cardiology, University School of Dental Medicine, Basel, Switzerland.,Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland
| | - M Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - L Tjäderhane
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Research Unit of Oral Health Sciences, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital, University of Oulu, Oulu, Finland
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - K Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
6
|
Tewari N, Mathur VP, Kaur A, Sardana D, Rahul M, Tamchos R, Ritwik P, Goel S, Schiavo J. Evidence mapping and quality assessment of systematic reviews in dental traumatology. Dent Traumatol 2020; 37:17-36. [PMID: 32949064 DOI: 10.1111/edt.12606] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS Evidence mapping of systematic reviews (SRs) systematically and comprehensively identifies, organizes, and summarizes the distribution of scientific evidence in a field. The aims of this study were to delineate domains in dental traumatology (DT), evaluate the existing SRs within the domains, and identify the paucity of evidence for future research. METHODS Domains and sub-domains of DT were established according to the methods of qualitative research. The protocol for evidence mapping was prepared as per the guidelines of GEM and PRISMA. The search strategy was formulated using words and MeSH terms in eight databases without restriction of languages and year of publication. Gray literature, protocol registries, and references of selected articles were also searched. Duplicates were removed, and the final selection of SRs was completed. Data extraction and quality analysis using the ROBIS tool and the PRISMA checklist were performed. RESULTS The overall search resulted in 64 SRs from 1999 to 2020 with 44 published in last six years. The highest number of SRs had been performed in the Prognostic domain (n = 19) followed by the domains of Epidemiology (n = 15), Therapeutics (n = 10), Oral Biology (n = 7), Diagnostics (n = 6), Preventive (n = 5), and Research Methods (n = 2). Within each domain, there were variabilities in the number of reviewers, a priori protocols, search limitations, risk of bias methods, and meta-analysis. Of the SRs, including 4 Cochrane reviews, 28.4% were inconclusive. A low risk of bias was found in 48.4% of the SRs. Among the registered and ongoing SRs, six were from the domain of epidemiology, two in the domain of therapeutics, five from prognostics, and one each in the domains of prevention and research methods. CONCLUSION The SRs in DT could be mapped in seven domains with variabilities in the methods. The majority had an a priori registered protocol and a low risk of reporting errors. Within the Epidemiology and Preventive domains, SRs were present in all the sub-domains with the majority demonstrating low-risk of bias (ROB). The domain of prognosis had SRs in most sub-domains but with a high ROB. Insufficient numbers of SRs were present in most sub-domains of the Diagnostics, Therapeutics, Research Methods and Oral Biology domains.
Collapse
Affiliation(s)
- Nitesh Tewari
- Pedodontics & Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Prakash Mathur
- Pedodontics & Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Amandeep Kaur
- Conservative Dentistry and Endodontics, Regional Institute of Medical Sciences, Imphal, India
| | - Divesh Sardana
- Department of Pediatric Dentistry, The University of Hong Kong, Hong Kong, China
| | - Morankar Rahul
- Pedodontics & Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Rigzen Tamchos
- Pedodontics & Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanshi Ritwik
- Department of Pediatric Dentistry, Health Sciences Centre at Houston, The University of Texas, Austin, TX, USA
| | - Shubhi Goel
- Pedodontics & Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Julie Schiavo
- Dental Library Services, Louisiana State University Dental School, New Orleans, LA, USA
| |
Collapse
|
7
|
Darley RM, Fernandes E Silva C, Costa FDS, Xavier CB, Demarco FF. Complications and sequelae of concussion and subluxation in permanent teeth: A systematic review and meta-analysis. Dent Traumatol 2020; 36:557-567. [PMID: 32790949 DOI: 10.1111/edt.12588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND/AIM The overall prognosis for teeth that have suffered concussion and/or subluxation is not yet known. The aim of this study was to systematically review the literature to identify the incidence of sequelae or complications associated with concussion and subluxation of permanent teeth. METHODS Four databases were used as follows: PubMed, Web of Science, Scopus, and Lilacs. The search for studies was carried out up to March 31, 2019, to identify studies evaluating patients diagnosed with dental trauma classified as concussion or subluxation and reporting their respective sequelae and/or complications. No restrictions were made for gender, follow-up period, and the year of publication or language. The selection of studies and data extraction were carried out independently by two researchers. The studies were grouped according to the type of trauma. A random-effect model was applied to calculate the pooled odds ratios (OR) and their respective 95% confidence intervals for each type of trauma. RESULTS Thirteen articles were included in the systematic review, and six were included in the meta-analysis. The pooled incidence of unfavorable outcomes (any sequel or complication) in teeth with concussion was 12% by the end of 1 year of follow up (0.12; CI95% 0.00-0.26). The pooled incidence of unfavorable outcomes in teeth with subluxation was 18% (0.18; CI95 % 0.07-0.29) by the end of 1 year of follow up. CONCLUSION Concussion and subluxation showed sequelae and/or complications by the end of 1 year, including pulp necrosis. Patients who have suffered mild supportive tissue injuries should be monitored.
Collapse
Affiliation(s)
| | | | - Francine Dos Santos Costa
- Center for Biological and Health Sciences, University of Vale do Taquari - Univates, Lajeado, Brazil
| | | | | |
Collapse
|
8
|
Cui Y, Xie J, Fu Y, Li C, Zheng L, Huang D, Zhou C, Sun J, Zhou X. Berberine mediates root remodeling in an immature tooth with apical periodontitis by regulating stem cells from apical papilla differentiation. Int J Oral Sci 2020; 12:18. [PMID: 32555173 PMCID: PMC7300019 DOI: 10.1038/s41368-020-0085-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 02/05/2023] Open
Abstract
Once pulp necrosis or apical periodontitis occurs on immature teeth, the weak root and open root apex are challenging to clinicians. Berberine (BBR) is a potential medicine for bone disorders, therefore, we proposed to apply BBR in root canals to enhance root repair in immature teeth. An in vivo model of immature teeth with apical periodontitis was established in rats, and root canals were filled with BBR, calcium hydroxide or sterilized saline for 3 weeks. The shape of the roots was analyzed by micro-computed tomography and histological staining. In vitro, BBR was introduced into stem cells from apical papilla (SCAPs). Osteogenic differentiation of stem cells from apical papilla was investigated by alkaline phosphatase activity, mineralization ability, and gene expression of osteogenic makers. The signaling pathway, which regulated the osteogenesis of SCAPs was evaluated by quantitative real time PCR, Western blot analysis, and immunofluorescence. In rats treated with BBR, more tissue was formed, with longer roots, thicker root walls, and smaller apex diameters. In addition, we found that BBR promoted SCAPs osteogenesis in a time-dependent and concentration-dependent manner. BBR induced the expression of β-catenin and enhanced β-catenin entering into the nucleus, to up-regulate more runt-related nuclear factor 2 downstream. BBR enhanced root repair in immature teeth with apical periodontitis by activating the canonical Wnt/β-catenin pathway in SCAPs.
Collapse
Affiliation(s)
- Yujia Cui
- State Key Laboratory of Oral Diseases & National Clinical Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jing Xie
- State Key Laboratory of Oral Diseases & National Clinical Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yujie Fu
- State Key Laboratory of Oral Diseases & National Clinical Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chuwen Li
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liwei Zheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Dingming Huang
- State Key Laboratory of Oral Diseases & National Clinical Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Changchun Zhou
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Jianxun Sun
- State Key Laboratory of Oral Diseases & National Clinical Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| |
Collapse
|
9
|
Sarac R, Helbig J, Dräger J, Jost-Brinkmann PG. A Comparative Study of Shock Absorption Capacities of Custom Fabricated Mouthguards using a Triangulation Sensor. MATERIALS 2019; 12:ma12213535. [PMID: 31661939 PMCID: PMC6862432 DOI: 10.3390/ma12213535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 01/22/2023]
Abstract
This in-vitro study compares the shock absorption qualities of five mouthguard designs measured with a triangulation laser sensor during small hard object collisions. The aim was to investigate the impact of different labial designs on mouthguard performance. Methods: Five different custom-fabricated ethylene vinyl acetate (EVA) types of mouthguards with varying thickness and different labial inserts (polyethylene terephthalate glycol-modified (PETG), nylon mesh, air space) were tested with a triangulation laser sensor during different energy blows, generated with a pendulum testing device. The pendulum hits were applied to the center of a pivoted tooth crown in a custom-built upper jaw model. Measurements were executed with the mouthguards on the model and with no mouthguard as a negative control. Results: Tooth deflection was reduced with all mouthguards in comparison to no mouthguard. Increasing mouthguard thickness improved the mouthguards’ shock absorption capacities. Also, adding labial inserts increased their preventive qualities in ascending order: Mouthguard with a soft insert (nylon mesh), a hard insert (PETG), air space plus a hard insert (PETG). Conclusion: Increasing EVA foil thickness of a mouthguard, increasing labial thickness, and adding labial inserts (soft, stiff and air space) improve mouthguard shock absorption capabilities during small hard object collisions, thereby improving dental trauma prevention.
Collapse
Affiliation(s)
- Rūta Sarac
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité-Universitätsmedizin, Center for Dental and Craniofacial Sciences, Aßmannshauser Straße 4-6, D-14197 Berlin, Germany.
| | - Julia Helbig
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité-Universitätsmedizin, Center for Dental and Craniofacial Sciences, Aßmannshauser Straße 4-6, D-14197 Berlin, Germany.
| | - Juliane Dräger
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité-Universitätsmedizin, Center for Dental and Craniofacial Sciences, Aßmannshauser Straße 4-6, D-14197 Berlin, Germany.
| | - Paul-Georg Jost-Brinkmann
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité-Universitätsmedizin, Center for Dental and Craniofacial Sciences, Aßmannshauser Straße 4-6, D-14197 Berlin, Germany.
| |
Collapse
|
10
|
Abstract
Teeth are vital sensory organs that contribute to our daily activities of living. Unfortunately, teeth can be lost for several reasons including trauma, caries, and periodontal disease. Although dental trauma injuries and caries are more frequently encountered in a younger population, tooth loss because of periodontal disease occurs in the older population. In the dental implant era, the trend sometimes seems to be to extract compromised teeth and replace them with dental implants. However, the long-term prognosis of teeth might not be comparable with the prognosis of dental implants. Complications, failures, and diseases such as peri-implantitis are not uncommon, and, despite popular belief, implants are not 99% successful. Other treatment options that aim to save compromised or diseased teeth such as endodontic treatment, periodontal treatment, intentional replantation, and autotransplantation should be considered on an individual basis. These treatments have competing success rates to dental implants but, more importantly, retain the natural tooth in the dentition for a longer period of time. These options are important to discuss in detail during treatment planning with patients in order to clarify any misconceptions about teeth and dental implants. In the event a tooth does have to be extracted, procedures such as decoronation and orthodontic extrusion might be useful to preserve hard and soft tissues for future dental implant placement. Regardless of the treatment modality, it is critical that strict maintenance and follow-up protocols are implemented and that treatment planning is ethically responsible and evidence based.
Collapse
|
11
|
Clark D, Levin L. In the dental implant era, why do we still bother saving teeth? Dent Traumatol 2019; 35:368-375. [DOI: 10.1111/edt.12492] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Danielle Clark
- Division of Periodontology Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
| | - Liran Levin
- Division of Periodontology Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
| |
Collapse
|
12
|
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.
Collapse
|
13
|
Abstract
The aim of the study was to review literature data on incidence and outcomes of traumatic dental injuries (TDI) in pediatric population. A systematic search was conducted using Elibray, Pubmed/Medline, Scopus databases in October 2018. Reference lists were also hand-searched to identify additional literature. The most prevalent complication of TDI is pulp necrosis (PN) which triggers inflammatory root resorption (IRR). PN and IRR are however much more specific for mature permanent teeth. In immature teeth pulp revascularization may occur even after avulsion. Pulpectomy timing is well defined for mature teeth only. It is accepted that pulp extirpation should be performed in the first 10 days after trauma. In immature teeth no criteria exist with pulp electrosensitivity having very low negative prognostic value as drop of pulp sensitivity because of trauma not necessary indicate PN. Follow-up protocol for immature teeth with various TDI would be useful for proper timing of pulpectomy and prevention of IRR.
Collapse
Affiliation(s)
- M V Korolenkova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - M S Rakhmanova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| |
Collapse
|