Advancements in tooth autotransplantation

BACKGROUND

Tooth autotransplantation (AT) involves the surgical relocation of a tooth from 1 site in the mouth to another site within the same patient. This approach is a good option in a growing patient when dental implant placements or fixed bridges are not suitable and when preserving natural teeth is a priority. Tooth AT is a complex procedure that requires specialized skills from a multidisciplinary team with careful patient and tooth selection and treatment planning.

TYPES OF STUDIES REVIEWED

The authors provided a review of the state of knowledge and research on tooth AT and presented a case scenario and barriers to adoption, with a focus on the United States.

RESULTS

Success rates for tooth AT can vary depending on several factors, including the patient's overall health, specific tooth involved, skill of the dental surgeon, and postoperative care provided. Long-term outcomes of autotransplanted teeth have been cited in the literature with impressive longitudinal follow-up spanning up to 26 years. Results of several systematic reviews showed survival rates from 75% through 98%.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Adoption of tooth AT has grown over the years, owing to advancements in dental techniques, improved patient outcomes, and increased awareness among both dentists and patients. Increasing awareness and availability of tooth AT to replace missing teeth can provide a natural and functional alternative to traditional prosthetic options. Tooth AT helps preserve the alveolar bone in growing patients and can offer excellent esthetic and functional outcomes.

A retrospective cohort study of pulp prognosis in luxated permanent teeth: a competing risk analysis

AIM

The present retrospective cohort study aimed to evaluate luxated permanent teeth for pulp prognosis and risk factors.

METHODOLOGY

Case records and radiographs of 224 patients, involving 427 luxated permanent teeth, referred for treatment at the Dental Trauma Center-School of Dentistry, Universidade Federal de Minas Gerais, (DTC-SD-UFMG) from 2014 to 2022, were assessed for pulp prognosis classified as vitality, necrosis and pulp canal obliteration (PCO). A competing risk survival analysis estimated the hazards of the three outcomes, and the effect of demographic, clinical and treatment variables was tested using a cause specific Cox regression model.

RESULTS

Pulp vitality was found in163 teeth (38.2%), pulp necrosis in 120 teeth (28.1%) and 55 teeth (12.9%) developed PCO. Pulp vitality decreased in the presence of concomitant crown fractures (HR 0.38 95% CI [0.2-0.8] p = 0.006). The risk of pulp necrosis (HR 0.62 95% CI [0.4-0.96] p = 0.03) was lower in cases with open apices but increased with concomitant crown fractures (HR 4.0 95% CI [2.6-6.1] p = 0.001) and intrusions (HR 2.3 95% CI [1.2-4.1] p = 0.007). Lateral or extrusive luxations (HR 3.0 95% CI [1.3-6.9] p = 0.001) and open apices (HR 2.4 95% CI [1.2-4.7] p = 0.01) showed higher rates of PCO.

CONCLUSION

Type of luxation, the diameter of the apical foramen, and the presence of concomitant crown fractures were main determinants of pulp prognosis after luxation injuries in permanent teeth.

CLINICAL RELEVANCE

Pulp prognosis after tooth luxation is dependent on the presence and direction of tooth displacement together with infection control.

CLINICAL TRIAL REGISTRATION

Not applicable.

Adhesion of tooth fragment after trauma: effect of adhesion strategy and storage in the rescue box

This study aims to investigate the impact of storage conditions for crown fragments (specifically, whether they were stored within a tooth rescue box or in tap water) on their adhesion to fractured teeth when subjected to two different adhesive systems (namely, total etch and self etch). Sixty maxillary premolars were sectioned to obtain tooth fragments. These fragments were stored briefly (2 hours) and reattached in the following groups: Group 1 (fragments stored in tooth rescue box and reattached with etch and rinse (E&R) technique), Group 2 (fragments stored in tap water and reattached with E&R technique), Group 3 (fragments stored in tooth rescue box and reattached with self-etch (SE) technique), and Group 4 (fragments stored in tap water and reattached SE technique). After reattachment, the bonded tooth fragments underwent thermal cycling (500 cycles, 5-55 °C) and bond strength testing using a universal testing machine. Two-way Analysis of Variance (ANOVA) and Tukey's tests were used for bond strength comparison (p ≤ 0.05). A two-parameter Weibull distribution was conducted to evaluate the reliability of the storage medium and adhesion modality on bond strength. The results showed that measured shear bond values (MPa ± Standard deviation (SD); arranged in descending order) for each group were: Group 2 (Tap water/E&R = 6.5 ± 2.1), Group 1 (Rescue box/E&R = 6.0 ± 2.5), Group 4 (Tap water/E&R = 5.1 ± 2.8), and Group 3 (Rescue box/SE = 3.6 ± 3.2). Significant differences were found only between Groups 2 and 3 (p = 0.002). In conclusion, storing crown fragments in a tooth rescue box did not significantly affect the shear bond strength of the restored tooth. However, fragments reattached using the self-etch technique showed comparable shear bond strength but a higher rate of adhesive failures compared to the E&R technique.

Awareness about emergency management of avulsed tooth among intern dentists-a cross-sectional observational study

Tooth avulsion is a frequently encountered dental emergency. Children are commonly reported group due to frequent sports activities, trauma, accidents and falls. Prompt emergency management is vital for long term success and to avoid morbidity. The study was aimed to assess the understanding of intern dentists about the emergency handling of avulsed teeth cases as mostly they are first responders among health care personnel. In this study a fourteen-item questionnaire with predefined responses was shared as online Google survey form with intern dentists of 5 different dental teaching hospitals of Islamabad, Pakistan. The duration of the study was 6 months (01 March 2022 to 31 August 2022). The questions were intended to collect personal information and to check level of knowledge and awareness about the management of avulsed tooth among the dental interns. The data was analyzed by statistical methods and is presented through tables and descriptive methods. In total, 152 participants completed the shared questionnaire. The vast majority (71%) of them were aware of the initial management of avulsed teeth, 49% were aware of the ideal transport medium for an avulsed tooth, (43%) were aware of the critical time for successful replantation, while (62%) had knowledge of the multiple factors responsible for the outcome of the tooth replantation. For majority of the statements, female participants had better knowledge as compared to their male counterparts. Statistically significant difference was noted for the statement "If you found the knocked-out tooth and it is dirty what will be your initial approach?" with female participants having better knowledge as compared to the male (p value = 0.005). Based on our study results, generally dental interns are well-informed but still lack expected level of awareness regarding the proper management protocol for avulsed tooth. Hence, improvement is needed regarding the effective handling of avulsed teeth cases.

Knowledge and management of traumatic dental injuries among schoolteachers in Hungary: a cross-sectional study with educational intervention

PURPOSE

This study aimed to evaluate the knowledge of Hungarian schoolteachers in the management of dental trauma injuries (TDI) of children between the ages of 3 and 18 and to illustrate a brief educational intervention on TDI management.

METHODS

A 15-item questionnaire on dental injuries was distributed in our observational cross-sectional study to 2720 Hungarian educational institutions to explore and evaluate teachers' knowledge in January 2019. Two years later, targeted information material was made accessible regarding TDI management. In the second post-intervention phase of the study, educator knowledge was re-evaluated using the same questionnaire. Statistical analysis (Mann-Whitney and Chi-square tests) was performed using IBM SPSS Statistics 28.

RESULTS

A total of 1426 answers were collected in the initial survey. Although more than half (51.9%) of the respondents previously witnessed TDIs, 86.5% still did not perceive themselves as adequately informed regarding TDI management. Most teachers submitted appropriate responses to the indicator questions relating to the urgency of referral to dental professionals (71.8%), immediate contact with parents (79.0%) or dentists (13.0%), and the solution for avulsed teeth (81.3%). However, only every second (56.2%) educator responded correctly regarding the proper cleaning method. Following accessibility to our educational material, 622 respondents completed the post-intervention questionnaire in the second phase of the study. The percentage of appropriate responses to the five indicator questions significantly increased by 5-20.6%.

CONCLUSION

Teachers' knowledge of TDI was inadequate yet can improve with online education. Efforts among dental professionals, the media, and targeted interventions will ensure adequate knowledge while also improving children's dental health.

Analysis of dental traumatic patterns in standing electric scooter-related accidents

BACKGROUND

There have been several studies about the increasing accident risks and injuries of standing electric scooters, but there is no study about the dental traumatic injuries related with standing electric scooter so far.

OBJECTIVES

The purpose of this study is to report the overall dental traumatic patterns, and compare the patterns of standing electric scooter-related dental trauma with other traumatic causes. Also, considerations about minimizing the risks of electric scooter-related trauma will be discussed.

METHODS

Data on patients who visited Region Trauma Center of Wonju Severance Christian Hospital with dental emergency from January 2020 to December 2022 were collected.

RESULTS

The crown-root fracture and avulsion occurred significantly higher in electric scooter-related accidents than others. Furthermore, relatively minor dental injuries including concussion and subluxation showed higher percentage to be occurred as combined injuries in electric scooter-related accidents. The prevalence of traumatized posterior teeth was significantly higher in electric scooter-related trauma than others. Most of patients were teenagers and twenties. Also, the electric scooter-related accidents mostly occurred at evening and night. Furthermore, the number of patients wearing a helmet in electric scooter accidents was 1 out of 33.

CONCLUSION

The standing electric scooter-related dental trauma resulted in an increased prevalence of relatively severe dental trauma. Supplementation and reinforcement of the related policies as well as strict enforcement of the laws on electric scooter users will be needed to prevent severe dental and craniofacial trauma.

Histological effects of photobiomodulation on delayed tooth replantation: a systematic review

This systematic review evaluated preclinical studies to assess whether PBM has a more favorable histological response than other treatments used before delayed replantation of avulsed teeth. This review followed the PRISMA checklist and was registered in PROSPERO. MEDLINE (PubMed), Embase, Scopus and Web of Science were searched from their inception to July 14, 2022. Data were independently extracted by two reviewers. Data were collected about species, number of animals, number and type of teeth, groups evaluated, extra-alveolar time, parameters for PBM and other study groups, presence and characteristics of containment, observation time points, evaluation methods, characteristics evaluated, and significant results. The ARRIVE and SYRCLE tools were used to assess the methodological quality and risk of bias (RoB) of the studies. After screening, six studies were included in the review synthesis. Three of the four studies that evaluated root resorption as an outcome found that PBM decreases its occurrence after delayed tooth replantation. A meta-analysis was not conducted because some data were missing in the included studies. Half of the studies evaluating ankylosis found an increase in its occurrence after PBM. Two studies evaluated inflammatory responses and found a reduction of inflammation after PBM. In general, studies had high methodological heterogeneity, intermediate reporting quality and high RoB. Despite the methodological quality and RoB limitations of the studies, the histological responses after delayed tooth replantation were more favourable in the PBM groups. Preclinical studies supported by guidelines should define laser parameters for future clinical studies.

Controversies in Dental Traumatology

The management of traumatic dental injuries is more a shade of gray than it is black and white because not all treatment procedures used for dental trauma management are fully evidence based. This chapter has highlighted some of the gray areas related to the treatment and outcome of traumatic dental injuries. Significant controversies in the management of luxation and avulsive injuries have been brought out. Adjunctive treatment such as antibiotic usage, tetanus vaccination, and pain management is also addressed.

Dental trauma: preparing for success

Dental trauma is an infrequent occurrence in daily general dental practice and, combined with a lack of confidence in its management, can be a significant cause of stress for the dental team. Excessive stress can have a significant impact upon our performance. This article presents practical ways in which the dental team can reduce the stress associated with dental trauma management. It promotes the use of standardised protocols and involves the whole dental team to achieve optimal outcomes for patients.

Dental trauma: assessment and acute management of fractures

Acute dental trauma is unscheduled and presents infrequently to the majority of practitioners. Therefore, a consistent, logical and systematic process for examination, prioritisation and management is imperative for all sustained injuries to have an optimal outcome. Fractures are a frequent sequela to dental trauma and can involve any aspect of the tooth structure or supporting alveolar bone. While some minor crown fractures may initially seem inconsequential, they may be a subtle indication to a more serious underlying root fracture. Concomitant injuries and injuries that have been initially missed are generally associated with poorer outcomes. The time sensitive management of traumatic dental injuries aims to preserve pulpal and periodontal health where possible. The follow up period for tooth or alveolar fractures are important to allow for early intervention if pathology develops.

A review of the iadt 2020 guidelines

Traumatic dental injuries (TDIs) are a relatively frequent occurrence, with roughly a third of adults experiencing a dental trauma at some time in their life.1 TDIs may present to dental professionals working within primary or secondary care settings. Patients presenting at the time of acute injury will require immediate management and careful long term follow up. Patients may also present later reporting a history of TDI, with developing complications and onward management required. To support dental care professionals, the International Association of Dental Traumatology's (IADT) Guidelines are available globally as a standardised tool to aid the assessment, management and follow up of dental trauma. These easy to access guidelines were updated in 2020 with four distinct publications:General Introduction,1 Fractures and Luxations,2 Avulsion of Permanent Teeth,3 and Injuries in the Primary Dentition.4 The current guidelines represent the best evidence based on available literature and expert opinion.1This paper aims to support dental professionals by specifically highlighting and describing updates in guidance, using the 2020 IADT published guidelines. By incorporating the 2020 guidelines into our everyday practice we aim to provide the most appropriate, standardised care, based on the highest level of available evidence to our patients.The full published guidelines are available free online via the IADT website.

The consequences of Dental trauma

Traumatic dental injuries pose a variety of complex ongoing issues to the dental practitioner. As dental injuries are commonly experienced at a young age, the treatment often takes place during adolescence or early in adulthood years at crucial development stages and very early in the life of the permanent successor. Therefore, the ability to correctly diagnose the injury, and follow an appropriate management plan should increase practitioners' ability to improve both the outcomes of dental trauma and long-term prognosis of the tooth.The consequences of dental trauma can be explored by taking into consideration the type of injury, which enables an assessment of the degree of insult to the pulpal tissues, neurovascular bundle, periodontal ligament and cemental cells. This has a direct influence on post-trauma complications. Early intervention, where indicated, and appropriate follow-up utilising international guidelines is imperative to identify changing diagnoses and act accordingly. This review paper will discuss the classification of traumatic injuries and their associated outcomes with management strategies for emerging disease including potential endodontic and restorative complexities and when to refer to secondary care.

Special considerations in paediatric dental trauma

Traumatic dental injuries (TDIs) in the paediatric population are common and frequently seen in general dental practice. The management of TDIs can be challenging and, in most cases, the General Dental Practitioner is tasked with the initial assessment and emergency treatment. Patients and their families typically attend with elevated levels of distress, which is complicated by the limited dental experience of some children. Behaviour management is essential and helps prepare patients for dental care at both their emergency and follow-up appointments. Early and accurate diagnosis in combination with appropriate treatment contributes to favourable outcomes for traumatised teeth. Early discussions with or referral to paediatric dental teams for management of complex TDIs is encouraged, however shared follow-up care is beneficial over the long-term. In specific cases, initial dental treatment can be delayed by a few days to a subsequent appointment, allowing the dental team to book sufficient time for the treatment and for the patient and their families to prepare. Education of the patients and adults with parental responsibility is essential to manage expectations, explain likely complications and encourage attendance for long-term follow-up visits. This paper discusses the management of paediatric patients to aid the primary care practitioner in providing effective immediate and long-term care.

Prevention of Dental trauma

Traumatic dental injuries (TDIs) occur commonly in children and young adults with one in three adults having experience of a TDI to their permanent dentition. Although the management of TDIs have evolved vastly, the consequences of TDIs can still be profound and generally carry a high burden for the patient, family, or carer, as well as the clinician and healthcare services. Hence, prevention of TDIs where possible is key. It is important to ensure that all risk factors for dental trauma are fully explored to allow preventative advice to be tailored to each patient. General Dental Practitioners are well placed to establish a rapport with patients owing to the continuity of care that is commonly seen in dentistry, however, it is imperative that the appropriate questions are asked.This article aims to review dental trauma highlighting the significance of identification of clinical and social risk factors and prevention of TDIs. These risk factors are further divided into modifiable and non-modifiable risk factors which can guide the clinician on what further action is required and when other members of the dental or medical team should be involved. The importance of patient education in prevention of TDIs, including use of mouthguards in sport, and mouthguard design will be discussed.

Presentation and subsequent care of dental injuries sustained by New Zealand adults

BACKGROUND/AIMS

Injuries to permanent teeth are common and can have lasting effects, but knowledge of their consequences is deficient because there is a lack of information from longitudinal follow-up studies of adult populations. The aim of this study was to use routinely collected adult dental trauma data from New Zealand's no-fault, Government-run social insurance scheme-the Accident Compensation Corporation-to investigate the presentation and subsequent care of dental injuries sustained by adults.

METHODS

Cross-sectional analysis of all new dental injuries recorded during 2008 was followed by prospective analysis of all treatment claimed in the following five years for all new injuries recorded in June 2008 for adults aged 18+ years. Those injuries were categorised into five clinically meaningful, ordinal groups of dental injuries, ranging from least severe (Minor injury) to most severe (Severe displacement). The prospective post-injury treatment information was summarised as (1) restorations; (2) crowns and veneers; (3) completed root canal treatment (preparation and obturation of root canal[s]); (4) extraction (extraction; surgical removal); and (5) implant placement.

RESULTS

Orofacial trauma details were recorded for 32 110 individuals (of all ages) in 2008; males predominated in all age groups, except for those aged 65+ years. Of the 68 890 separate injuries to permanent teeth recorded, 74.9% involved maxillary teeth, with almost 50% involving teeth 21 and 11. Some 66.9% of the dental injuries were classified as Minor; 21.7% involved Fractures or loosening, and 8.2% were Severe fractures. Displacement and Severe displacement injuries comprised 1.8% and 2.5% respectively. During June 2008, dental injuries were recorded for 1325 adults. More than 80% of those dental injuries underwent treatment during the subsequent five years, and more severe initial trauma required more complicated treatment. Minor injuries accounted for 33.5%, fractures/loosening for 50.8%, severe fractures for 1.2%, displacements for 8.8%, and severe displacements for 5.8% of the total cost of treatment provided over that five-year period.

CONCLUSIONS

Although most injuries sustained were minor, their subsequent treatment burden is not only high but also greater with more severe initial trauma. The ongoing societal cost of orofacial trauma appears to be high.

Risk of concomitant traumatic brain injuries in children with traumatic dental injuries in a pediatric emergency department: A case-control study

BACKGROUND

Children with traumatic dental injuries (TDIs) may simultaneously sustain a traumatic brain injury (TBI). The aim of this study was to investigate the risk of concomitant TBI in children with TDIs.

METHODS

Children (≤ 18 years) who sought treatment at the emergency department of a major children's hospital for TDIs from 2010 through 2019 were identified. Children with a concomitant TBI were assigned as case patients (TDI and TBI). Two control patients (TDI only) were randomly age- and sex-matched with each case patient. Associations between variables of TDI and concomitant TBI were tested using 6 logistic regression models.

RESULTS

Of 2,126 children with TDIs, 119 had concomitant TBIs (case patients). The control group consisted of 238 children with TDIs only who were age- and sex-matched with case patients. Mean (SD) age of children was 8.9 (4.8) years. Twenty-seven percent of case patients were female vs 32% of control patients. There was a statistically significant direct association between total number of injured teeth and concomitant TBIs (P = .01; odds ratio, 2.42; 95% CI, 1.22 to 4.79). For every tooth injured, the odds of concomitant TBI increased by 45% (P < .001; odds ratio, 1.45; 95% CI, 1.18 to 1.79). Number of displaced teeth, presence of avulsion or intrusion, number of fractured teeth, presence of complicated tooth fracture, and presence of alveolar fracture were not significantly associated with the odds of concomitant TBI.

CONCLUSIONS

The total number of injured teeth was positively associated with higher odds of concomitant TBI in this setting.

PRACTICAL IMPLICATIONS

In an emergency department setting, children with various types of TDIs sustained concomitant TBIs. For every tooth injured, the odds of concomitant TBI increased by 45%. Clinicians must systematically evaluate children with any TDI to rule out the possibility of concomitant TBI.

Long-term Outcome of Endodontically Treated Traumatized Immature Upper Incisors

INTRODUCTION

In a growing child, preservation of traumatized immature permanent upper incisors is challenging. This study aimed to evaluate the long-term outcome of endodontically treated traumatized immature upper incisors and associated variables.

METHODS

A total of 183 traumatized immature upper incisors treated with pulpotomy, apexification, or regenerative endodontic procedure (REP), with follow-up between 4 and 15 years, were assessed for presence of pulpal responses or periodontal/bone responses using standardized clinical and radiologic criteria. Logistic regression, including stage of root development, type and complexity of traumatic event, type of endodontic intervention, and history of orthodontic management, were used to estimate impact on tooth survival and occurrence of tissue responses. Study approved by Ethics Committee Research UZ/KU Leuven (S60597).

RESULTS

After a median follow-up of 7.3 years (interquartile range, 6.1-9.2), 159 teeth (86.9%) were still functional. From these teeth, 58 (36.5%) developed tissue responses. This was significantly associated with stage of root development at moment of trauma (root length <¾) and type of endodontic intervention (REP presenting worst outcome). Tooth loss (24 teeth, 13.1%) occurred after a mean time span of 3.2 years (±1.5) and was significantly associated with type and complexity of the traumatic event and type of endodontic intervention, with apexification showing better results than REP (odds ratio, 0.30; 95% confidence interval, 0.11-0.79).

CONCLUSIONS

A large number of endodontically treated traumatized immature teeth could be kept functional. Very immature teeth, teeth with periodontal tissue damage, and teeth treated with REP were at highest risk for an unfavorable outcome.

Dental trauma in endoscopy: A systematic review and experience of a tertiary endoscopy centre

BACKGROUND

Dental injury is the leading cause of litigation in anaesthesia but an underrecognized preventable complication of endoscopy.

AIM

To determine frequency and effects of dental injury in endoscopy, we present findings from an audit of outpatient endoscopy procedures conducted at a tertiary university hospital and a systematic review of literature.

METHODS

Retrospective review of 11265 outpatient upper endoscopy procedures over the period of 1 June 2019 to 31 May 2021 identified dental related complications in 0.284% of procedures. Review of literature identified a similar rate of 0.33%.

RESULTS

Pre-existing dental pathology or the presence of prostheses makes damage more likely but sound teeth may be affected. Pre-endoscopic history and tooth examination are key for risk stratification and may be conducted succinctly with limited time outlay. Tooth retrieval should be prioritized in the event of dental injury to minimize aspiration and be followed by prompt dental consultation for specific management.

CONCLUSION

Dental complications occur in approximately 1 in 300 of upper endoscopy cases. These are easily preventable by pre-endoscopy screening. Protocols to mitigate dental injury are also suggested.

Do orthodontic movements of traumatized teeth induce dental pulp necrosis? A systematic review

INTRODUCTION

Usually, orthodontic movements encompass children and young adult patients, which are more susceptible to the occurrence of traumatic dental injuries. It is necessary to understand whether the effects of orthodontic movements on traumatized teeth could induce pulp necrosis. The aim of this study was to answer the following question: "Do orthodontic movements of traumatized teeth induce dental pulp necrosis?".

MATERIAL AND METHODS

Searches were performed for studies published up to May 11, 2023, in the MEDLINE/PubMed, Cochrane Library, Scopus, SciELO Citation Index, Web of Science, EMBASE, and Grey Literature Report databases, without restriction for language or year of publication. The revised Cochrane risk of bias tools for nonrandomized interventions (ROBINS-I) was used to assess the quality of the included studies. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.

RESULTS

Of 2671 potentially relevant studies, five were included. Four were classified as having a moderate risk of bias and one as a serious risk of bias. It was reported a higher susceptibility to pulp necrosis in teeth subjected to orthodontic movements with history of trauma involving periodontal tissues. Additionally, orthodontic movements of traumatized teeth with total pulp obliteration had an increased risk of pulp necrosis. GRADE analysis presented a moderate certainty of evidence.

CONCLUSIONS

An increased risk for pulp necrosis when traumatized teeth are subjected to orthodontic movements was verified. However, this is based on evaluations performed with subjective tests. Further well-designed studies are necessary to confirm this trend.

CLINICAL RELEVANCE

Clinicians must be aware of the possibility of pulp necrosis. However, endodontic treatment is recommended when verified signs and symptoms of pulp necrosis.

Knowledge, Attitudes, and Practices of School Teachers Regarding Dental Trauma and its Emergency Management in Madinah, Saudi Arabia: A Questionnaire-Based Online Cross-Sectional Survey

Introduction

Traumatic dental injuries (TDIs) are a common occurrence in the general population, and they are one of the most severe dental public health issues among children.

Aim

This cross-sectional study aims to assess the knowledge, attitude, and practices of school teachers in Madinah, Saudi Arabia, regarding dental trauma and its emergency management.

Material and Methods

This cross-sectional study included teachers of elementary and middle schools both male and female in Madinah. Each teacher received a study questionnaire and was briefed about the procedure of filling it. The questionnaire contained 17 questions which are related to the knowledge, attitude, and practices relating to TDIs.

Results

A total of 294 teachers participated in the present study, which includes 163 males (55.4%) and 131 females (44.6%). When we asked the respondents if an avulsed tooth may be replanted, 49.7% answered in the positive and men show more awareness compared to women. When questioned regarding the storage media, 31.3% of participants said they will store the tooth in a cloth or tissue which was the wrong answer and 60.9% of males and 39.1% of females were unaware of appropriate storage media. A percentage of 68.4 of the teachers were not willing to replant a knocked-out tooth (tooth avulsion), 59.7% of these were males, and 40.3% were females. A percentage of 59.2 of participants consider that the dental trauma is an emergency situation, while 25.9% did not consider it as an emergency situation and 15% were not aware of the same.

Conclusion

The majority of the participants were not aware of dental trauma and its emergency management. Children indulge in contact sports and play at schools posing the risk for a significant amount of dental trauma. Affirmative action from teachers is critical for successful treatment outcomes.

Development and validation of a novel index to assess the perceived impact of sports-related oro-dental trauma among adolescents: findings from Sri Lanka

BACKGROUND

Sports-related oro- dental trauma, such as tooth fracture, displacement, mobility, and avulsion, cause significant concern among adolescent players due to detrimental impacts. The current study aims to develop, validate and assess the reliability of a simple index as a questionnaire to assess the impact of sports-related oro-dental trauma both untreated and treated, among adolescent school children in Sri Lanka.

METHODS

AODTII, an adolescent oro-dental trauma impact index, was developed and validated using a mixed-method approach. Items for the index were generated by quantitative as well as qualitative analysis of the results from Oral Health-Related Quality of Life Questionnaires, personnel interviews with experts and focus group discussions with adolescents. Principal component analysis and Exploratory factor analysis were used to create the index. The index was validated in the Sinhala language, and the reliability of the index was assessed using a separate sample in the school context in the Colombo district.

RESULTS

The initial list of 28 items was reduced to 12 by the Principal Component Analysis. Exploratory Factor Analysis categorised the variables into four latent constructs; physical impact, psychosocial effect influenced by peer pressure, the impact of oral health care and the impact caused due to unmet dental trauma treatment need. The cut-off values of the AODTII were based on PCA. The index achieved the Content Validity Ratio of 88.33. The construct validity was assessed with confirmatory factor analysis by developing a structural equation model. It obtained good model fit indices of RMSEA value of 0.067, SRMR of 0.076, CFI of 0.911 and the Goodness of Fit index of 0.95. The homogeneity was ensured with convergent and discriminant validity. The Cronbach's alpha value was 0.768, ensuring reliability. The index assesses the level of impact due to oro- dental trauma and identifies whether the adolescents perceive it significantly or not.

CONCLUSION

Twelve-item AODTII emerged as a reliable and valid tool to assess the perceived impact of untreated and treated sports-related oro- dental trauma on Sri Lankan adolescents with implications for its use in other populations. Further research is required to improve the translational value of AODTII. Moreover, the tool is potential as a patient-centred communication tool, clinical adjunct, advocacy tool and a useful OHRQoL index. However, it is needed to be supported end-users' feedback.

Impact of dental and orofacial trauma on oral health-related quality of life in adults: A systematic review

PURPOSE

Dental and orofacial trauma among the adult population constitutes a major public health problem. The impact is not just physical but also psychological. To analyse the impacts of dental and orofacial trauma on oral health-related quality of life (OHRQoL) in adults and determine whether the 2 variables are closely interlinked.

METHODS

This is a systematic review. The terms "dental trauma", "orofacial trauma", "oral health", "oral health related impact life", "OHRQoL", "positive and negative affect scale", "quality of life", "facial injuries", "adults", and "young adults" were researched in the databases of PubMed, ScienceDirect, Scopus and Google Scholar for associated studies up to December 30, 2022. A comprehensive search was designed and the articles were independently screened for eligibility by 2 reviewers. The included studies' author, year of publication, the country where the study was conducted, population demographics (number and age), an instrument used for assessing OHRQoL and the relevant result were recorded and compared. The quality of the evidence was assessed using Joanna Briggs Institute checklist for observational studies.

RESULTS

Out of 482 unique records, 3 articles were included for data extraction. Observational studies were included. Two studies did not mention confounding factors. Different scales were used for dental and orofacial trauma and OHRQoL. OHRQoL has a directly proportional relationship with orofacial trauma. Adolescents with orofacial trauma have a significant impact on this value with a prevalence of 88.4%.

CONCLUSION

The highest impact on OHRQoL was seen immediately after the diagnosis of an orofacial trauma. The impact increases with the severity of the trauma. Therefore, to promote overall dental and general health, health education initiatives should include information on the causes, prevention, and requirement for prompt responses by the populace in seeking dental intervention.

Splinting in the management of dental trauma in the primary dentition: a systematic review

PURPOSE

The purpose of this study was to gather existing data on the efficacy of tooth splinting (TS) in patients with traumatized primary teeth, evaluating their overall prognosis and reported complications.

METHODS

Electronic searches were performed in seven databases up to Februray/2023. Clinical studies published in the last two decades and presenting the following characteristics were included: (a) reporting on children with traumatized primary teeth; (b) describing the efficacy of splinting those teeth. Studies describing imobilization of dental avulsion were excluded.

RESULTS

A total of 163 potentially relevant studies were initially found. After title/abstract screening, and full-text evaluation, three retrospective studies with moderate to high risk of bias were included. The studies described the outcomes of TS in primary teeth with luxation (intrusion, extrusion, lateral displacement), intra-alveolar root fracture, and/or alveolar fracture. High clinical success rate was observed for teeth with root fracture. Benefits of spliting teeth with lateral luxation were not identified, although it may be a reccomended approach. No study was found evaluating TS for alveolar fracture.

CONCLUSION

Based on a low level of evidence, the findings highlight a better clinical success rate of the use of TS in the management of deciduous teeth with root fractures.

Assessment of mouthguards worn by Irish children playing contact sports: an observational cross-sectional cohort study

PURPOSE

Traumatic dental injuries occur during participation in sports. Prevention of these injuries by wearing a mouthguard (MG) is desirable, especially in a paediatric population. There are several types of MG available, and their effectiveness depends on device design. The aim of this study was to examine the features of MG worn by children playing a contact sport (Gaelic football), and to determine whether these MG fulfilled recommendations for adequate dentoalveolar protection.

METHODS

A cross-sectional observational cohort study design was developed. Dentists were trained and calibrated in assessing MGs, both qualitatively (retention, extension, integrity) and quantitatively (thickness). A convenience sample of male and female subjects aged 9-16 years was selected for MG assessment via their sports clubs. Data were collected anonymously and analysed using descriptive and comparative statistics.

RESULTS

One hundred and six children presented with their MG for assessment. Two-thirds were wearing mouth-formed MG (N = 71, 66.96%). Only four were wearing custom MG (3.77%). Most MG had inadequate retention (N = 86, 81.13%) and labial extension (N = 89, 83.96%), with a significant relationship between MG type and retention. Mouthguard thickness varied widely at each site. Mouth-formed MG were significantly thicker than both stock and custom MG.

CONCLUSIONS

Mouth-formed MG were the most common type followed by stock MG. Most MG did not have appropriate retention or labial extension. Parents and coaches need to be aware of MG features that maximise protection. If mouth-formed MG are provided in this age group, education on how to adapt them is essential. Paediatric dentists should check MG routinely for appropriate fit.

Dentist perspective on knowledge and practice toward Ellis class 3 tooth fracture: A survey

Traumatic dental injuries otherwise referred to as dental trauma is common in dental practice. The etiology of dental trauma is mostly falls and accidents in case of children and young adults. The treatment provided should be quick and effective which depends on the extent of the dental trauma, the injury might expose enamel, dentine and pulp of the affected teeth. Ellis class 3 involves all the 3 layers mentioned, so there should be quick measures taken. A survey was conducted among dental practitioners to assess their knowledge and practice experience about Ellis class 2 fracture. Detailed questionnaire was created with questions about Ellis class 3 tooth fracture and was circulated to 100 dental practitioners in Chennai, Tamilnadu through google forms. The collected data was analyzed using SPSS software. The knowledge and practice of Ellis class 3 trauma was 85%, the dental practitioners have adequate knowledge about the various clinical, diagnostic aids used and are aware to provide the correct treatment for each case. Based on the responses from the dental practitioners there is not much practice of Ellis class 3 dental trauma in their dental practice. Thus the present study concludes that the knowledge and practice of Ellis class 3 teeth fracture is good among dental practitioners and the various aspects are well known by dentists.

Impact on Quality of Life and Risk Factors Associated with Visible Maxillary Incisors Trauma among Young Children in Faridabad, Haryana

Aim

To assess the impact of upper incisor trauma on the quality of life (QoL) in young children studying between the age group 8 and 13 years in Faridabad, Haryana.

Materials and methods

A cross-sectional, prospective study was conducted to assess the visible permanent maxillary incisor traumas according to the classification of traumatic dental injuries (TDI) and to determine the predisposing risk factors that affect TDI and their impact on QoL in children aged 8-13 years. Questionnaires were made to gather information on demographic and socioeconomic characteristics like age, gender, and the father's and mother's education. Data on dental caries in anterior teeth were also collected using current World Health Organization criteria.

Result

There were a total of 66 males and 24 females. The total decayed, missing, and filled permanent teeth (DMFT) prevalence observed was 8.9%. The main reason for trauma was found to be an accident or accidental fall (36.7%). The most common place for trauma followed by road (21.1%). Time lapsed from the injury reported was >1 year in males (34.8%), while it was within 1 year (41.7%) in females (p = 0.014). The most prevalent and impacted performance was smiling (80.0%; m = 8.7778 ± 8.658), and the least affected was speaking (4.4%; m = 0.5111 ± 3.002).

Conclusion

A number of risk factors need to be considered when assessing TDIs, as TDIs can have a negative impact on the functional, social, and psychological well-being of young children. As they are frequent in children, affecting teeth, their supporting structures, and adjacent soft tissues, they may cause both functional and esthetic problems.

Clinical significance

When injuries to incisor(s) produce pain, disfigurement, poor aesthetics, or other psychological effects, children may avoid laughing or smiling, and this can affect their social relationships. So, it is important to address the risk factors that predispose upper front teeth to TDIs.

How to cite this article

Elizabeth S, Garg S, Saraf BG, et al. Impact on Quality of Life and Risk Factors Associated with Visible Maxillary Incisors Trauma among Young Children in Faridabad, Haryana. Int J Clin Pediatr Dent 2022;15(6):652-659.

Association of malocclusion and trauma in children: A retrospective study

Malocclusion is considered one of the most prevalent oral issues and it is considered one of the major risk factors for dental trauma. Dental trauma is a distressing experience for children, and they can have long-term physical, esthetic, and psychological effects. Hence, the main aim of this retrospective study is to evaluate the association between dental trauma and malocclusion in children. Four hundred and fifty patients between the age of 8 and 17 years during March 1, 2020-February 31, 2021, with Ellis classes 1, 2, and 3 were included in the study. Association of type of fracture with gender and malocclusion was calculated using Chi-square test. In case of Ellis class 1 fracture, 9.1% of the patients had no malocclusion, 21.8% of them had crowding, 11% of them had spacing, and 21.8% of them had anterior protrusion. In case of Ellis class 2 fracture, 4.3% of them had no malocclusion, 6.4% of them had crowding, 2.8% of them had spacing, and 3.6% of them had anterior protrusion. In case of Ellis class 3 fracture, 2.7% of them had no malocclusion, 6.4% of them had crowding, 4.6% of them had spacing, and 4.6% had anterior protrusion. The results were not statistically significant. Children with anterior protrusion and anterior crowding are more prone to severe damage during traumatic dental injuries.

Prevalence and Risk Factors of Dental Trauma in Ha'il, Saudi Arabia

AIM

This study will aid in determining the prevalence and risk factors for dental trauma. This will assist in developing a treatment budget plan, thereby, fend off complications.

MATERIALS AND METHODS

This study was an observational study, having a cross-sectional design, in which information was obtained from 555 participants. Data were obtained using a non-probability convenient sampling technique. A validated questionnaire was used as a study tool. Data were analyzed using the statistical package for the social sciences (SPSS, version 20). Descriptive and inferential statistics were used. Data were displayed as numbers and percentages, and the Chi-squared test was used to measure the association.

RESULTS

Dental trauma was found to be 44% prevalent. Most of the injuries occurred in the 6-9-years age-group (19.1%) and were more common in boys (54.13%) than in girls. The majority of respondents (61%) identified "falls" as the most common cause of dental trauma, and the frequent location for the occurrence of dental injuries was found to be "home" (64.44%). Only 18% of parents reported that their kid's experienced nail-biting concerns, with the majority claimed that their kids never developed oral habits. Most dental injuries occurred during the summer season (48%).

CONCLUSION

Young aged group and male gender group were more prone to dental injuries; dental injuries along with fall were found as the most common cause of dental trauma, whereas most of the dental traumas were reported to have occurred at home.

CLINICAL SIGNIFICANCE

The study evaluated risk factors and the prevalence of dental trauma in the population of Ha'il, Saudi Arabia. It will be an effective tool for determining the need for treatment facilities.

Measurement of association between malocclusion, nutritional status, and dental trauma in adolescents: A cross-sectional study

Background

With the decrease in the incidence of dental caries globally, traumatic dental injury (TDI) has emerged as a major cause of morbidity and distress among adolescents. The aim of this study was to assess the prevalence of TDI and explore its association with malocclusion and nutritional status among adolescent population of Udupi taluk, Karnataka state, India.

Methods

The sample consisted of 770 children, from randomly selected schools in Udupi taluk. An anthropometric measurement was done to record the "body mass index", an oral examination was done to record the "Dental Aesthetic Index" for malocclusion and "Andreasen classification" for TDI. Statistical analysis included chi-square test and bivariate and multivariate binary logistic regression. A p value of ≤0.05 was considered statistically significant.

Results

The prevalence of TDI was 11.8%. The prevalence of overweight and obesity was 20.3%. The prevalence of malocclusion recorded in the study population was 49.8%. When prevalence of TDI was compared against gender, the type of school attended, and presence/absence of malocclusion, it was found that there was a statistically significant difference in prevalence of trauma between the aforementioned parameters (p ≤ 0.05). Results of the multivariate analysis through logistic regression indicated that being a male [3.87 (3.21-4.72)], attending a public school [1.41 (1.19-1.63)], and having malocclusion [1.55 (1.32-1.71)] significantly increased the odds of sustaining TDI.

Conclusion

The results indicated a strong association between TDI, gender, the type of school attended, and malocclusion, and they have important implications toward the health and well-being of the individual communities.

Evolution of root length throughout orthodontic treatment in maxillary incisors with previous history of dental trauma: a longitudinal controlled trial

OBJECTIVES

To compare changes in root length of maxillary incisors with and without dental trauma throughout orthodontic treatment.

MATERIALS AND METHOD

Patients younger than 18 years, with trauma on at least one maxillary incisor, undergoing orthodontic treatment between 2017 and 2021 were included, using the contralateral side as control without trauma when available. Periapical radiographs were taken pre-treatment and at 6 months intervals, and root/crown ratio was calculated. Linear mixed models were used to describe the evolution of root length at the different time points and to compare trauma and control values. Differences between central and lateral incisors and between treatment modalities were additionally explored.

RESULTS

A total of 1768 measurements were performed on 499 teeth (201 with trauma) in 135 patients. Incisor root length significantly decreased during orthodontic treatment in teeth with and without trauma. Lateral incisors with trauma were more susceptible to root resorption than those without trauma and central incisors. No significant decrease in root length was observed with removable appliances, which never exceeded 15 months of treatment. Treatment with fixed appliances led to gradually increasing, significant root length shortening in teeth with and without trauma.

CONCLUSION

Treatment duration directly correlated with root length shortening both in teeth with and without trauma history. Teeth with trauma showed significantly more root resorption after treatment with fixed appliances while removable appliances had no significant influence on root length.

CLINICAL RELEVANCE

Previous history of dental trauma is no absolute contra-indication to start orthodontic treatment, as long as treatment duration is kept as short as possible.

Spontaneous healing of complicated crown-root fractures in children: Two case reports

BACKGROUND

Complicated crown-root fracture is considered a severe dental trauma and is unlikely to heal without treatment. Usually, dentists have to remove the loose coronal fragment of the fractured tooth and treat the remaining part with multidisciplinary approaches. However, we observed spontaneous healing of fracture in two pediatric cases with a history of complicated crown-root fractures over 4 years ago.

CASE SUMMARY

In case 1, a 12-year-old boy complained of pain at tooth 11 following an accidental fall 1 d ago. Clinical examination showed a crack line on the crown of tooth 11. Cone beam computed tomography (CBCT) images of tooth 11 showed signs of hard tissue deposition between the fractured fragments. The patient recalled that tooth 11 had struck the floor 1 year ago without seeking any other treatment. In case 2, a 10-year-old girl fell down 1 d ago and wanted to have her teeth examined. Clinical examination showed a fracture line on the crown of tooth 21. CBCT images of tooth 21 also showed signs of hard tissue deposition between the fractured fragments. She also had a history of dental trauma 1 year ago and her tooth 11 received dental treatment by another dentist. According to her periapical radiograph at that time, tooth 21 was fractured 1 year ago and the fracture was overlooked by her dentist. Both of these two cases showed spontaneous healing of complicated crown-root fractures. After over 4 years of follow-up, both fractured teeth showed no signs of abnormality.

CONCLUSION

These findings may provide new insights and perspectives on the management and treatment of crown-root fractures in children.

Does clinical experience with dental traumatology impact 2D and 3D radiodiagnostic performance in paediatric dentists? An exploratory study

Background

The aim of this study is to evaluate the impact of experience with traumatic dental injuries (TDI) on paediatric dentists’ performance and self-assessed confidence when radiodiagnosing traumatic dental injuries (TDI) and to explore whether this is influenced by the imaging technique used (2D versus 3D).

Materials and methods

Both 2D and 3D radiological images of young anterior permanent teeth having experienced dental trauma were assessed randomly by a panel of paediatric dentists using structured scoring sheets. The impact of level of experience with dental traumatology on radiological detection, identification and interpretation of lesions and on observer’s self-assessed confidence was evaluated. Findings were compared to benchmark data deriving from expert consensus of an experienced paediatric endodontologist and dentomaxillofacial radiologist. Results were analysed using generalized linear mixed modelling.

Results

Overall, observers performed moderately to poor, irrespective of their level of TDI experience and imaging modality used. No proof could be yielded that paediatric dentists with high TDI experience performed better than those with low experience, for any of the outcomes and irrespective of the imaging modality used. When comparing the use of 3D images with 2D images, significantly higher sensitivities for the detection and correct identification of anomalies were observed in the low experienced group (P < 0.05). This was not the case regarding interpretation of the findings. Self-assessed confidence was significantly higher in more experienced dentists, both when using 2D and 3D images (P < 0.05).

Conclusion

There was no proof that paediatric dentist’s higher experience with TDI is associated with better radiodiagnostic performance. Neither could it be proven that the use of Cone Beam Computed Tomography (CBCT) contributes to an improved interpretation of findings, for any experience level. More experienced dentists feel more confident, irrespective of the imaging modality used, but this does not correlate with improved performance. The overall poor performance in image interpretation highlights the importance of teaching and training in both dental radiology and dental traumatology.

Patient-reported outcome measures for children and adolescents having dental bleaching in the UK

PURPOSE

Dental bleaching in paediatric patients can be used to address discolouration of teeth due to trauma, endodontic treatment, or enamel and dentine defects. Despite being a minimally invasive and successful treatment, the use of bleaching products in children and young people remains controversial. This evaluation was designed to provide insight into the child's perspective on dental bleaching and the influence that this treatment has upon their life.

METHOD

A dental bleaching patient reported outcome measure (PROM) was developed and piloted in 2019. Data were collected from 3 UK units (January-March 2020). Children attending these units for bleaching reviews were invited to complete the PROM.

RESULTS

Twenty seven PROM questionnaires were completed including 19 courses of external bleaching and 8 courses of internal/external bleaching. The average age was 14 years old (9-17 years). The common indications for bleaching were Amelogenesis Imperfecta, dental trauma and Molar Incisor Hypomineralisation. Patients reported improvements in their appearance (89%) and self-confidence (81%). Sensitivity was the most common side effect, reported in 63% of cases.

CONCLUSION

This PROM supports the use of dental bleaching in children and young people when treating dental disease that causes discolouration. Bleaching not only improved the appearance of teeth, but also patients' self-confidence. Sensitivity is a common side effect and clinicians should discuss this common risk and its management with patients and their families.

Re-evaluating the need for orthopantomography in the management of mandibular trauma: is computed tomography enough?

BACKGROUND

Mandibular fractures are frequent indications for computed tomography (CT) and orthopantomography (OPG) scans in emergency rooms. Numerous studies found CT to have higher sensitivity and enhanced accuracy compared to OPG in diagnosing mandible fractures. Controversy exists regarding additional need for OPG when evaluating dental trauma. This study investigates whether OPG adds diagnostic value to CT in mandibular trauma and whether additional OPG significantly alters management.

METHODS

A retrospective chart review identified 100 patients ≥ 18 years of age with known mandibular trauma who received CT and OPG in the emergency department between May 2015 and January 2020. All patients demonstrated a fracture in at least one study. CT and OPG studies were anonymized and randomized. A single attending surgeon evaluated mandible fracture and dental trauma characteristics and subsequently compared findings.

RESULTS

One hundred patient CT and OPG scans were reviewed. CT detected mandible fractures in all patients and OPG detected fractures in 93% (p = 0.01). Twenty-eight patients had different findings between scans. CT demonstrated 1 or more additional fracture(s) than OPG in 20 patients and dental trauma not seen on OPG in 4. OPG detected 1 fracture and no dental trauma that was not seen on CT. CT drove treatment-determining differences in 17 cases and OPG in 0 cases.

CONCLUSIONS

CT appears efficacious in detecting clinically significant mandible fractures and dental trauma with little additional benefit from OPG in emergency settings. Helical CT may be the only imaging necessary in evaluating patients with such trauma.

Traumatogenic Occlusion in a Pediatric Dental Patient: A Case Report

Aim and objective

This case report aims to describe the management of mandibular anterior teeth subjected to occlusal trauma.

Background

Occlusal trauma occurs as a result of reduced ability of the tissues to resist the occlusal forces most likely as a result of masticatory system dysfunction abnormal contact of the teeth, and prosthetic or orthodontic treatments that create occlusal interferences.

Case description

This paper describes a case of traumatogenic occlusion seen in the dentition of a 13-year-old female patient and its management by stabilization, endodontic, and orthodontic therapy.

Conclusion

The removal of the anomalous occlusal forces and stabilization of the affected teeth is the most relevant therapy for teeth affected by trauma from occlusion (TFO).

Clinical Significance

Periodic monitoring of developing occlusion contributes to preventive care and encourages the maintenance of a healthy periodontium.

How to cite this article

Kartha S, Vellore KP, Challa SK, et al. Traumatogenic Occlusion in a Pediatric Dental Patient: A Case Report. Int J Clin Pediatr Dent 2022;15(2):222-226.

IADT 2020 Guidelines: What should the dental professional know?

Traumatic dental injuries are a common occurrence among children. Effective acute and long-term management of traumatic dental injuries can improve patient outcomes, especially in the paediatric patient. It is important that all dental professionals follow up-to-date, evidence-based guidance when treating patients. This article aims to highlight the main changes in the 2020 International Association of Dental Traumatology (IADT) Guidelines for Evaluation and Management of Traumatic Dental Injuries, to ensure that all dental professionals are fully aware of current guidelines and are managing patients appropriately.

Intentional Replantation as Treatment of Extrusive Luxation: A Case Report

Accurate diagnosis, immediate care and proper treatment planning are important factors for the successful treatment of dental traumatic injuries. In extrusive luxation, postponement in treatment may lead to the need for new strategies for the resolution of unwanted consequences. The present case report describes an unusual condition of delayed treatment regarding extrusive luxation of two anterior teeth treated by intentional replantation. An 18-year-old female patient attended the Dental School for the treatment of a traumatic injury to the anterior teeth 5 days after a fall from a bicycle. Clinically, teeth #21 and #22 were extruded in incisal edges for 5 mm from their neighboring teeth, had edematous gingiva, showed grade II mobility and were painful to percussion. Radiographically, the roots were intact and the periodontal ligament space was thickened along its entire length. As immediate repositioning could not be performed, intentional replantation was recommended. After detaching the periodontal ligament, the teeth were extracted and the alveolus was curetted and irrigated with saline solution to remove the already-formed clot. After replantation, the teeth were restrained and the patient was medicated with antibiotics as well as analgesics. After 10 days, the splint was removed, the root canals were instrumented and then, filled with calcium hydroxide. After 30 days, they were completely obturated using gutta-percha. The 5-year follow-up showed root integrity, absence of mobility and normal periodontium. The outcomes of the current case report revealed that when intentional replantation was properly conducted, it could be considered an option for the treatment of extrusive luxation where the teeth were not to be immediately repositioned.

Sports Cult in Hyderabad: Role of a Pedodontist in Protecting Winning Smile

Aim and objective

To assess dental trauma, level of knowledge of participants about the preventive measures, and management of traumatic dental injuries during sports in children aged 6–15 years in private sports academies in Hyderabad.

Materials and methods

A cross-sectional study was carried out among 317 children aged 6–15 years and 25 coaches by a structured questionnaire to assess the prevalence of dental trauma during sports followed by an awareness program on prevention. Data obtained were analyzed.

Results

Twenty-two percent (76) of children reported an incidence of dental injuries. Thirty-five percent (111) of children were aware that reimplantation was possible. Forty-three percent (139) of children knew that mouthguards can prevent orofacial injuries, but none are using them. Seventy-six percent (19) coaches would refer the child to a general physician in cases of reported trauma.

Conclusion

In our study, most of the children and coaches lack awareness about sports-related dental injuries, their prevention, and initial management. None of the children were using mouthguards. Pediatric dentists should conduct programs at schools/sports academies to spread knowledge and awareness about sports-related dental injuries. Further studies are required in this aspect with a larger sample size.

How to cite this article

Pranitha V, Mounika PBN, Dwijendra SK, et al. Sports Cult in Hyderabad: Role of a Pedodontist in Protecting Winning Smile. Int J Clin Pediatr Dent 2021;14(5):652–656.

Traumatic Dental Injuries in Pediatric Patients: A Retrospective Analysis

Aim

This retrospective study aimed to analyze dental traumatic injuries and their management in children up to 16 years of age.

Materials and methods

Records of the patients who sustained dental trauma from 2013 to 2018 were evaluated for age, gender, etiology, type of injuries, and their management. Children were divided into three groups-primary (0-5 years), mixed (6-11 years), and permanent dentition group (12-16 years). Dental trauma was assessed by Ellis and Davey's classification of tooth fracture along with other associated injuries.

Results

Total records of 466 children with 750 injured teeth (665 permanent and 85 primary) were evaluated. Males were reported twice as females. Fall was noted as the major etiological factor (93.1%). The highest frequency of dental trauma was observed in the permanent dentition group (54.7%). Ellis class IV fracture was the most common dental injury and maxillary central incisor was the most frequently injured tooth. Soft tissue injury was noted as the most commonly associated injury. Most of the dental traumatic injuries in permanent teeth were treated by root canal treatment while the majority of primary dentitions were managed by observation and wound care.

Conclusion

Ellis class IV fracture was noted as the most frequent type of dental injury and fall was a major etiological factor. The permanent dentition group of children was more affected and a male predominance was observed.

Clinical significance

The information gained from the present study would help in providing various preventive modalities to parents, caregivers, and teachers regarding these injuries in the future and also facilitate several new researches in this field.

How to cite this article

Patidar D, Sogi S, Patidar DC, et al. Traumatic Dental Injuries in Pediatric Patients: A Retrospective Analysis. Int J Clin Pediatr Dent 2021;14(4):506-511.

Dental Trauma and Alveolar Fractures

A dentoalveolar fracture requires thorough clinical and radiographic examination for an accurate diagnosis to guide appropriate treatment. Dentoalveolar fractures can be classified into the following 4 groups: (1) crown/root fractures, (2) luxation/displacement of teeth, (3) avulsion, and (4) alveolar fractures. Treatment can be divided into nonrigid fixation (splinting with wires and composite) and/or rigid fixation (Erich arch bars, Risdon cable wires) depending on the extent of dentoalveolar fractures. Special considerations must be made for primary teeth and mixed dentition to avoid injuring tooth buds and arising permanent dentition.

Limitations and Management of Static-guided Endodontics Failure

Endodontic treatment in severely calcified canals is always a challenging task because it can result in accidents such as deviations or perforations. Recently, guided endodontics has become an alternative approach for pulp canal calcification, facilitating the location of root canals more predictably through the combined use of cone-beam computed tomographic imaging, oral scanning, and endodontic access guides. Although several reports have shown that guided endodontics is safer, faster and can be performed without an operating microscope and by less experienced operators, the technique has limitations, and iatrogenesis may occur. This article describes the limitations of static-guided endodontics and possible causes of failures. In the present case, not fixing the guide to the bone and inaccuracies generated by manually performing mesh merger software led to root perforation. Endodontic microsurgery was effective in resolving this case and should be considered the treatment of choice when guided endodontics cannot be used safely or when it fails.

Management of extrusive luxation of upper incisors in young permanent teeth: a case report

This case report documents the clinical approach adopted for two permanent maxillary incisors with extrusive luxation in a 16-year-old boy. The proposed procedures involved reposition of both teeth, by digital pressure and stabilized by using semi-rigid splint for 2 weeks. Endodontic therapy was performed. Clinical and radiographic follow-up examinations were conducted at 6-month intervals for two years. Assessment revealed the absence of pulpal and periapical disease and the restoration of the maxillary incisors to a state of health and normal function. A long-term clinical and radiological follow-up is needed to prevent and precociously detect possible complications that may occur following a extrusive luxation.

Prevalence, Trends, and Associated Risk Factors of Traumatic Dental Injury among Children and Adolescents in India: A Systematic Review and Meta-analysis

AIM AND OBJECTIVE

Traumatic dental injury (TDI) is a significant public health concern. This study aimed to perform a systematic review on the prevalence, trends, and possible risk factors of dental trauma in permanent teeth among children and adolescents in India.

MATERIALS AND METHODS

Literature search was carried out, in PubMed, EMBASE, Web of Science, Cochrane, Google scholar, and Gray literature (MDS dissertation, manuscripts) database up to October 5, 2020, reporting on dental trauma prevalence in India. Meta-analyses were done using random effects model. Pooled estimates were calculated with a confidence interval of 95% (95% CI) both for prevalence and odds ratios (OR). Trend analysis was performed for the included studies. Quality assessment of the included studies was done using the Hoy checklist for prevalence studies. Qualitative synthesis was done for predictors in which meta-analysis could not be performed.

RESULTS

This online searching strategy collected and listed 2,491 articles on this topic. After evaluating their titles and abstracts, only 59 were finally selected for complete review and data collection. All studies had been performed in children and adolescents. The pooled prevalence of dental trauma in permanent teeth was 11%. Positive summary association of dental trauma with male gender (pooled OR = 1.52; 95% CI: 1.37-1.70), inadequate lip coverage (pooled OR = 4.76; 95% CI: 3.18-7.11), and increased overjet of >3.5mm (pooled OR = 4.84; 95% CI: 2.86-8.19) and >5.5 mm (pooled OR = 4.93; 95% CI: 4.32-5.63) was observed. Prevalence of dental trauma showed an increasing trend with time. All of the studies were having moderate-high risk of bias.

CONCLUSION

Approximately 9-13% of the children and adolescents in India presented some type of TDI in permanent teeth, with an increasing trend. Boys, children, and adolescents presenting inadequate lip coverage, or an increased overjet greater than 3.5 and 5.5 mm are more likely to have traumatic dental injuries.

CLINICAL SIGNIFICANCE

Future population-based analytical studies on TDI in India are recommended.

A three-dimensional finite element analysis of permanent maxillary central incisors in different stages of root development and trauma settings

BACKGROUND AND OBJECTIVES

Differences in dental maturation may affect the prognosis and clinical management of traumatized teeth. However, evaluation of the outcomes of dental trauma to the tooth and support structures in an in vivo model involves major methodological and ethical implications. Thus, the aim of the present study was to perform a three-dimensional finite element analysis of permanent maxillary central incisors in different stages of root development under different trauma settings.

METHODS

The study factors included two trauma conditions (B, buccal; I, incisal) on upper permanent central incisors showing three different stages of root development (CR, complete rhizogenesis; IRA; incomplete rhizogenesis in the apical third of the root; and IRM, incomplete rhizogenesis in the middle third of the root) to yield six models. The complete rhizogenesis model was obtained with a cone-beam computed tomography examination of an extracted tooth. The two incomplete rhizogenesis models were modeled on the basis of similar examinations of patients. Trauma was simulated by applying a 300 N static surface to surface load on the incisal edge or perpendicular to the buccal surface of the tooth. The displacement and equivalent von Mises (σvM) stress values were obtained for alveolar bone, periodontal ligament, apical papilla, and dentin for the quantitative analysis. A σvM color-coded scale was used for qualitative analysis.

RESULTS

The force direction had a greater influence on the stress than the root-formation stage. Buccal forces resulted in higher stress concentration in the bone and periodontal ligament, especially in B-CR. Lower stress was found on the periodontal ligament as the root formation progressed (decrease of 8% from B-IRA to B-CR and 11% from B-IRM to B-CR). The incomplete rhizogenesis models showed higher σvM stress peak values in dentin in comparison with complete rhizogenesis (increase of 52% from B-CR to B-IRA and 56% from B-CR to B-IRM).

CONCLUSIONS

Buccal forces yielded greater stress values regardless of the stage of rhizogenesis. Teeth with fully formed roots showed a higher stress concentration in the alveolar bone and periodontal ligament in comparison with immature teeth, with the latter presenting high stresses in the tooth crown.

Minimally invasive approach supported by the use of mouthguard in the treatment of sport-related root fracture: a case report

All sporting activities have an associated risk of orofacial injuries that can affect the oral health-related quality of life (OHRQoL). A custom-made mouthguard can be used as an adjuvant treatment for faster recovery of an athlete to resume sporting activities. This case report described a minimally invasive approach by use of mouthguard for treating sport-related root fracture and its impact on OHRQoL. In a dental trauma care program, the patient was treated by repositioning the coronary portion and the confection of a splint. It was opted to not realize the endodontic treatment and the patient was inserted in a rigorous clinical and radiographic follow-up. A custom-made mouthguard was made, which allowed for the immediate return of athletes to practicing sports. The athlete's OHRQoL was negatively impacted by dental trauma, but the treatment proposed was associated with the use of custom-made mouthguards. After 2 years, the absence of radiographical lesions and a positive response to sensibility tests were observed. The success of the minimally invasive approach was attributed to immediate conduct following dental trauma, the implementation of follow-up, and associated with the use of custom-made mouthguard.

Assessment of the knowledge and attitudes about the management of dental trauma among ear, nose and throat physicians

PURPOSE

Ear, nose and throat physicians (ENTp) encounter dental trauma (DT) when patients refer to the emergency department, as well as during operations such as tonsillectomy and suspension laryngoscopy. This study aimed to investigate the attitudes and knowledge of ENTp about managing DT, and motivation for further education.

METHODS

This study was a cross-sectional observational survey on a sample of ENTp from 15 different private/public hospitals. A questionnaire of 22 questions was divided into three parts: the level of professional experience and the frequency of encountering DT; specific questions on the management of DT; self-assessment of educational approach and level of knowledge regarding DT.

RESULTS

A total of 128 surveys were accomplished and included in the evaluation. A larger percentage (96.9%) of the participants have experienced at least one case in the practice, and one-third (31.3%) have encountered more than ten DT cases. Although the duration of experience significantly affected the total number of correct responses to knowledge and attitudes regarding DT questions (p:0.028), more than half of the participants (44.38%) responded incorrectly to the questions. The majority of participants (97.7%) stated that they had no education on DT, and 90.6% were willing to receive DT training.

CONCLUSIONS

The results of this study emphasize the deficiency of ENTp' knowledge level about the management of DT. In addition, results demonstrated the enthusiasm of ENTp for further training, which can contribute to the requirement of education for providing appropriate management of DT cases.

Dental Trauma on whole Body Trauma CT-An underreported finding

Background

The prevalence of dental injuries (DI) in polytrauma patients is unknown. The purpose of our study was to identify the frequency of dental injuries on whole body CTs acquired in a trauma setting and to estimate how often they are correctly reported by the radiologist.

Methods

In the time period between 2006 and 2018 the radiological database of one university hospital was screened for whole-body trauma CTs. A total of 994 CTs were identified and re-evaluated.

Results

Dental injuries were identified in 127 patients (12.8% of patients). There were 27 women (21.3%) and 100 men (78.7%) with a mean age of 51.0 ± 18.9 years (range 10–96 years). Regarding localization, most findings involved the molars (n = 107, 37.4%), followed by the incisors (n = 81, 28.3%), premolars (n = 59, 20.6%) and canines (n = 39, 13.7%). Most common findings were as follows: luxations (n = 49, 45.8%), followed by crown fractures (n = 46, 43%), root fractures (n = 10, 9.3%), extrusions (n = 1, 0.9%), and intrusions (n = 1, 0.9%). Only 15 findings (11.8% of all patients with dental injuries) were described in the original radiological reports.

Conclusion

DI had a high occurrence in polytrauma patients. A high frequency of underreported dental trauma findings was identified. Radiologists reporting whole-body trauma CT should be aware of possible dental trauma to report the findings adequately.

Web-based dental trauma database using Eden Baysal dental trauma index: a turkish multicenter study

Purpose

To describe the prevalence and pattern of traumatic dental injuries (TDIs) among Turkish children in a web-based and multicenter design using Eden Baysal Dental Trauma Index (EBDTI).

Materials and methods

The study sample consisted dental trauma patients aging 1-15 years and a webbased form was developed and used to record the information of the patients' clinical and radiographic findings including EBDTI. The obtained data also included patient gender, age at the initial date of trauma, date of trauma, cause of injury and emergency treatment. Data were analyzed using Pearson Chi-square and Fisher's exact tests.

Results

A total of 280 traumatized teeth in 252 patients were evaluated. Dental trauma was seen more in boys and 7-10 years age group (p<0.05). There were significant differences between permanent and deciduous teeth with regard to uncomplicated and complicated crown fracture rate (p<0.05). The root fractures were mostly located at the apical third of the root in both dentitions.

Conclusion

TDI was associated with age, gender, and type of dental trauma. EDBTI provided easy and proper recording of multiple dental injuries and maturity of the apex and it was found to be a very useful tool to facilitate online recordings of dental injuries.

Dental trauma splint color preference of adults

The prevalence of dental trauma among children and adults is high. Most luxated teeth need splinting. The Titanium Trauma Splint (TTS) is a widely used appliance with good performance properties. Esthetics is increasingly important for most patients. Splints placed on the front teeth have a clearly visible impact on patients' appearance and, thus, on their quality of life during splint therapy. Therefore, the aim of the present study was to evaluate the esthetic preferences of adult patients with regard to different splint color and surface finish characteristics. TTS appliances were fabricated in four different colors (silver, gold, green and violet) and two different surface finishes (matt or polished) to yield a total of eight variants. The finished splints were applied to the teeth of a human model, photographed by a professional photographer, and printed as posters. Adults aged between 18 and 79 years were asked to complete a written survey containing items regarding their TTS color and surface preferences based on the posters with photographs as well as questions about previous tooth bleaching treatments, the importance of having esthetic teeth in general, and the prioritization of esthetic versus function-driven dentistry. Over 80% of participants preferred the silver matt splint over the other variants. Neither gender nor age nor other parameters had a significant influence on the choice of splint color or surface. Women placed greater importance on esthetic rather than function-driven treatment.