Replantation of an avulsed maxillary primary central incisor and management of dilaceration as a sequel on the permanent successor

Evaluation of primary teeth affected by dental trauma in patients visiting a university clinic, part 2: dental injury types, treatment strategies, and complications

OBJECTIVES

This article focuses on treatments and complications in patients presenting dental trauma in primary teeth. Treatment alternatives begin with the decision of performing a procedure under clinical settings or pharmacological techniques (PC) in young children. Correct diagnosis and treatment are crucial to maximize the chances of a favorable outcome.

MATERIALS AND METHODS

The files of 320 patients aged 0-9 years who presented to the Erciyes University Faculty of Dentistry Department for dental trauma management in primary teeth were evaluated in between 2018 and 2021 for 3-year period. The following information were extracted from patients' records: injury type, affected teeth, caries condition of the teeth, treatment preferences of the dentists. Additionally postoperative complications and their management were evaluated.

RESULTS

While 63.1% of the traumatized teeth were caries-free, 35.8% of the teeth had caries. The most frequent dental injuries was simple crown fractures (42.9%), followed by complicated crown fractures (38.5%). Treatments were mostly done in clinical conditions (67.9%) and mostly patients attend regularly to follow-up visits (85.6%). Clinicians prefer more radical treatments under sedation or GA (92.4% extraction of injured tooth). Coronal discoloration was the most common complication, and 35.3% had pulp necrosis for longer term results.

CONCLUSION

Follow-up decisions made after concussion in the primary teeth might be appropriate for the patient. Examination of the complication status of primary teeth with simple crown fracture injury revealed that 59.5% of patients did not have any complications. Follow-up decisions were found to be appropriate for crowns with coloration alone.

CLINICAL RELEVANCE

All options should be considered to provide the best care for children after primary tooth trauma; this can be achieved by being informed about the treatment and its consequences, and if necessary, a positive prognosis can be achieved with an interdisciplinary approach.

Assessment of Parents’ Knowledge and Attitudes on Emergency Management of Permanent Avulsed Teeth in Western Saudi Arabia

Objective:

One of the most common dental injuries is dental avulsion. This study, conducted in the western region of Saudi Arabia, aimed to evaluate parent’s knowledge and attitudes regarding the emergency management of avulsed permanent and deciduous teeth in children.

Methods:

A cross-sectional study was conducted among 393 parents recruited from six dental clinics and hospitals in Makkah and Jeddah, Saudi Arabia. The data were collected with a self-administered questionnaire that assesses the level of knowledge for managing deciduous and permanent avulsed teeth.

Results:

The total score for correct answers about managing permanent avulsed teeth had a mean of 4.77 and a standard deviation of 2.14 (out of 10 questions). With a permanent avulsed tooth, 35.37% were aware of dental reimplanting, 27.7% identified milk as an appropriate medium, and 57.5% would seek professional help immediately after dental trauma. Females and participants with a bachelor’s or higher degree had significantly higher levels of knowledge than males and participants with a high school or lower education. There were 28.5% of respondents who had a previous history of dental trauma for a child. A total of 62.1% knew that there is a difference in managing deciduous versus permanent teeth, but only 40.7% knew the proper management for deciduous avulsed teeth. Previous history of child dental avulsion was not found to be associated with more knowledge on managing avulsed deciduous or permanent teeth.

Conclusion:

Parents in the western region of Saudi Arabia have inadequate levels of knowledge to manage deciduous and permanent tooth avulsion. More efforts should be applied for conducting promotional health campaigns aimed at improving parents’ knowledge.

Interdisciplinary management of an impacted dilacerated maxillary central incisor

INTRODUCTION

Tooth dilacerations are dental anomalies characterized by an abrupt deviation in the longitudinal axis of a tooth. They may occur either in the crown, between the crown and root, or in the root. Although not so common, impacted maxillary incisors exhibiting root dilaceration pose a diagnostic and treatment challenge to the clinician.

DESCRIPTION

This case report describes the management of a horizontally impacted and dilacerated maxillary central incisor in a 12-year-old girl. Cone-beam computed tomographic scans were used to accurately localize the position of the dilacerated tooth, and to assess the extent of root formation and degree of dilaceration present in the root. Treatment included surgical exposure and orthodontic traction, followed by root canal treatment and apicoectomy.

RESULTS

Through a meticulously planned interdisciplinary approach, the impacted dilacerated central incisor was properly aligned and demonstrated good stability after the long-term follow-up.

CONCLUSION

Taking into consideration the concerns and expectations of the patient, communicative feedback between the oral surgeon, orthodontist and endodontist helped achieving successful esthetic, structural and functional outcome in the present case.

Knowledge and Attitude of Parents towards Avulsed Permanent Tooth of their Children and its Emergency Management in Bhopal City

INTRODUCTION

Dental avulsion is a commonly reported traumatic injury causing pain, aesthetic, functional, psychological and mental impairment. Since parents are in the immediate vicinity of children in such situations, their knowledge regarding the same is of great importance.

AIM

The aim of present study was to assess the level of parental knowledge and their attitude towards dental avulsion and its emergency management.

MATERIALS AND METHODS

A 10-stemmed questionnaire was prepared for this study which was modified form of questionnaire used by Raphael and Gregory. The questionnaire consisted of two parts and was provided in both English and Hindi languages. Parents had to mark one option provided to them in multiple choice questions, which they found to be right. A written consent according to ethical guidelines was taken by all the participants before filling up the questionnaire. The survey consisted of 550 parents who accompanied their children aged between 6 to 13 years in the Department of Pedodontics and Preventive Dentistry, Peoples Dental Academy, Bhopal, Madhya Pradesh, India. Chi- square test was applied to evaluate the associations in this study.

RESULTS

Statistically it was observed that 34.5% of male participants exhibited more knowledge regarding the necessity of reimplantation of avulsed tooth in comparison to female participants. Also parents with higher educational background have showed positive response toward knowledge and attitude of emergency treatment of avulsed permanent tooth. About 25.6% of higher secondary level, 20.9% of undergraduate level, 10.9% of elementary school level and 0.4% of illiterate participants responded that reimplantation of avulsed permanent tooth is possible.

CONCLUSION

It was concluded from the study that regardless of the age, education level or other factors, parental knowledge of tooth avulsion management was found to be very low in our society. Parents who participated in this study reported having insufficient knowledge about dental trauma and unskilled to provide emergency care to their child.

Diagnostic imaging: Morphological and eruptive disturbances in the permanent teeth

This paper reviewed the literature on newer three-dimensional imaging techniques and their applications in diagnosis and treatment planning of various dental anomalies. Developmental anomalies can occur during any of the developmental stages and are manifested clinically after the tooth is fully formed. These dental anomalies may involve a single tooth, a group of teeth, or the entire dentition. Two-dimensional diagnostic imaging, including periapical, occlusal, panoramic, or cephalometric radiographs are essential in localization and management of morphological and eruptive disorders. However, due to their inherent limitations such as insufficient precision because of unusual projection errors and lack of information about spatial relationships, these methods are considered unreliable. Thus, the use of newer image acquisition techniques that allow comprehensive three dimensional imaging and visualization of dental abnormalities is highly recommended for making a confirmatory diagnosis. The significance of accurate endodontic, surgical and orthodontic treatment planning in dental abnormalities cannot be overstated as it pertains to critical anatomic landmarks such as proximity to adjacent teeth or the mandibular canal. The precise information on spatial relationships provided by multiplanar imaging helps the dental surgeon to establish more accurate diagnosis, management strategies and also increases the patient safety. This review highlights the use of high-end diagnostic imaging modalities in diagnosis of the various morphologic and eruptive dental abnormalities.

Replantation of avulsed primary teeth: a systematic review

BACKGROUND

There is little evidence regarding the risks and benefits of replantation of avulsed primary teeth.

AIM

The aim of this study was to perform a systematic review of the literature on the replantation of avulsed primary teeth, analysing the risks and benefits to help guide dentists regarding the best clinical decision-making in such cases.

DESIGN

The Medline/Pubmed, LILACS, and SciELO databases were searched for articles published in English, Portuguese, German or Spanish on the replantation of avulsed primary teeth in dental journals dating from the inception of the databases through to May 2013.

RESULTS

Among the 891 papers identified in the search, nineteen fulfilled the inclusion criteria. All 19 studies were case reports involving a total of 41 replanted primary teeth. No negative consequences to either the primary tooth or permanent successor were observed in 15 cases. Among the other 26 cases, there were negative consequences to only the replanted primary tooth in 16 cases, only the permanent successor in three cases and both the replanted primary tooth and permanent successor in seven cases.

CONCLUSION

There is a lack of high-quality studies that can help guide clinicians regarding the best approach in cases of primary tooth avulsion.

Management of a permanent tooth after trauma to deciduous predecessor: an evaluation by cone-beam computed tomography

Impaction of permanent teeth represents a clinical challenge with regard to diagnosis, treatment plan, and prognosis. There is a close relationship between deciduous teeth and permanent teeth germ, and any injury in the deciduous dentition may influence the permanent teeth eruption. The extent of the damage caused to the permanent teeth germ depends on the patient age at the time of injury, type of trauma, severity, and direction of the impact. Conventional radiographic images are frequently used for diagnosis; however, recent developments in three-dimensional (3D) imaging systems have enabled dentistry to visualize structural changes effectively, with better contrast and more details, close to the reality. The cone-beam computed tomography (CBCT) has been used in the diagnosis and treatment plan of these impacted teeth. The purpose of the present case report is to describe a successful conservative management of a retained permanent maxillary lateral incisor with delayed root development after a trauma through the deciduous predecessor in a 9 year-old patient. After clinical and radiographic examination, a CBCT examination of the maxilla was requested to complement the diagnosis, providing an accurate 3D position of the retained tooth and its relationship to adjacent structures. The proposed treatment plan was the surgical exposure and orthodontic traction of the retained tooth. The lateral incisor spontaneously erupted after 6 months. Therefore, this case report suggests that permanent teeth with incomplete root formation have a great potential for spontaneous eruption because no tooth malposition or mechanical obstacles are observed.

Comprehensive and sequential management of an impacted maxillary central incisor with severe crown-root dilacerations

Tooth dilaceration refers to a dental anomaly characterized by an abrupt deviation in the longitudinal axis of tooth. Crown-root dilaceration is diagnosed in teeth with sharp angles at the cement-enamel junction. The greater the bending degree is, the less chance there is for successful teeth preservation and relocation. In this report, a clinical case of an impacted maxillary central incisor with severe crown-root dilacerations was described by means of an operative evaluation using three-dimensional dental computed tomography and a multidisciplinary approach that included surgical, orthodontic, endodontic, prosthetic and periodontal therapy.