Clinical and Practical Implications of Storage Media used for Tooth Avulsion

Application of Oxygen Saturation Test after Replantation of Avulsed Immature Permanent Teeth: A Prospective Observational Study

INTRODUCTION

The evaluation of pulp status is crucial for avulsed immature permanent teeth after replantation. In addition to commonly used clinical and radiographic examinations providing clinical evidence, the oxygen saturation test may offer valuable assistance. The aim of this study was to analyze the efficacy of a pulse oximeter in evaluating pulp status in avulsed and replanted immature permanent teeth.

METHODS

A prospective observational study was performed including 51 avulsed and replanted immature permanent teeth. Routine clinical and radiographic examinations were performed and used as the basis for the diagnosis of pulp status during the 1-year follow-up period. Meanwhile, the oxygen saturation values of these teeth were recorded using a modified pulse oximeter at each visit.

RESULTS

Seven teeth completed pulp revascularization (success group), whereas 44 teeth failed to revascularize (failure group). Abnormal clinical and/or radiographic manifestations in the failure group were observed at an average period of 42.7 days, which was too late because a high incidence of inflammatory root resorption (43.18%) had occurred. For oxygen saturation tests, teeth in the success group showed an immediate postreplantation oxygen value of 70.71 ± 3.35, then an upward trend starting from the 2-week postreplantation visit, and a significantly increased final value of 81.86 ± 2.34 at the 1-year visit. In contrast, no increase trend was found for teeth in the failure group because abnormal clinical and/or radiographic manifestations emerged.

CONCLUSIONS

The oxygen saturation test is a reliable diagnostic method to evaluate pulp status of avulsed teeth as early as 2 weeks after replantation.

Effects of Doxycycline-Loaded NO-Releasing Nanomatrix Gel on Delayed Replanted of Rat Molar

BACKGROUND/AIM

Tooth avulsion and delayed replantation may cause inflammatory responses and root resorption of the tooth. The aim of this study is to investigate the effect of a doxycycline-loaded nitric oxide-releasing nanomatrix (DN) gel on the delayed replantation of avulsed rat teeth, with a focus on assessing the gel's potential to promote regeneration and inhibit complications associated with the replantation process.

MATERIALS AND METHODS

Twenty-four right maxillary first molars from male Sprague-Dawley rats were atraumatically extracted using sterile extraction forceps. The molars were dried for 1 h at room temperature (approximately 23 °C) and divided into four groups according to the root conditioning methods after extra-alveolar 60-min drying: Group 1, no root conditioning treatment prior to replantation; Group 2, soaking in 2% NaF solution for 5 min before replantation; Group 3, 5-min soaking in NO gel and injection of the gel into the alveolar socket; Group 4, 5-min soaking in DN gel and injection of the gel into the alveolar socket before replantation. The animals were euthanized four weeks after the operation and the specimens were evaluated histologically.

RESULTS

The use of NO gel alone showed better anti-inflammatory and periodontal effects than the control group, but it did not show a significant effect compared to the group using NaF. When using NO gel loaded with doxycycline, it showed a significant anti-inflammatory effect compared to the control group and showed a similar inhibitory effect to the group using NaF.

CONCLUSIONS

Within the limits of this study, in delayed replantation situations, the control of inflammatory resorption and replacement resorption is an important factor for achieving a better prognosis of replanted teeth. Root surface treatment with DN gel decreased root resorption after delayed replantation.

Dental and Dentoalveolar Injuries in the Pediatric Patient

Dental and dentoalveolar injuries are common in the pediatric population. Management is predicated on the type of tooth injured (primary or permanent), extent of injury, the dental and behavioral age of the patient, and ability of the patient to tolerate treatment. Although many dental injuries occur in isolation, a systematic evaluation of the patient is mandatory to confirm the absence of basal bone fractures of the maxilla or mandible, traumatic brain injury, cervical spine injury, and/or facial soft tissue injury. Long-term follow-up is paramount to achieving a functional occlusion and optimal dental health following injury.

An In Vitro Evaluation of Morinda citrifolia and Ocimum sanctum as Potential Storage Media to Maintain Cell Viability for Avulsed Teeth Using Collagenase Dispase Assay

Aim This study aimed to evaluate the protective effects of Ocimum sanctum extract and Morinda citrifolia juice on human periodontal ligament (PDL) cells after the reimplantation of avulsed teeth using a collagenase-dispase test. Materials and methods Sixty-five human premolars, all of which would eventually need to be extracted, were split into three experimental groups: one treated with Hanks Balanced Salt Solution, another with Morinda citrifolia juice and Ocimum sanctum extract, and two control groups (positive and negative). There were 10 teeth in each control group and 15 teeth each were used in the experimental groups, with the first 30 minutes spent dry before being submerged in one of three experimental media for 45 minutes, followed by 30 minutes of treatment with collagenase and dispase II. The cells' vitality was measured by the trypsin dye exclusion technique. To determine how many PDL cells were still alive, An optical microscope and a hemocytometer were used. The data were analyzed using Kruskal-Wallis one-way ANOVA and Mann-Whitney U tests. Results The percentage of viable PDL cells was greatest in Morinda citrifolia juice (85.18%), followed by HBSS (84.3%), and finally by Ocimum sanctum extract (68.04%). There was no significant difference in the number of viable PDL cells in Morinda citrifolia juice and HBSS. Conclusion The results of this research suggest that Morinda citrifolia juice has potential as a storage medium and as an alternative to HBSS, within the study's constraints, considering its availability as well as economic feasibility.

Evaluation of delphinidin as a storage medium for avulsed teeth

BACKGROUND

Delphinidin (DP), an anthocyanidin found in blueberries, has antioxidant and anti-inflammatory effects. This study aimed to investigate the efficacy of DP as a storage medium for avulsed teeth.

METHODS

Human periodontal ligament cells were cultured and exposed to DP solution (10, 50, and 100 μM), Dulbecco's modified Eagle's medium, Hank's balanced salt solution and tap water. Cell counting kit-8 assays were performed after 0.5, 1, 6, and 24 h to measure the cell viability. Nitric oxide assays and gelatin zymography were performed to evaluate the anti-inflammatory effects of DP. Reverse transcription-polymerase chain reaction was used to determine the expression levels of inflammatory cytokines.

RESULTS

The viability of periodontal ligament cells was greatest at 100 μM DP. At 1 h, 100 μM DP decreased nitric oxide synthesis (p < .0167). Matrix metallopeptidase-9 activity was inhibited by DP in a dose-dependent manner (p < .0167). Moreover, treatment with 100 μM DP decreased the expression levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-8 in periodontal ligament cells (p < .0167).

CONCLUSIONS

Within the limits of this study, DP preserved the viability and suppressed the inflammatory response of periodontal ligament cells. These findings suggest that DP could be promising for preservation of avulsed teeth.

Evaluation of teachers' knowledge about dental injuries in primary schoolchildren in the city of Isfahan

Background

Dental trauma is a common problem in children, which mostly occurs at school. Traumatic dental injuries often cause unpleasant experiences for children, and immediate and appropriate measures are needed. Its prognosis depends on immediate posttraumatic measures, and schoolteachers can play a key role in the treatment of children. The current study aimed to investigate teachers' knowledge about dental injuries in primary school children in the city of Isfahan.

Materials and Methods

Following a cross-sectional design, the current study was conducted on 248 elementary school teachers who were selected using the simple two-stage random cluster. Then the teachers' knowledge was measured based on a four-choice questionnaire consisted of two parts. According to this questionnaire, teachers were divided into five categories based on their knowledge score which was consist of strongly high knowledge, high knowledge, average knowledge, low awareness, and strongly low knowledge. Data were analyzed using the Spearman correlation coefficient and independent t-test. Statistical significance was considered when P < 0.05.

Results

The total knowledge score of teachers was 45.9%. About 61% of the teachers had a history of exposure to dental injuries. Furthermore, 49.6% of them believed milk was the best environment to keep the avulsed teeth. There was no significant association between teachers' knowledge and education level, history of previous trauma, or participation in a training course, but there was a direct association between teachers' knowledge and their work experience (P < 0.05). Female teachers' knowledge score was significantly higher than their male counterparts (P < 0.001).

Conclusion

Participants had a moderate level of knowledge about the management of dental traumas. Hence, it is suggested to develop educational programs to increase teachers' awareness about this issue.

Regenerative Endodontic Treatment of Maxillary Incisors with a History of Severe Traumatic Injury

The treatment objective for children with avulsed anterior teeth should concentrate on preserving the alveolar bone volume and contour. Posttraumatic external inflammatory root resorption (EIRR) is also a high-risk complication often observed in children. Regenerative endodontic procedure (REP) has been considered a successful treatment to arrest EIRR, especially in posttraumatic cases. This case report presents clinical outcomes of REP in two teeth of an 8-year-old systemically healthy patient with a history of severe dentoalveolar traumatic injury, one with a history of avulsion, and the other with an EIRR. The treatment consisted of REP on both teeth #8 and #9. The results showed some evidence of maturation in the apical third of tooth #9 and resolution of signs and symptoms on tooth #8.

Primary School Teachers' Knowledge on Tooth Avulsion

Objective

Permanent teeth trauma is most frequent in children aged 7-9 years, and the primary school teachers (PSTs) are often the first to notice it. The aim of this study was to evaluate the competence in tooth avulsion clinical issues and knowledge on dental trauma of PSTs, as they can occasionally take on the role of school nurses.

Material and Methods

Questionnaires were handed to 312 PSTs from 24 randomly selected primary schools in Zagreb, Croatia. An algorithm was designed for PST competence assessment.

Results

Response rate amounted to 81.37% (N=255). Only 3.14% (N=8) of the PSTs would replant the permanent tooth properly and only 43.92% of them (N=112) would immediately take the child to a doctor of dental medicine. Dry tissue, as a transport medium for an avulsed tooth, was chosen by 50.20% (N=128) of the respondents. Altogether, 4.71% (N=12) of PSTs were graded as competent in case of child’s tooth avulsion.

Conclusion

These results provided significant implications for school health, showed the educators' serious lack of knowledge in cases of dental trauma and stressed a need for continuous education of PSTs on the topic.

Dry extraoral storage and delayed replantation of avulsed tooth: Therapy and outcome

Introduction: The aim of this study was to present the therapeutic procedure and the outcome of replantation of the avulsed permanent central maxillary incisor, found at the site of high contamination, after an extraoral period of 15 hours and dry transport. Case report: By clinical examination it was determined that the root reached the full length, with parallel edges, which corresponded to the age of the girl-8.5 years. After carefully removing the necrotic periodontal ligament from the root of the tooth, extraoral endodontic treatment was performed. The pulp was removed, the multi-sessional intracanal medicament fillings were avoided and the definitive obturation of the root canal was performed. The tooth was returned to the alveolar socket and immobilized with a wire-composite splint. After replantation, the condition of the tooth was monitored. Replacement resorption and dentoalveolar ankylosis occurred after nine months, and then cervical inflammatory resorption led to tooth loss after three and a half years. Conclusion: The achieved result can be considered as a success because during this time the replanted tooth met the developmental, functional and aesthetic requirements, which is especially important in the period of intensive growth and development of the child.

Management of Dental Avulsion Injuries: A Survey of Dental Support Staff in Cairns, Australia

Background/Aim: The aim of this study was to assess the knowledge of dental support staff in providing appropriate first-aid advice regarding dental avulsion emergencies. Methods: This study was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies. Dental support staff (includes dental assistants, administrative staff and other non-clinical staff) were contacted and data were collected from 50 private dental clinics across the Greater Cairns Area, Queensland, Australia. These data were collected through an online survey throughout 2020. Descriptive statistics and Pearson’s Chi-squared test was used to analyze the data and any associations between categorical outcomes. Results: This survey yielded a response rate of 34.1% with a margin of error of 10.3%. More than four-tenths of participants (42%) reported that they had received some form of dental avulsion management training previously. All but five participants (92%) denoted that they would immediately replant an avulsed permanent tooth. More than half of all participants would choose to rinse a soiled avulsed tooth with fresh milk (55%) and transport that tooth in fresh milk (65%) should they not be able to replant the tooth at the site. Almost nine in every ten participants (85%) expressed willingness to further their training in this area. Knowledge in replanting avulsed permanent teeth was found to be significantly impacted by gender, age, years of experience and participation in formal avulsion training. Male participants were found to be significantly more likely (p = 0.025) to replant a permanent avulsed tooth than their female counterparts. Participants who were 40 years of age and above were found to be significantly more likely to choose fresh milk to transport avulsed teeth (p = 0.0478). Older participants (p = 0.0021), alongside those who had greater years of experience (p = 0.0112) and those who had undertaken formal avulsion training (p = 0.0106) were all significantly more likely to express greater confidence in their ability to manage dental avulsion injuries. Participants who had previously received some form of education regarding avulsion injury management were also most likely to warrant further education and training in this area (p < 0.0001). Conclusion: This study demonstrated that dental support staff in the Greater Cairns Area seem to have a fair grasp of first-aid knowledge regarding the management of dental avulsion injuries. This result indicates that this knowledge has been picked up through years of experience, rather than a formal education. Despite this, one would expect people who work in the dental industry to be able to provide accurate and appropriate assistance during dental emergencies, hence, further training is warranted to ensure optimum patient outcomes.

Awareness of Parents About the Emergency Management of Avulsed Tooth in Eastern Province and Riyadh

Objective

To assess the level of parents knowledge about the emergency management of tooth avulsion in Eastern Province and Riyadh.

Methods

A cross-sectional study was carried out by means of a questionnaire-based internet survey in which 1201 parents from Eastern Province and Riyadh participated. The questionnaire contained 10 closed-ended questions and was used to assess the knowledge of parents about the emergency management of avulsed teeth in Eastern Province and Riyadh. Chi-square test was used for data analysis.

Results

In response to closed-ended questions, the statistically significant result was obtained for the history of child dental trauma in which 35% (P=0.04) of parents reported history of dental trauma in their children. These parents were belong to Eastern province (51%) and Riyadh (49%). Furthermore, only 31.3% of the parents were aware of possible storage media for transportation of avulsed tooth while 68.7% (49.5% in Eastern Province and 50.5% in Riyadh) were unaware (P=0.02) of it.

Conclusion

That the majority of the parents were unaware of emergency management for tooth avulsion in two densely populated regions of Saudi Arabia. Education of parents should be initiated at a national level.

The Use of Histidine-tryptophan-ketoglutarate Solution as a New Storage Medium for the Avulsed Tooth

INTRODUCTION

Histidine-tryptophan-ketoglutarate (HTK) is a preservation solution used for organ transplantation. The physiological pH and osmolality of this solution are known to facilitate cell proliferation and cell membrane stabilization. The purpose of the present study was to investigate the efficacy of several concentrations of HTK solution as a storage medium for avulsed teeth.

METHODS

Cultured human periodontal ligament cells were stored in different concentrations of HTK solutions. After 1, 3, 6, 12, 24, 48, and 72 hours, cell viability was assessed using the Cell-Counting Kit-8 (Dojindo Molecular Technologies, Kumamoto, Japan) and LIVE/DEAD (Invitrogen, Carlsbad, CA) assay. Cell response of the most effective concentrations of HTK solution were further analyzed by gene expression profiling, and their cell viability was compared with other storage media.

RESULTS

The highest cell viability was observed in 50% HTK solution in various concentrations of HTK solution (P < .05). In periodontal ligament cells stored in 50% HTK solution for 3 hours, the expression of genes related to angiogenesis, the inflammatory response, and cell proliferation was increased compared with the control. Compared with other storage media, the highest cell viability was observed in 50% HTK solution.

CONCLUSIONS

Our study suggests that 50% HTK solution containing cell culture medium represents a suitable storage medium for avulsed teeth.

A Preexperimental Study to Assess the Impact of an Interdisciplinary Educational Intervention on Nurses' Knowledge of Perinatal and Infant Oral Health Care

OBJECTIVE

The objective of this study was to assess the impact of an interdisciplinary educational intervention on the knowledge of nursing practitioners regarding perinatal and infant oral health (PIOH) care.

MATERIALS AND METHODS

This was a preexperimental study conducted among nursing practitioners in Lagos, Nigeria. Participants received hands-on training and didactic lectures, which included dental caries etiology and risk factors; oral hygiene and dietary education; teething and its management; dental trauma and its prevention; nonnutritive habits; screening, referrals, and counseling; and fluoride varnish application. Knowledge of the trainees was assessed using pre- and posttest questionnaires. Level of statistical significance was set at P < 0.05.

RESULTS

Overall, 110 nurses participated in the study with a mean age of 40.9 ± 10.8 years; 106 (96.4%) were females. Approximately 88% of the participants had not received formal training on PIOH. The baseline mean scores of the participants' knowledge on oral hygiene, teething, trauma, caries, and oral habits were 4.31 ± 1.9, 9.84 ± 2.6, 2.59 ± 1.7, 4.24 ± 1.8, and 1.45 ± 0.6, respectively; this increased significantly (P < 0.001) following the educational intervention with posttest mean scores as 7.58 ± 0.8, 11.79 ± 1.3, 4.34 ± 1.9, 6.19 ± 1.8, and 1.82 ± 0.4 and six-month evaluation scores as 6.21 ± 1.8,7 10.27 ± 3.1, 4.39 ± 1.5, 5.91 ± 1.8, and 1.79 ± 0.5, respectively. Overall posttest (31.4 ± 4.2) and six-month (28.6 ± 6.2) knowledge scores were significantly higher than the pretest values (22.4 ± 4.8, P < 0.001). At the six-month post-intervention survey, 84% of the nurses reported inclusion of PIOH education in their routine general health education sessions.

CONCLUSION

There was a positive impact of the educational intervention as evidenced by an increase in the knowledge of the nurses on PIOH care and the inclusion of PIOH education in their general health education. A slight decline between posttest and six-month evaluation scores indicates a need for continuous education and evaluation.

Anti-inflammatory and anti-resorptive efficacy of adrenergic blockers on late replanted rat incisors

BACKGROUND/AIM

In addition to their anti-inflammatory and anti-osteoclastogenesis properties, adrenergic blockers may also have promising anti-resorptive effects that can prevent root resorption when teeth are replanted because of avulsion. The aim of this study was to investigate the effects of phentolamine (Ph) and propranolol (Pr) in gels on the repair process of late replanted rat incisors. A further aim was to evaluate the biocompatibility of both drugs to human periodontal ligament fibroblasts (HPDLFs).

MATERIALS AND METHODS

Forty-eight maxillary right incisors were extracted from male Wistar rats, stored in paper napkins for 60 minutes, and randomly allocated to one of eight groups (n = 6). The root canal, root surface, and alveolus were treated with 0.75 µg/mL Ph gel (Ph0.75), 10 µg/mL Ph gel (Ph10), 100 µg/mL Ph gel (Ph100), 2.5 µg/mL Pr gel (Pr2.5), 10 µg/mL Pr gel (Pr10), 100 µg/mL Pr gel (Pr100), or sodium carboxymethylcellulose gel (CMC) before replantation. In the control group (CH), only the root canal was treated with calcium hydroxide paste. Thirty days following surgery, the animals were euthanized, and the right hemimaxilla was removed to perform micro-CT and histomorphometric analysis to determine osteoclastic activity. Ethanolic solutions of Ph10 and Pr10 were selected based on the in vivo study, and the viability of HPDLFs stimulated with lipopolysaccharide was determined by MTT assays.

RESULTS

The micro-CT and histomorphometric analysis revealed no significant differences among the treatments (P > .05). The presence of active osteoclasts was significantly decreased in the Ph10 and Pr10 groups (P < .05). Ph10 and Pr10 produced statistically similar cell survival rates compared to the control group (P > .05).

CONCLUSIONS

Ph10 and Pr10 significantly decreased osteoclastogenesis in delayed replanted rat teeth and were not cytotoxic toward HPDLFs.

Survival of a Maxillary Incisor in an Adolescent Male 16 Years after Its Delayed Replantation

Introduction: Recreational and sport activities, traffic accidents and human behaviour represent the main causes of trauma in young people. Case presentation: This report describes a case of a 15.2-year-old male who suffered uncomplicated crown fracture and avulsion of tooth 11 and uncomplicated crown fracture of tooth 21 due to a bicycle accident. Tooth 11 was dry stored and it was replanted 18 h after the trauma. The root was planed to remove the necrotic periodontal tissue, the pulp was extirpated before replantation and a flexible splint was applied to tooth 13 to tooth 23 for 3 weeks. A replacement root resorption of replanted tooth was suspected at the 3-month radiographic control and suffered a dramatic increase later; minimal infraocclusion, about 1 mm, was observed due to its ankylosis. Sixteen years after the trauma the patient was scheduled for an orthodontic and implanto-prosthetic rehabilitation. Conclusion: Delayed replantation usually has a long-term poor prognosis, so it is very important to promote awareness regarding emergency management modalities in dental traumatology especially among parents, school teachers, and coaches that are usually present at the site of the accident.

Comparative evaluation of periodontal ligament fibroblasts stored in different types of milk: effects on viability and biosynthesis of collagen

Milk remains one of the most frequently recommended solutions for storage of avulsed teeth because it can maintain cell viability and is easily accessible. However, some negative effects of milk on avulsed teeth have been reported, just as the effects of milk on the long-term functions of cells are not clear. This study aimed to evaluate the effects of different types of milk on the viability, proliferation, and functions of periodontal ligament fibroblasts (PDLF)s in vitro. Human PDLFs were culture-medium depleted for 5 min and stored in Hanks' balanced salt solution (HBSS), whole cow's milk, low-fat cow's milk, or almond milk for 1 h at 25°C. Cell viability and proliferation were assessed using MTT assays. Expression of the genes encoding type I collagen and its modifying enzymes were analyzed using real-time PCR. Collagen matrix production was evaluated using Picrosirius red polarization. Our results showed the overall efficiency of low-fat cow's milk in maintaining the viability and proliferation of PDLFs, and in enhancing the process of collagen production. Almond milk storage resulted in the highest rate of PDLF proliferation, and comparable collagen biosynthesis ability to the control. Therefore, besides low-fat cow's milk, almond milk may potentially be an alternative tooth-storage medium for PDLF preservation and PDL tissue regeneration.

Efficacy of Hank's balanced salt solution compared to other solutions in the preservation of the periodontal ligament. A systematic review and meta-analysis

This systematic review and meta-analysis (MA) aimed to verify the capacity of different storage media to preserve viability of periodontal ligament cells in comparison to Hank’s Balanced Salt Solution. The searches, selection process, data extraction and Risk of Bias control were conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Five MA were conducted to compare the cell viability between milk versus Hank's balanced salt solution (HBSS) in a dichotomous (1) or continuous (2) data model; tap water versus HBSS (3); medicinal herbals versus HBSS (4); and saline solution versus HBSS (5). 693 potentially studies were identified, with 18 studies included in the qualitative and 8 studies included in the quantitative analysis. Most of the articles presented a low risk of bias. HBSS medium showed a superior ratio of cell viability compared to tap water (RR 0.26; 95% CI [0.21, 0.32]; p < 0.00001; I2 = 96%) and saline solution (RR 0.76; 95% CI [0.69, 0.84]; p < 0.0001; I2 = 99%). Herbal medicines showed a similar ratio of cell viability when compared to HBSS (RR 0.97; 95% CI [0.94, 1.00]; p = 0.08; I² = 50%). Mixed results were observed between milk and HBSS: a superior ratio of HBSS was observed in an overall evaluation (RR 0.26; 95% CI [0.21, 0.32]; p < 0.00001; I² = 96%), and a similar ratio was achieved when periodontal ligament (PDL) cells were removed prior to immersion in the solution (RR 0.94; 95% CI [0.87, 1.01]; p = 0.10; I2 = 0%) or rinsed in tap water or maintained in open air prior to immersion (RR 0.63; 95% CI [0.35, 1.12]; p = 0.11; I2 = not applicable). This systematic review and MA suggests that milk and herbal medicines could represent an alternative to HBSS. However, more studies are necessary to obtain a reliable conclusion.