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Sheikhnezami M, Shahmohammadi R, Jafarzadeh H, Azarpazhooh A. Long-Term Outcome of Horizontal Root Fractures in Permanent Teeth: A Retrospective Cohort Study. J Endod 2024; 50:579-589. [PMID: 38354906 DOI: 10.1016/j.joen.2024.02.002] [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: 12/13/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Horizontal root fracture (HRF) is a complex traumatic dental injury that affects the pulp, dentin, cementum, and periodontal ligament. This retrospective cohort study evaluated treatment outcomes in permanent teeth with HRF. METHODS We analyzed clinical and radiographic data from a dental trauma center (2006-2022). Permanent teeth with HRF with a follow up of ≥12 weeks were considered for outcome assessment (defined as clinical normalcy and radiographic healing at the fracture line). Prognostic factors were identified through multivariable logistic regression analyses (P value ≤ .05). RESULTS 125 teeth from 103 patients were included. After a median follow-up of 79 weeks, the overall favorable outcome was 92%. This includes teeth that received emergency splinting/repositioning at baseline (62.2%) and those that received subsequent endodontic intervention for the coronal fragment (baseline: 85%; subsequent follow-ups: 91.8%). Being male and incomplete root development were both significantly associated with a better outcome of splinting/repositioning (OR = 2.58; 95% CI, 1.06-6.24 and OR = 4.37; 95% CI, 1.16-16.41, respectively) and a reduced likelihood of requiring endodontic treatment (OR = 0.44; 95% CI, 0.20-0.96 and OR = 0.24; 95% CI, 0.08-0.76, respectively). Treatment delays surpassing one week were significantly associated with an increased likelihood of requiring endodontic treatment compared to timely presentations within 24 hours (OR = 3.06; 95% CI, 1.07-8.77; P value < .05). CONCLUSION With timely diagnosis and treatment, and close monitoring, HRF cases can achieve a 92% favorable outcome. Male sex and incomplete root development correlate with improved baseline outcomes and a reduced need for endodontic treatment. Conversely, delayed presentation increases the likelihood of requiring endodontic intervention.
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Affiliation(s)
- Mahshid Sheikhnezami
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Dental Trauma Center, Iranian Academic Center for Education, Culture, and Research, Mashhad, Iran
| | - Reza Shahmohammadi
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Hamid Jafarzadeh
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Dental Trauma Center, Iranian Academic Center for Education, Culture, and Research, Mashhad, Iran
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Clinical Epidemiology and Health Care Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada.
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2
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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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3
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Krastl G, Weiger R, Ebeleseder K, Galler K. Present status and future directions: Endodontic management of traumatic injuries to permanent teeth. Int Endod J 2021; 55 Suppl 4:1003-1019. [PMID: 34862800 DOI: 10.1111/iej.13672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/02/2021] [Indexed: 12/26/2022]
Abstract
The prognosis of traumatized teeth depends largely on the fate of the pulp and its treatment. This review aims to update the present status on the endodontic management of traumatic injuries to permanent teeth and to identify relevant research areas that could contribute to an improvement in diagnosis and treatment of traumatized permanent teeth. Future research should pay greater attention to (1) diagnostic methods to assess the perfusion of the pulp and enhance detection of tooth cracks and initial signs of root resorption; (2) improved materials for vital pulp treatment; (3) studies focusing on type and duration of splinting after root fractures; (4) antiresorptive intracanal medication in case of posttraumatic pulp necrosis and infection-related resorption and (5) long-term data on the apical barrier technique compared to revitalization.
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Affiliation(s)
- Gabriel Krastl
- Department of Conservative Dentistry and Periodontology, Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, Center of Dental Traumatology, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland
| | - Kurt Ebeleseder
- University Clinic of Dental Medicine and Oral Health, Medical University Graz, Graz, Austria
| | - Kerstin Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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4
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Sadeghi SM, Moradi S, Soltani S. Management of Inflammatory Root Resorption of Maxillary Central Incisors following Traumatic Avulsion. Case Rep Dent 2021; 2021:6309711. [PMID: 36097633 PMCID: PMC8492246 DOI: 10.1155/2021/6309711] [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: 05/02/2021] [Accepted: 09/06/2021] [Indexed: 12/01/2022] Open
Abstract
Background Avulsion is among the most severe types of dental trauma, which often occurs at young ages and can compromise the long-term prognosis of the traumatized tooth. Case Report. Herein, we report replantation of two avulsed teeth. Our patient was an 11-year-old boy with two avulsed maxillary central incisors due to a bicycle fall 2 months earlier. The patient was referred to us after rigid splinting of his teeth by a surgeon. Long-term calcium hydroxide (CH) therapy was performed for the patient, and after healing of periodontal ligament (PDL), apexification was performed for both teeth followed by root canal therapy. During the 2-year follow-up, both teeth were functional and had no radiographic or clinical evidence of resorption or ankylosis. Conclusion The reported case highlights the favorably high tissue healing potential following severe dental trauma, given that appropriate treatment is performed. Correct endodontic management can guarantee the long-term prognosis of teeth following severe dental trauma.
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Affiliation(s)
- Seyed Mohsen Sadeghi
- School of Dentistry, Department of Endodontics, Qom University of Medical Sciences, Qom, Iran
| | - Samaneh Moradi
- School of Dentistry, Department of Endodontics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samaneh Soltani
- School of Dentistry, Department of Periodontology, Qom University of Medical Sciences, Qom, Iran
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5
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Özler CÖ, Cehreli ZC. Conservative management of a cervical horizontal root fracture by long-term stabilisation: A case report. AUST ENDOD J 2021; 48:338-341. [PMID: 34322945 DOI: 10.1111/aej.12551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
Cervical root fractures are often more difficult to manage than fractures of the apical and middle third of the root, due to the weak chance of healing with dental hard tissue between fragments, and the likelihood of subsequent infection of the root canal system. This case report describes the management of a cervical horizontal root fracture by repositioning the coronal fragment of a maxillary central incisor, and long-term splinting using a bonded lingual orthodontic retainer wire. Throughout the 7-year stabilisation period with clinical and radiographic follow-up, the tooth has remained asymptomatic with radiographic evidence of progressive pulp canal obliteration. In applicable cases, long-term stabilisation of the fractured coronal fragment with a fixed orthodontic retainer may offer a minimally invasive solution to maintain pulp vitality, function and aesthetics until cessation of growth or until a more comprehensive, multidisciplinary approach is required.
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Affiliation(s)
- Cansu Özşin Özler
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Zafer C Cehreli
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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6
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Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, Ree M, Connert T, Widbiller M, Tjäderhane L, Dummer PMH, Galler K. European Society of Endodontology position statement: endodontic management of traumatized permanent teeth. Int Endod J 2021; 54:1473-1481. [PMID: 33934366 DOI: 10.1111/iej.13543] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023]
Abstract
This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on the endodontic management of traumatized permanent teeth. A recent comprehensive review with detailed background information provides the basis for this position statement (Krastl et al. 2021, International Endodontic Journal, https://doi.org/10.1111/iej.13508). The statement is based on current scientific evidence as well as the expertise of the committee. Complementing the recently revised guidelines of the International Association of Dental Traumatology, this position statement aims to provide clinical guidance for the choice of the appropriate endodontic approach for traumatized permanent teeth. Given the dynamic nature of research in this area, this position statement will be updated at appropriate intervals.
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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 Cariology, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland.,Center of Dental Traumatology, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland
| | - A Filippi
- Center of Dental Traumatology, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland.,Department of Oral Surgery, University Center for Dental Medicine UZB, University of Basel, 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 Cariology, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland.,Center of Dental Traumatology, University Center for Dental Medicine UZB, University of Basel, 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 and University of Oulu, Oulu, Finland
| | - P M H Dummer
- School of Dentistry, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - K Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
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7
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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.
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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
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8
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Ong TK, Lim GS, Singh M, Fial AV. Quantitative Assessment of Root Development after Regenerative Endodontic Therapy: A Systematic Review and Meta-Analysis. J Endod 2020; 46:1856-1866.e2. [DOI: 10.1016/j.joen.2020.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022]
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9
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Tzanetakis GN, Tzimpoulas N, Markou M, Papanakou SI, Gizani S, Georgopoulou M. Evaluating the knowledge level, attitudes, and therapeutic approaches of Greek dentists for traumatic dental injuries. Dent Traumatol 2020; 37:177-187. [PMID: 33179334 DOI: 10.1111/edt.12623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND/AIM Greek dentists are facing a new era of a globally continuous effort to improve the first-aid management and long-term treatment outcome of traumatic dental injuries (TDI). In Greece, where the basic and clinical research in the field of dental trauma has been limited until recently, assessing the attitudes and therapeutic strategies of Greek dentists for dental trauma is of great importance. The aim of this study was to evaluate the knowledge attitudes and therapeutic approaches of Greek dentists in different clinical scenarios of TDI. MATERIALS AND METHODS A cross-sectional study was conducted among 448 dentists. A questionnaire-based survey of demographic characteristics, attitudes, and a scenario-based knowledge test, of TDI, which was used to formulate a "Dental Trauma Knowledge Score" with a 0-8 score range, was administered. Mann-Whitney U tests (for two categories variables) and Kruskal-Wallis tests (for more than two categories variables) were performed. RESULTS The median knowledge score was 5.0 (IQR: 4-7), a level considered as "Acceptable." Knowledge scores were found to significantly differ by age group, with the younger dentists presenting the highest scores. Dentists with a self-evaluation as "Acceptable" had significantly higher scores. Most of the dentists would refer for CBCT in severe trauma cases. A significant association was found between younger ages and on awareness of the mobile application ToothSOS. Female dentists had significantly higher scores compared to males when asked about avulsion management. CONCLUSION An acceptable level of knowledge on TDI management was revealed among dentists in Greece. Higher knowledge scores were observed among younger dentists.
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Affiliation(s)
- Giorgos N Tzanetakis
- Department of Endodontics, School of Dentistry, University of Athens, Athens, Greece
| | | | | | - Styliani I Papanakou
- Department of Paediatric Dentistry, School of Dentistry, University of Athens, Athens, Greece
| | - Sotiria Gizani
- Department of Paediatric Dentistry, School of Dentistry, University of Athens, Athens, Greece
| | - Maria Georgopoulou
- Department of Endodontics, School of Dentistry, University of Athens, Athens, Greece
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10
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Abstract
Abstract
Background
Endodontic disease can adversely affect the quality of life and therefore early diagnosis and consequent timely treatment is of paramount importance for the Endodontist. Radiology is an essential component in treatment planning, disease monitoring and assessment of treatment outcome. Periapical radiographs and panoramic radiography are frequently utilised but they provide only two-dimensional representation of three-dimensional structures. The advent of cone beam computed tomography (CBCT) offers three-dimensional accuracy of the hard tissue images with a reasonable cost and this has revolutionised imaging of the dentomaxillofacial structures. This imaging system has been seen to overcome some limitations of conventional radiography, as brought out in this review. The improvement in the accuracy is, however, accompanied at the cost of increased radiation exposure to the patient. Nevertheless, smaller areas of exposure are normally appropriate for endodontic imaging, and adjustment in the exposure parameters can further moderate the effective dose (Loubele et al. 37(6):309-18, 2008).
Aims and objectives
The aim of this review is to present the pertinent literature on the various applications of cone beam computed tomography in the field of endodontics.
Methods
Literature was electronically searched on the following sources; Medline and Keats Library. Further, a manual search was performed on the following journals: International Endodontic Journal, Journal of Endodontics, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, Endodontology, Journal of Dental Research, European Journal of Oral Sciences & Odontology and Dentomaxillofacial Radiology. A preliminary search was performed to gain an idea of the available literature using keywords ‘Cone Beam Computed Tomography’ to view the volume of the literature evident and identify questions to be addressed in this review. The initial search showed 243 potential articles. After scrutinising the titles and abstracts of the retrieved articles, 70 relevant studies were reviewed in full text. Furthermore, ‘published guidelines on the use of CBCT’ were also searched so as to include the results as an additional source material. All the articles eligible to be included in the review were in the English language and ranged from the year 1960 to the present. Also all the studies reviewed were based on the various uses of cone beam computed tomography in the field of endodontics. The keywords used to search were ‘Cone Beam Computed Tomography (CBCT)’, ‘Conventional radiography’, ‘Applications of CBCT in endodontics’, ‘CBCT and tooth morphology’, ‘CBCT and apical periodontitis’, ‘CBCT and vertical root fractures’, ‘CBCT and resorption’, ‘CBCT and pre-surgical assessment’, ‘CBCT and dento-alveolar trauma’ and ‘CBCT and endodontic outcome’.
Results
Every case is unique and CBCT should be considered only after studying each case individually. CBCT imaging needs to be adopted or used where information from conventional imaging systems is either inadequate for the management of endodontic problems or inconclusive. Having said that, it is safe to state that CBCT imaging has the potential to become the first choice for endodontic treatment planning and outcome assessment, especially when new scanners with lower radiation doses and enhanced resolution would be available.
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11
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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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12
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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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13
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Soares Ditzel A, Tulio Manfron AP, Westphalen FH, da Silva Neto UX, Kowalczuck A, Carneiro E, Ditzel Westphalen VP. Management of Multiple Dental Trauma: Case Report with Eight-Year Follow-up. IRANIAN ENDODONTIC JOURNAL 2018; 13:410-412. [PMID: 30083217 PMCID: PMC6064017 DOI: 10.22037/iej.v13i3.21090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
This case report documents the clinical approach adopted for two maxillary incisors with intrusion and horizontal root fracture in the middle third after trauma. The proposed procedures involved maintaining pulp vitality and periodontal stability of the fractured teeth with 8 years of follow-up.
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Affiliation(s)
- Alessandra Soares Ditzel
- Department of Oral Radiology, School of Life Sciences, Pontifícia Universidade Católica do Paraná. Curitiba, Paraná, Brazil
| | | | | | - Ulisses Xavier da Silva Neto
- Department of Endodontics, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Alexandre Kowalczuck
- Department of Endodontics, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Everdan Carneiro
- Department of Endodontics, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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14
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Diogenes A, Hargreaves KM. Microbial Modulation of Stem Cells and Future Directions in Regenerative Endodontics. J Endod 2018; 43:S95-S101. [PMID: 28844309 DOI: 10.1016/j.joen.2017.07.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Regenerative endodontic procedures (REPs) have been shown to promote the resolution of signs and symptoms of disease and increase survival compared with traditional treatment procedures. However, there is still variable predictability of continued root development and evidence that the tissues formed do not recapitulate the native pulp-dentin complex. There is growing evidence that the apical papilla is capable of surviving prolonged endodontic infection and apical periodontitis and that it represents a rich source of undifferentiated mesenchymal stem cells in REPs. The survival and proper differentiation of stem cells transferred into infected root canals are fraught with challenges. Residual antigens, such as lipopolysaccharides, have been shown to be present in dentin even after adequate chemomechanical debridement. These antigens have a profound effect on stem cell fate by modulating their proliferative capacity and postdifferentiation phenotype. Thus, root canals must be detoxified in addition to disinfection. There is a strong need for translational studies that incorporate all aspects of tissue engineering in endodontics in models that include an existing infection to promote further advancement of the field. This is particularly important to make REPs more predictable when treating immature teeth in young patients. Importantly, regenerative procedures could eventually promote tooth longevity in our aging population. Lessons learned from translational studies that best mimic the clinical challenges could be evaluated in pragmatic clinical trials to determine the effectiveness of these procedures to promote desirable patient-centered outcomes.
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Affiliation(s)
- Anibal Diogenes
- Department of Endodontics at University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Kenneth M Hargreaves
- Department of Endodontics at University of Texas Health Science Center at San Antonio, San Antonio, Texas
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15
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Ataol E, Erbaş Ünverdi G, Güngör HC. Management of cervical root fracture injury in a patient with epilepsy: Case report with 5-year follow-up. SPECIAL CARE IN DENTISTRY 2018; 38:319-323. [PMID: 29971831 DOI: 10.1111/scd.12304] [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: 03/23/2018] [Revised: 05/30/2018] [Accepted: 06/13/2018] [Indexed: 11/30/2022]
Abstract
The difficulty in providing stability to the coronal segment makes cervical root fracture one of the most challenging dental traumatic injury. This type of injury is less frequent in children. However, due to their serious consequences and poor prognosis, tooth loss may occur. This report presents the management of a case of cervical root fracture in an 11-year-old patient with epilepsy. The stabilization of the root-fractured tooth with a splint failed due to the recurrent seizures the patient had. Coronal fragment was removed and vital root submergence was performed in order to support the alveolar growth. The natural tooth crown was incorporated into a modified Nance appliance to meet the esthetic and functional requirements of the patient. After 5-year follow-up, this treatment approach has seemed to offer a long-term provisional and satisfactory solution to the consequences of a cervical root fracture injury.
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Affiliation(s)
| | - Gizem Erbaş Ünverdi
- Faculty of Dentistry, Department of Pediatric Dentistry, Hacettepe University, Ankara, Turkey
| | - Hamdi Cem Güngör
- Faculty of Dentistry, Department of Pediatric Dentistry, Hacettepe University, Ankara, Turkey
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16
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Westphalen VPD, Carneiro E, Fariniuk LF, da Silva Neto UX, Westphalen FH, Kowalczuck A. Maintenance of Pulp after Horizontal Root Fractures in Three Maxillary Incisors: A Thirteen-Year Evaluation. IRANIAN ENDODONTIC JOURNAL 2017; 12:508-511. [PMID: 29225650 PMCID: PMC5722107 DOI: 10.22037/iej.v12i4.16617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This case report documents the clinical approach adopted for three upper incisors with horizontal root fracture in the middle or cervical third. The proposed procedures involved maintaining pulp vitality and periodontal stability of the fractured teeth with 13 years of follow-up.
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Affiliation(s)
- Vânia Portela Ditzel Westphalen
- Department of Endodontics, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Everdan Carneiro
- Department of Endodontics, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Luiz Fernando Fariniuk
- Department of Endodontics, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Ulisses Xavier da Silva Neto
- Department of Endodontics, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Fernando Henrique Westphalen
- Department of Oral Radiology, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná and Department of Stomatology, School of Dentistry, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Alexandre Kowalczuck
- Department of Endodontics, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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17
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A five-year follow-up of a root fracture in a ten-year-old boy. Int Orthod 2017; 15:728-739. [DOI: 10.1016/j.ortho.2017.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Wagner D, Offner D, Musset AM. Présentation d’un cas âgé de 10 ans souffrant d’une fracture radiculaire, le suivi sur 5 ans. Int Orthod 2017; 15:728-739. [DOI: 10.1016/j.ortho.2017.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Clinical management of horizontal root fractures aided by the use of cone-beam computed tomography. GIORNALE ITALIANO DI ENDODONZIA 2017. [DOI: 10.1016/j.gien.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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Differences in Healing of a Horizontal Root Fracture as Seen on Conventional Periapical Radiography and Cone-Beam Computed Tomography. Case Rep Dent 2017; 2017:2728964. [PMID: 28744379 PMCID: PMC5514331 DOI: 10.1155/2017/2728964] [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: 03/11/2017] [Accepted: 06/04/2017] [Indexed: 11/25/2022] Open
Abstract
Different locations and healing patterns of horizontal root fractures bear different prognoses. Conventional periapical radiographs have been routinely used for the evaluation of the locations and healing of horizontal root fractures, with the limitation of presenting two-dimensional images. The three-dimensional imaging technology, cone-beam computed tomography (CBCT), has recently gained interest in dental traumatology, in particular for locating and diagnosing root fractures. However, the assessment of healing patterns of horizontal root fracture using CBCT compared to conventional radiographs has not been established. This case report describes the different healing patterns evaluated by two-dimensional radiographs and CBCT of a horizontally root-fractured maxillary right central incisor treated with mineral trioxide aggregate (MTA) with a two-year follow-up. The findings suggest that the healing patterns of horizontal root fractures seen on conventional radiographs and CBCT may be different.
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21
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Stojanac IL, Bajkin BV, Premovic MT, Ramic BD, Petrovic LM. Multidisciplinary Treatment of Complicated Crown-Root Fractures: A Case Study. Oper Dent 2016; 41:e168-e173. [PMID: 27820690 DOI: 10.2341/15-080-t] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Traumatic dental injuries usually occur among children and adolescents, with maxillary central incisors as the most often affected teeth. Complicated crown-root fractures are particularly challenging for esthetic and functional rehabilitation and often require a multidisciplinary approach. A 21-year-old male patient came to the Dental Clinic due to fractured maxillary incisors caused by trauma during a sporting activity. Clinical examination revealed horizontal fractures of teeth 7, 8, and 9, initiating in the labial cervical third and extending subgingivally on the palate, with exposed pulp tissues. On provisional repositioning and splinting the fragments, root canal treatment was performed. Definitive repositioning was accomplished by raising a full-thickness gingival flap, using fiber-reinforced composite posts, by an endodontist and an oral surgeon. Reattachment was accomplished under surgical conditions to ensure precise positioning of fragments by exposing the palatal aspect of the fracture lines and providing a dry operating field. Definitive composite resin veneers were performed after seven days.
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Affiliation(s)
- IL Stojanac
- Igor Lj Stojanac, DDS, PhD, assistant professor, Faculty of Medicine, University of Novi Sad, Clinic of Dentistry, Novi Sad, Serbia
| | - BV Bajkin
- Branislav V Bajkin, DDS, PhD, assistant professor, Faculty of Medicine, University of Novi Sad, Clinic of Dentistry, Novi Sad, Serbia
| | - MT Premovic
- Milica T Premovic, DDS, PhD student, Faculty of Medicine, University of Novi Sad, Clinic of Dentistry, Novi Sad, Serbia
| | - BD Ramic
- Bojana D Ramic, DDS, PhD student, Faculty of Medicine, University of Novi Sad, Clinic of Dentistry, Novi Sad, Serbia
| | - LM Petrovic
- Ljubomir M Petrovic, DDS, PhD, full professor, Faculty of Medicine, University of Novi Sad, Clinic of Dentistry, Novi Sad, Serbia
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22
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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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23
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Tsai YL, Liao WC, Wang CY, Chang MC, Chang SH, Chang SF, Chang CW, Huang YD, Chan CP, Jeng JH. Horizontal root fractures in posterior teeth without dental trauma: tooth/root distribution and clinical characteristics. Int Endod J 2016; 50:830-835. [PMID: 27677655 DOI: 10.1111/iej.12704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 09/23/2016] [Indexed: 11/30/2022]
Abstract
AIM To describe the clinical characteristics and radiographic findings of horizontal root fractures (HRF) in posterior teeth without a history of dental trauma. METHODOLOGY A total 24 patients and 31 HRF cases in 28 posterior teeth were collected from 2006 to 2015. Clinical examinations and radiographic imaging were evaluated. Value of confidence intervals of the proportions was calculated for data presentation. RESULTS The number of males (54%) was similar to females (46%). The patients were predominantly between 50 and 70 years of age (75%). Most HRF cases were found in nonendodontically treated teeth (79%), without crown and bridge restorations (82%), and maxillary molars (54%). Many roots of maxillary molars had developed HRF, and the probability was nearly equal. Fractured teeth usually presented with periodontal and apical bone loss, and most patients (92%) were diagnosed with full mouth chronic periodontitis. Tooth wear was another common clinical feature amongst these patients. CONCLUSIONS HRF in posterior teeth without dental trauma occurred mainly in patients aged between 50 and 70, in nonendodontically treated teeth, teeth with attrition but without crown and bridge restorations, maxillary molars and with periodontal and periapical bony destruction. Periodontal condition, occlusal wear and patients' age at diagnosis were the possible related factors. HRF in posterior teeth without dental trauma is a diagnostic challenge and even misdiagnosed. A thorough clinical examination, radiographic analysis and recognition of the clinical characteristics are helpful in the early diagnosis and treatment of HRF.
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Affiliation(s)
- Y-L Tsai
- Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - W-C Liao
- Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - C-Y Wang
- Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - M-C Chang
- Biomedical Science Team, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - S-H Chang
- Biostatistics Laboratory, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - S-F Chang
- Department of Dentistry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - C-W Chang
- Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Y-D Huang
- Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - C-P Chan
- Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - J-H Jeng
- Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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24
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Kim D, Yue W, Yoon TC, Park SH, Kim E. Healing of Horizontal Intra-alveolar Root Fractures after Endodontic Treatment with Mineral Trioxide Aggregate. J Endod 2015; 42:230-5. [PMID: 26725177 DOI: 10.1016/j.joen.2015.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The purpose of this retrospective study was to evaluate the healing type and assess the outcome of horizontal intra-alveolar root fractures after endodontic treatment with mineral trioxide aggregate (MTA) as filling material. METHODS The clinical database of the Department of Conservative Dentistry at Yonsei University Dental Hospital, Seoul, Korea, was searched for patients with histories of intra-alveolar root fractures and endodontic treatments with MTA between October 2005 and September 2014. Radiographic healing at the fracture line was evaluated independently by 2 examiners and was classified into 4 types according to Andreasen and Hjørting-Hansen. RESULTS Of the 22 root-fractured teeth that received endodontic treatment with MTA, 19 cases participated in the follow-up after a period of at least 3 months. Seventeen of the 19 teeth (89.5%) exhibited healing of the root fractures. For each healing type, 7 teeth (36.8%) showed healing with calcified tissue, 8 teeth (42.1%) showed interposition of connective tissue, 2 teeth (10.5%) showed interposition of connective tissue and bone, and 2 teeth (10.5%) showed interposition of granulation tissue without healing. CONCLUSIONS Within the limitations of this study, intra-alveolar root fractures showed satisfactory healing outcomes after endodontic treatment with MTA. MTA could be considered to be suitable filling material for the endodontic treatment of horizontal intra-alveolar root fractures.
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Affiliation(s)
- Dohyun Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, South Korea
| | - Wonyoung Yue
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, South Korea
| | - Tai-Cheol Yoon
- Department of Conservative Dentistry and Endodontics, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Sung-Ho Park
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, South Korea
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, South Korea.
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25
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Kapoor S, Bansal P, Chandran S, Agrawal V. Surgical Management of a Non-healing Intra-alveolar Root Fracture Associated with Pulpal Calcification and Root Resorption: A Case Report. J Clin Diagn Res 2015; 9:ZD03-5. [PMID: 26266223 DOI: 10.7860/jcdr/2015/12829.6046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/25/2015] [Indexed: 11/24/2022]
Abstract
Radicular fractures are very challenging to address due to various complications like periodontal communication, increased mobility, and continued pulpal infection leading to necrosis and its long term sequelae like root resorption and pulp canal obliteration. This paper present a case of a long standing horizontal mid root fracture with root resorption and pulp canal obliteration, which was preserved functionally and aesthetically by surgical approach using MTA (mineral trioxide aggregate) and PRF (platelet rich fibrin).
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Affiliation(s)
- Sonali Kapoor
- Professor and Head, Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College , Vadodara, Gujarat, India
| | - Parul Bansal
- Reader, Department of Conservative Dentistry and Endodontics, Subharti Dental College , Meerut., Uttar Pradesh, India
| | - Sarath Chandran
- Professor and Head, Department of Periodontics, Manubhai Patel Dental College , Vadodara, Gujarat, India
| | - Vineet Agrawal
- Reader, Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College and Hospital , Vadodara, Gujarat, India
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26
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Skaare AB, Pawlowski AA, Maseng Aas AL, Espelid I. Dentists’ self-estimation of their competence to treat avulsion and root fracture injuries. Dent Traumatol 2015; 31:368-73. [DOI: 10.1111/edt.12186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Anne B Skaare
- Department of Paediatric Dentistry and Behavioural Science; Institute of Clinical Dentistry; University of Oslo; Oslo Norway
| | - Andrzej Adam Pawlowski
- Department of Paediatric Dentistry and Behavioural Science; Institute of Clinical Dentistry; University of Oslo; Oslo Norway
- Public Dental Health Service; Rogaland Norway
| | - Anne-Lise Maseng Aas
- Department of Paediatric Dentistry and Behavioural Science; Institute of Clinical Dentistry; University of Oslo; Oslo Norway
| | - Ivar Espelid
- Department of Paediatric Dentistry and Behavioural Science; Institute of Clinical Dentistry; University of Oslo; Oslo Norway
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27
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Wolff J, Sándor GK, Forouzanfar T, Schulten EAJM, Oikarinen KS. A 22-year follow-up of an endodontic implant. Dent Traumatol 2015; 31:409-12. [PMID: 25865147 DOI: 10.1111/edt.12174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2015] [Indexed: 11/28/2022]
Abstract
Root fractures in the middle and apical thirds of the root are treated by repositioning and for approximately 6 weeks of immobilization while those in the cervical third are immobilized for 3 months. Even though the results are good, some root-fractured teeth are lost and replaced by dental implants or fixed partial dentures. One historic but effective treatment option for those root fractures with unfavorable crown to root ratios is an endodontic implant in middle and apical third root fractures. This method offers immediate stable fixation of a crown and its coronal root segment to the underlying alveolar bone. This report documents the long-term survival of a tooth treated with an endodontic implant. A 25-year-old male patient presented following a bicycle accident with a dislocated unfavorable root fracture in the middle third. The crown with the coronal root segment was secured to the bone using a commercially available endodontic implant. The apical part of the root was removed. Although the clinical and radiological follow-up results of the endodontic implant demonstrated a good clinical function and little bone loss, the implant ultimately had to be removed after 22 years of service due to pain and increasing mobility.
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Affiliation(s)
- Jan Wolff
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - George K Sándor
- Department of Oral and Maxillofacial Surgery, Medical Research Center, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland.,BioMediTech, Institute of Biosciences and Medical Technology, University of Tampere, Tampere, Finland
| | - Tim Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Engelbert A J M Schulten
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Kyösti S Oikarinen
- Department of Oral and Maxillofacial Surgery, Medical Research Center, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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28
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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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29
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Fagundes DDS, de Mendonça IL, de Albuquerque MTP, Inojosa IDFDAJ. Spontaneous healing responses detected by cone-beam computed tomography of horizontal root fractures: a report of two cases. Dent Traumatol 2014; 30:484-7. [PMID: 24910176 DOI: 10.1111/edt.12117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 11/28/2022]
Abstract
Horizontal root fractures (HRF) usually affect the anterior teeth as a result of trauma, and generally heal spontaneously, depending on the vitality of the pulp. Diagnosis based on clinical findings, sensitivity tests, and radiographic examination is important to determine the presence of a root fracture and to prevent a root fracture from passing unnoticed. Cone-beam computed tomography (CBCT) has been used successfully for diagnosis and prognosis imaging of root fractures and has proved to be superior to other radiographic methods. This study reports two cases of dental trauma caused by a collision and a sports accident. The patients suffered horizontal root fractures in the maxillary left central incisor and in the mandibular left central incisor. The diagnosis of root fracture was confirmed by cone-beam computed tomography (CBCT) images, which also demonstrated spontaneous healing of the fracture line. The repair occurred by interposition of connective tissue in the former case and by interposition of bone and connective tissue in the latter case. The final diagnoses of both cases were based on CBCT images, indicating the importance of a CBCT examination to reach a firm diagnosis and to follow the healing process of root fracture cases, avoiding unnecessary radical endodontic treatment.
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30
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Patel S, Durack C, Abella F, Shemesh H, Roig M, Lemberg K. Cone beam computed tomography in Endodontics - a review. Int Endod J 2014; 48:3-15. [DOI: 10.1111/iej.12270] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 02/14/2014] [Indexed: 01/27/2023]
Affiliation(s)
- S. Patel
- Department of Conservative Dentistry; King's College London Dental Institute; London & Specialist Practice, London UK
| | - C. Durack
- Riverpoint Specialist Dental Clinic; Limerick Ireland
| | - F. Abella
- Department of Restorative Dentistry and Endodontics; Section for Endodontology; Universitat Internacional de Catalunya; Barcelona Spain
| | - H. Shemesh
- Academic Center for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - M. Roig
- Department of Restorative Dentistry and Endodontics; Section for Endodontology; Universitat Internacional de Catalunya; Barcelona Spain
| | - K. Lemberg
- Institute of Dentistry and Oral Radiology; University of Helsinki; Helsinki Finland
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31
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Choi Y, Hong SO, Lee SR, Min KS, Park SJ. Healing after horizontal root fractures: 3 cases with 2-year follow-up. Restor Dent Endod 2014; 39:126-31. [PMID: 24790926 PMCID: PMC3978103 DOI: 10.5395/rde.2014.39.2.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 01/09/2014] [Indexed: 11/25/2022] Open
Abstract
Among dental traumas, horizontal root fractures are relatively uncommon injuries. Proper initial management and periodical evaluation is essential for the successful treatment of a root-fractured tooth. If pulpal necrosis develops, endodontic treatment is indicated, exclusively for the coronal fragment. Fragment diastases exert a great influence on healing at the fracture line and on pulpal necrosis. An adequately treated root-fractured tooth has a good prognosis. This case report describes the treatment and 2-yr follow up of 3 maxillary central incisors, first with horizontal root fracture, second with horizontal root fracture and avulsion, and third with horizontal root fracture and lateral luxation. All three cases were treated with mineral trioxide aggregate (ProRoot, Dentsply). During 2 yr of follow-up evaluation, the root-fractured teeth of the present patients were well retained in the arch, showing periodontal healing, even after endodontic treatment.
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Affiliation(s)
- Yoorina Choi
- Department of Conservative Dentistry, Wonkwang University School of Dentistry, Iksan, Korea
| | - Sung-Ok Hong
- Department of Conservative Dentistry, Wonkwang University School of Dentistry, Iksan, Korea
| | - Seok-Ryun Lee
- Department of Conservative Dentistry, Wonkwang University School of Dentistry, Iksan, Korea
| | - Kyung-San Min
- Department of Conservative Dentistry, Chonbuk National University School of Dentistry, Jeonju, Korea
| | - Su-Jung Park
- Department of Conservative Dentistry, Wonkwang University School of Dentistry, Iksan, Korea
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Management of root fracture: a novel, noninvasive treatment approach. Case Rep Dent 2013; 2013:653261. [PMID: 24282648 PMCID: PMC3825216 DOI: 10.1155/2013/653261] [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: 07/20/2013] [Accepted: 09/05/2013] [Indexed: 11/18/2022] Open
Abstract
Traumatic injuries to teeth account for approximately 25% of dental conditions where a patient seeks dentist for emergency treatment. Radicular fractures are one such entity which is very challenging to address due to various complications like periodontal communication, increased mobility, and continued pulpal infection leading to necrosis. Radicular fractures in the middle third have long been considered teeth of salvage due to their unfavourable fracture pattern. During the recent years introduction of biomimetic materials has opened the horizon for saving these teeth. In the present case report a novel approach to the management of radicular fractures in the middle third has been presented.
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Cho SY, Kim E. Does apical root resection in endodontic microsurgery jeopardize the prosthodontic prognosis? Restor Dent Endod 2013; 38:59-64. [PMID: 23741707 PMCID: PMC3670978 DOI: 10.5395/rde.2013.38.2.59] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 03/07/2013] [Accepted: 03/20/2013] [Indexed: 11/11/2022] Open
Abstract
Apical surgery cuts off the apical root and the crown-to-root ratio becomes unfavorable. Crown-to-root ratio has been applied to periodontally compromised teeth. Apical root resection is a different matter from periodontal bone loss. The purpose of this paper is to review the validity of crown-to-root ratio in the apically resected teeth. Most roots have conical shape and the root surface area of coronal part is wider than apical part of the same length. Therefore loss of alveolar bone support from apical resection is much less than its linear length.The maximum stress from mastication concentrates on the cervical area and the minimum stress was found on the apical 1/3 area. Therefore apical root resection is not so harmful as periodontal bone loss. Osteotomy for apical resection reduces longitudinal width of the buccal bone and increases the risk of endo-perio communication which leads to failure. Endodontic microsurgery is able to realize 0 degree or shallow bevel and precise length of root resection, and minimize the longitudinal width of osteotomy. The crown-to-root ratio is not valid in evaluating the prosthodontic prognosis of the apically resected teeth. Accurate execution of endodontic microsurgery to preserve the buccal bone is essential to avoid endo-perio communication.
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Affiliation(s)
- Sin-Yeon Cho
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
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Contemporary Management of Horizontal Root Fractures to the Permanent Dentition: Diagnosis—Radiologic Assessment to Include Cone-Beam Computed Tomography. J Endod 2013; 39:S20-5. [DOI: 10.1016/j.joen.2012.10.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 10/17/2012] [Accepted: 10/18/2012] [Indexed: 11/22/2022]
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Avsever H, Gunduz K, Orhan K, Uzun İ, Ozmen B, Egrioglu E, Midilli M. Comparison of intraoral radiography and cone-beam computed tomography for the detection of horizontal root fractures: an in vitro study. Clin Oral Investig 2013; 18:285-92. [DOI: 10.1007/s00784-013-0940-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/30/2013] [Indexed: 11/24/2022]
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Heithersay AO GS, Kahler B. Healing responses following transverse root fracture: a historical review and case reports showing healing with (a) calcified tissue and (b) dense fibrous connective tissue. Dent Traumatol 2013; 29:253-65. [DOI: 10.1111/edt.12029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2012] [Indexed: 12/15/2022]
Affiliation(s)
| | - Bill Kahler
- School of Dentistry; University of Queensland; Brisbane; Australia
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38
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Current Literature. J Am Dent Assoc 2012. [DOI: 10.14219/jada.archive.2012.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Dental trauma can result in tooth loss despite best efforts at retaining and maintaining compromised teeth (Dent Traumatol, 24, 2008, 379). Upper anterior teeth are more likely to suffer from trauma, and their loss can result in significant aesthetic and functional problems that can be difficult to manage (Endod Dent Traumatol, 9, 1993, 61; Int Dent J 59, 2009, 127). Indeed, teeth of poor prognosis may not only present with compromised structure but trauma may also result in damage to the support tissues. Injury to the periodontium and alveolus can have repercussions on subsequent restorative procedures (Fig. 19). Where teeth are identified as having a hopeless prognosis either soon after the incident or at delayed presentation; planning for eventual tooth loss and replacement can begin at the early stages. With advances in both adhesive and osseointegration technologies, there are now a variety of options for the restoration of edentate spaces subsequent to dental trauma. This review aims to identify key challenges in the provision of tooth replacement in the traumatized dentition and outline contemporary methods in treatment delivery.
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Affiliation(s)
- Aws Alani
- Department of Restorative Dentistry, Newcastle Dental Hospital, Newcastle, UK
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Andreasen JO, Ahrensburg SS, Tsilingaridis G. Root fractures: the influence of type of healing and location of fracture on tooth survival rates - an analysis of 492 cases. Dent Traumatol 2012; 28:404-9. [PMID: 22443169 DOI: 10.1111/j.1600-9657.2012.01132.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed. MATERIAL AND METHODS Long-term survival rates were calculated using data from 492 root-fractured teeth in 432 patients. The cause of tooth loss was assessed as being the result of either pulp necrosis (including endodontic failures), new traumas or excessive mobility. The statistics used were Kaplan-Meier and the log rank method. RESULTS AND CONCLUSIONS The location of the root fracture had a strong significant effect on tooth survival (P = 0.0001). The 10-year tooth survival of apical root fractures was 89% [95% confidence interval (CI), 78-99%], of mid-root fractures 78% (CI, 64-92%), of cervical-mid-root fractures 67% (CI, 50-85%), and of cervical fractures 33% (CI, 17-49%). The fracture-healing type offered further prognostic information. No tooth loss was observed in teeth with hard tissue fracture healing regardless of the position of the fracture. For teeth with interposition of connective tissue, the location of the fracture had a significant influence on tooth loss (P = 0.0001). For teeth with connective tissue healing, the estimated 8-year survival of apical, mid-root, and cervical-mid-root fractures were all more than 80%, whereas the estimated 8-year survival of cervical fractures was 25% (CI, 7-43%). For teeth with non-healing with interposition of granulation tissue, the location of the fracture showed a significant influence on tooth loss (P = 0.0001). The cause of tooth loss was found to be very dependent upon the location of the fracture. In conclusion, the long-term tooth survival of root fractures was strongly influenced by the type of healing and the location of the fracture.
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Affiliation(s)
- Jens Ove Andreasen
- Department of Oral and Maxillo-Facial Surgery, Resource Center for Rare Oral Diseases, University Hospital (Rigshospitalet), Copenhagen, Denmark.
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Andreasen JO, Ahrensburg SS, Tsilingaridis G. Tooth mobility changes subsequent to root fractures: a longitudinal clinical study of 44 permanent teeth. Dent Traumatol 2012; 28:410-4. [DOI: 10.1111/j.1600-9657.2011.01107.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Malmgren B, Hübel S. Transient discoloration of the coronal fragment in intra-alveolar root fractures. Dent Traumatol 2011; 28:200-4. [DOI: 10.1111/j.1600-9657.2011.01073.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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43
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Influence of a Parafunctional Oral Habit on Root Fracture Development After Trauma to an Immature Tooth. J Craniofac Surg 2011; 22:1304-6. [DOI: 10.1097/scs.0b013e31821c6d16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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44
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Berrezouga L, Belkhir C, Jbir R, Belkhir MS. Acute treatment of a concomitant horizontal root fracture and luxation of the coronal fragment of the right upper central incisor: a case report. Dent Traumatol 2010; 26:360-2. [DOI: 10.1111/j.1600-9657.2010.00885.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Scarfe WC, Levin MD, Gane D, Farman AG. Use of cone beam computed tomography in endodontics. Int J Dent 2010; 2009:634567. [PMID: 20379362 PMCID: PMC2850139 DOI: 10.1155/2009/634567] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 12/15/2009] [Indexed: 01/04/2023] Open
Abstract
Cone Beam Computed Tomography (CBCT) is a diagnostic imaging modality that provides high-quality, accurate three-dimensional (3D) representations of the osseous elements of the maxillofacial skeleton. CBCT systems are available that provide small field of view images at low dose with sufficient spatial resolution for applications in endodontic diagnosis, treatment guidance, and posttreatment evaluation. This article provides a literature review and pictorial demonstration of CBCT as an imaging adjunct for endodontics.
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Affiliation(s)
- William C. Scarfe
- Division of Radiology and Imaging Science, Department of Surgical and Hospital Dentistry, The University of Louisville School of Dentistry, 501 South Preston Street, Louisville, KY 40292, USA
| | - Martin D. Levin
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19103, USA
| | - David Gane
- Kodak Dental Imaging/Practiceworks, 1765 The Exchange, Atlanta, GA 30339, USA
| | - Allan G. Farman
- Division of Radiology and Imaging Science, Department of Surgical and Hospital Dentistry, The University of Louisville School of Dentistry, 501 South Preston Street, Louisville, KY 40292, USA
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Bornstein MM, Wölner‐Hanssen AB, Sendi P, Von Arx T. Comparison of intraoral radiography and limited cone beam computed tomography for the assessment of root‐fractured permanent teeth. Dent Traumatol 2009; 25:571-577. [DOI: 10.1111/j.1600-9657.2009.00833.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Michael M. Bornstein
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea B. Wölner‐Hanssen
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Pedram Sendi
- Institute for Clinical Epidemiology & Biostatistics, Basel University Hospital, Basel, Switzerland
| | - Thomas Von Arx
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
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