Papilla Reformation at Single-Tooth Implant Sites Adjacent to Teeth with Severely Compromised Periodontal Support

Reformation of the lost interdental papilla remains one of the most challenging goals for clinicians. When a single tooth is replaced with an implant, the papilla between the tooth and the implant can often be maintained or predictably reformed as long as the adjacent tooth's periodontal attachment and bone are preserved. However, if the periodontal support is compromised on the neighboring natural tooth, the papilla will often be deficient or missing. The cases presented herein demonstrate long-term follow-up of successful reformation of periodontal/peri-implant tissue contours, including reconstruction of lost interproximal bone and papilla at periodontally compromised sites using a combined hard and soft tissue surgical approach.

Fracture Strength After Fatigue Loading of Lithium Disilicate Pressed Zirconia Crowns

PURPOSE

The aim of this study was to evaluate the fracture resistance of fatigued lithium disilicate pressed zirconia crowns versus other ceramic crowns.

MATERIALS AND METHODS

Lithium disilicate pressed zirconia, fluorapatite pressed zirconia, monolithic lithium disilicate, and monolithic zirconia crowns were fabricated. Cyclic and static loadings were applied to the mesiobuccal cusp tip after thermocycling and fracture strengths were recorded.

RESULTS

Fatigued lithium disilicate pressed zirconia crowns were found to have a fracture resistance of 9,117.81 ± 727.04 N, compared with 9,240.61 ± 887.21 N for monolithic zirconia crowns, 3,030.18 ± 1,505.83 N for fluorapatite pressed zirconia crowns, and 4,173.94 ± 877.46 N for monolithic lithium disilicate crowns (P = .001).

CONCLUSION

This in vitro study shows that fatigued lithium disilicate pressed zirconia and monolithic zirconia crowns have better fracture resistance than fluorapatite pressed zirconia and monolithic lithium disilicate crowns.

Dentofacial injuries in commercial motorcycle accidents in Cameroon: pattern and cost implication of care

OBJECTIVE

To assess the pattern of dentofacial injuries in commercial motorcycle accidents among riders and passengers in Cameroon.

METHODS

This was a hospital based study conducted in 6 out of 10 regional capitals in the months of December 2011 to September 2012. Analyzed information included age, gender, residence, role on the motorcycle (rider or passenger), type, pattern and month of injury, cost, duration and patient's perception about the cost of treatment.

RESULTS

A total of 387 patients were studied with majority of the patients being 21-30 years (39.8%), males (63.8%), passengers (57.3%) and urban dwellers (85.8%). Most of the injuries occurred in December (20.7%), January (19.4%) and February (20.2%). Soft tissue injuries were most frequent (91.2%) followed by trauma to the teeth (83.5%), of which 62.3% were tooth loss. Mandibular fracture was commoner than maxillary fracture; (45% versus 25.3%). A total of 44.2% of patients received their treatment as in-patients. The treatment of the dentofacial injuries among 64.3% of the patients lasted for more than a month. A total of 51.9% of the patients spent 100,000 francs ($200) or more for their treatment. More than half (51.4%) of the patients perceived the cost of treatment as expensive.

CONCLUSION

Dentofacial injuries in commercial motorcycle accidents necessitated hospital admission and lengthy treatment time with high attendant cost. Preventing these injuries will serves as a form of poverty reduction as money that will be used by the victim to better their life is not used to correct deformities or treat injuries.

An 11-year review of dental injuries associated with maxillofacial fractures in Turin, Italy

INTRODUCTION

The aim of the study was to analyze the incidence, characteristics, and correlations between maxillofacial fractures and dental injuries in patients who were treated at a first-level trauma center in a metropolitan center in northwest Italy in the last 11 years.

MATERIAL AND METHODS

Between January 1, 2001 and December 31, 2011, 2,110 patients with maxillofacial fractures were admitted. Only dentulous patients with complete clinical records who presented with associated dental injuries were included in this study. Data on the age, gender, mechanism of injury, damaged tooth, type of dental injury, site of facial fractures, and concomitant injuries were recorded.

RESULTS

On the whole, 267 patients (13.1%), mainly males aged 20-29 years, presented with 759 dental injuries associated with maxillofacial fractures, especially following motor vehicle accidents. The maxillary teeth, most often the anterior elements with decreasing involvement from the incisors to the molars, were the teeth most frequently damaged overall. The main types of dental trauma in patients with maxillofacial fractures were luxations and dental fractures.

DISCUSSION

Our findings show that patients with mandibular fractures were statistically and significantly associated with dental injury, and the teeth in the upper jaw were the most frequently injured teeth, exhibiting mainly luxations and crown fractures. Confirmation of the predominant impact site in patients with dental injuries associated with maxillofacial fractures comes from the 177 lacerations noted in the chin and lip regions in 267 patients.

Occurrence of dental avulsion and associated injuries in patients with facial trauma over a 9-year period

INTRODUCTION

This retrospective study aimed to assess the occurrence of dental avulsions in patients with facial trauma over a 9-year period.

MATERIALS AND METHODS

Data was collected from records of patients attended to at the Division of Oral and Maxillofacial Surgery at Piracicaba Dental School-State University of Campinas, Piracicaba (SP), Brazil.

RESULTS

Two hundred three patients with 387 avulsed teeth were evaluated, the central incisors being the most common teeth involved (42 % of permanent and 61 % of primary teeth). Thirty-four percent of the cases occurred on weekends, mainly on Saturdays (20 %) and the distribution in relation to the time of year was similar with slight peaks in January. The most prevalent associated dentoalveolar injury was lateral luxation (26 %) and 19 % of the patients presented with an associated facial fracture. The most common sign presented was laceration (23 %), and the main symptoms found were pain (58 %). Associated general trauma was present in 139 patients (68 %), and the most prevalent was the upper limb (41 %).

DISCUSSION

Special emphasis should be given not only to diagnosis and treatment of dental avulsion but for prevention, too. An understanding of the etiology, severity, and distribution of associated traumatic injuries can help for future studies and for an effective prevention of these injuries.

Aesthetic restoration of upper lip after removal of post-trauma foreign body (orthodontic bracket)

AIM

Approach to dental trauma should always be based on a careful examination of the traumatised area, including both hard and soft tissues, to ascertain the presence of a foreign body and to assess the best treatment and follow-up. In this work a case of an orthodontic bracket migrated to the upper lip and retained there for 10 years, following a trauma is discussed.

CASE REPORT

The patient complained symptomatic swelling of the upper lip; palpation and x-rays showed the presence of a foreign body, identified as an orthodontic bracket. Medical history revealed that patient had a dental trauma 10 years prior. The foreign body was localised and removed. At the two week follow-up visit after surgical incision of the lip, signs and symptoms (i.e. the swollen lip) were resolved. This case emphasises the importance of accurate management of the traumatic event, through proper diagnosis and therapy of both hard and soft tissues, even if the examination if the patient is performed years after the dental trauma.

[Apical root end resection (Apicoectomy) as treatment option in cases of dental trauma in young patient]

Apical root end resection is becoming popular procedure as a treatment option in cases of ortho-grade endodontic failure. In this case report it has been shown that root end resection (Apicoectomy) had succeed to preserve a tooth after dental trauma with root fractured in the apical third. Any other conservative endodontic treatment failed. One-year follow-up revealed complete healing of the area. Apical root end resection might serve as a viable treatment option in cases of dental trauma in young patient in carefully selected patients.

Tooth loss among Nigerians treated in teaching hospitals: a national pilot study

AIM

The aim of this study was to identify the causes and patterns of tooth loss among Nigerian adults.

BACKGROUND

Tooth loss continues to be a major problem in clinical dentistry and has received significant attention in everyday dental practice. In Nigeria there is a discernible lack of current data that would explain the reasons and patterns of tooth loss from its different geopolitical zones.

METHODS AND MATERIALS

The reasons for tooth extractions during a period of 12 months were obtained from the hospital records of teaching and specialist hospitals in Nigeria's six geopolitical zones and the Federal Capital Territory (FCT). Data were analyzed using Statistical Package for the Social Sciences for Windows (SPSS) version 9.0.

RESULTS

A total of 4,204 teeth were extracted from 3,431 patients. Of these teeth 52.4 percent were lost due to dental caries while 30.2 percent were removed because of periodontal disease, 5.0 percent were missing as a result of trauma, and 3.9 percent were impacted and required extraction. The remaining 8.5 percent were extracted for a variety of reasons such as orthodontic treatment, overeruption, neoplasms, supernumerary teeth, attrition, a cystic lesion, and hypoplasia. Dental caries was the most common diagnosis given for tooth loss in the South-South (79 percent), South-East (68 percent), North-East (47 percent), North-West (69 percent), and North-Central (35 percent) zones followed by periodontal disease. In contrast, periodontal disease was the most common cause of tooth loss in the South-West zone (65 percent) and in the FCT (55 percent), followed by dental caries at 22 percent and 33 percent, respectively.

CONCLUSION

Although teeth were extracted based on a variety of diagnoses, dental caries was identified as the common reason cited for tooth loss in Nigeria and to a lesser extent periodontal disease. Also different reasons were given for tooth loss among the various geographical zones.

CLINICAL SIGNIFICANCE

Tooth loss among Nigerians was attributed largely to dental caries and secondarily to periodontal disease. Both conditions can be prevented if diagnosed early enough and treatment is instituted in a timely manner.

Implant periapical lesion. A case series report

One complication in implant dentistry is the implant periapical lesion-IPL--which is a lesion around the apex of a stable implant diagnosed radiographically as a radioluscency in the bone at the apical part of an implant.The IPL can perform with or without clinical symptoms such as tenderness, swelling, suppuration and fistulation. This report describes 4 cases of IPL which were treated surgically with sectioning and removal of the affected portion of a stable implant and thorough debridement of the granulomatous tissue around it. This treatment was, up to 4 years after treatment, successful in all 4 cases. It can also from this report be concluded that IPL is a rather rare condition and that it can occur at any stage of implant treatment, in these cases from 4 months up to 11 years after implant installation. Finally there is a discussion about the aetiology of IPL and a comparison to findings in other reports on IPL and it is concluded that it is difficult to claim that there is a single cause to IPL. Rather it is evident that the condition might be a sequel of the summation of many possible causes.This summation exceeds the local biological threshold for the individual patient.

A new cone beam computerized tomography system for use in endodontic surgery

AIM

To present a newly developed cone beam computerized tomography system (3DX Micro-CT) and its application in endodontic surgery.

SUMMARY

Cone beam CT has attracted considerable attention as a new diagnostic imaging technique in dentistry. The assessment of fractured endodontic instruments and the planning of endodontic surgery present challenges that conventional radiography cannot meet successfully. In this report, the value of the 3DX cone beam computerized radiography system is illustrated by the case of a fractured endodontic instrument protruding into the maxillary sinus.

Using composite bonding in oral and maxillofacial surgical office practice

OBJECTIVE

Composite bonding plays a significant role in all phases of dental practice from orthodontics to restorative dentistry and even endodontics, yet, at the present time has had limited use by the oral and maxillofacial surgeon. The purpose of this article is 3-fold: to recommend a material for bonding and the method of application for composites; to describe the requirements of the orthodontist when referring a patient for the uncovering of teeth because this is usually the surgeon's primary, if not only, experience with bonding; and to describe situations that may present in the office that will benefit with the use of composite bonding.

PATIENTS AND METHODS

Patients with various problems requiring the stabilization of teeth are presented and in a number of cases the effectiveness of the wired bar and the bonded bar is compared. These cases include the management of dentoalveolar fractures, avulsed or displaced teeth, its application to porcelain restorations without ill effects, and other situations that may arise in the office where fixation and stabilization of teeth is mandatory for success.

RESULTS

Composite bonding provides the most effective method of stabilizing and immobilizing teeth with successful results in almost all cases. On the other hand, the wired arch bar and other wire combinations, which at the present time is the primary, if not the only treatment for these cases, are second to it from all aspects.

CONCLUSION

The successful results with composite bonding along with its case of placement without pain or bleeding or psychological stress on the patient or operator warrants consideration by the oral and maxillofacial surgeon for greater utilization of this material in his office.

Root perforations following endodontics: a case for surgical management

Despite technological advancements in dental instrumentation and techniques, endodontic mishaps remain commonplace. Perforations during access preparation, canal instrumentation, root filling, or preparation of post space are not unusual and instruments may fracture during filing or reaming or when attempting to bypass fractured instruments in the root canal. Many of these complications are hard to avoid due to extreme variations in root canal anatomy, root shapes, curvatures, and canal calcification. Procedural errors impede proper endodontic therapy and increase the risk of treatment failure; as a result, the prognosis is compromised, especially in nonvital teeth or teeth with periradicular lesions. Perforations may lead to short-term or long-term complications (that is, infection, periapical cyst, or granuloma formation); in addition, restorative material may be extruded through the perforation. Clinicians often have difficulty diagnosing and treating root perforations, particularly in posterior teeth (specifically in the area of the mandibular bifurcation); however, such complications do not mean that the tooth must be extracted. This article discusses treatment of perforations near the bifurcation of a mandibular first molar and an apical perforation in a premolar. Both teeth were salvaged via surgery without the use of additional biomaterials.

Treatment of lateral root perforation with mineral trioxide aggregate: a case report

Root perforations are undesired complications of endodontic treatment which result in loss of integrity of the root and further destruction of the adjacent periodontal tissues. In recent literature mineral trioxide aggregate (MTA) has been regarded as an ideal material for perforation repair. In this case iatrogenic perforation was observed in a maxillary central incisor. It was not possible to reach the perforation from the access cavity due to the angulation and excessive bleeding even though the root canal was filled with calcium hydroxide paste between appointments. Therefore, surgical intervention was preferred. After the root canal was filled with gutta percha and AH plus, the perforation site was subsequently sealed with MTA. The restoration was made with strip crown and composite resin. The symptoms were ceased and the results were satisfactory after 15 months follow-up.

Surgical repositioning of traumatically intruded permanent incisor: case report with a 10-year follow up

This report describes the case of a 10-year-old boy that was referred to the pediatric dentistry clinic 15 days after sustaining a severe traumatism that led to complete intrusion of the maxillary left mature permanent central incisor. The intruded tooth was repositioned by using surgical extrusion. Endodontic therapy was performed with calcium hydroxide-based paste as root canal dressing and root canal filling was performed with a calcium hydroxide-based root sealer and gutta-percha points. The postoperative course was uncomplicated, with both clinical and radiographic success up to 10 years of follow up. In this case surgical repositioning combined with endodontic therapy constituted a viable alternative treatment for intrusive luxations in mature permanent teeth.

[Assessment of traumatic tooth injuries in the emergency room]

Many patients with facial injuries are first seen by doctors in the emergency room. Injuries affecting teeth and alveolar process are common in children; approximately half of all children have sustained such an injury before adulthood. Dentoalveolar trauma does not pose a significant morbid risk for the trauma patient. However, failure to recognise or obtain appropriate consultation can result in premature tooth or alveolar bone loss, resulting in problematic prosthetic rehabilitation. Emergency room doctors should know the initial treatment guidelines for traumatic dental injuries to provide optimal treatment before the patient can seen by a dentist. An avulsed tooth should be replanted immediately, or kept moist until it can be replanted. Prognosis is related to storage media and the length of the extra-alveolar period. Teeth replanted within 5 minutes have the best prognosis. If the primary consultation is by phone the patient, or the parent, should be informed to replant the avulsed tooth. If this is not feasible the tooth should be stored in milk, saliva (oral cavity) or physiologic saline until replanted. Primary teeth are not replanted.

Surgical repositioning of a developing maxillary permanent central incisor in a horizontal position: spontaneous eruption and root formation

This report describes the surgical repositioning of a developing maxillary permanent central incisor in a horizontal position, followed by spontaneous eruption and root formation without orthodontic traction. Surgical exposure of the right central incisor was achieved. A 7-year-old boy referred for orthodontic consultation. Radiographic examination showed the crown of a maxillary right central incisor to be positioned horizontally with root formation at the initial stage. The surgically repositioned incisor (by a close-eruption surgical flap technique) spontaneously erupted into correct alignment after 2 years 3 months. The erupted incisor remained vital and responded normally to percussion, mobility and sensitivity testing. The soft tissue, periodontal attachment, gingival contour and probing depths were normal. Follow-up radiographs confirmed the continued development of the root, with revascularization of the pulp and a normal appearance of the periodontal space and lamina dura. There was, however, shorter root formation and a narrower root cavity compared with the contralateral incisor. As a result, no orthodontic traction and alignment were required. This method of surgical repositioning is a viable alternative to the traditional approach of extraction or surgical exposure followed by orthodontic traction for a developing maxillary permanent central incisor in a horizontal position.

Cemental tear: a case report

AIM

To report a case of a cemental tear.

SUMMARY

A case is reported of a patient with a history of trauma, root canal treatment and retreatment procedures to eliminate recurring sinus tracts. An exploratory surgery, extraction, and biopsy resulted in a diagnosis of cemental tear.

KEY LEARNING POINTS

* The detachment of a fragment of cementum is described as a cemental tear. * Cemental tears have been reported in the periodontal literature associated with localized, rapid periodontal breakdown. Common causative factors are aging and traumatic occlusion but the exact aetiology is unknown. * Trauma may be considered as a potential aetiologic factor for cemental tears in addition to occlusal traumatism and aging.

[New technologies and ways of endodontic-endoossal implantation improving]

There were developed, tested and used in practice new transdental implants (TDI) considerably widening the indications to endodontic-endoossal implantation. Universal TDI has a number of advantages over the known analogs and meant for osseointegration and fibro-osseointegration. The implant provides full tooth fixation in small bone volume, on maxilla including.

The frequency of repeat general anaesthesia for teeth extractions in children

AIM

The purpose of this study was to determine the frequency of repeat extractions under general anaesthesia (GA) in children.

METHODS

The dental hospital records of patients attending for outpatient GA extractions at Liverpool University Dental Hospital, Liverpool, UK, between January and March 2003 were examined retrospectively. A data collection form was used to record the relevant information.

RESULTS

A total of 278 patients with a mean age of 6.5 years (SD = 2.2 years) were seen for GA extractions. Of those, 33 patients (11.9%) with a mean age of 4.9 years (SD = 2 years) at the time of their initial GA had had a previous or would undergo a subsequent episode of GA extraction. The mean interval between repeat GA was 2.3 years (SD = 1.6 years). Fifteen cases (45.5%) had the repeat GA within 2 years. Radiographs were available as part of the assessment process for 84 (34.3%) of the 245 patients who had had a single episode of GA. However, of the 33 patients who had had a repeat GA, only seven (21.2%) had radiographs available at the time of the initial GA. Regarding the number of teeth extracted, a significant difference (P < 0.01) was found between the number of teeth extracted in patients who had had a single GA (mean = 4.6, SD = 2.5), compared with those extracted at the initial GA for the repeat GA group (mean = 3.2, SD = 2).

CONCLUSION

The frequency of repeat GA is relatively low, but there is a need for appropriate treatment planning incorporating the use of radiographs to reduce this even further.

[Root canal therapy opportunity in replanted teeth due to injury.]

PURPOSE

To investigate the opportunity of different root canal therapies in replantation of tooth due to injury.

METHODS

49 cases with teeth luxation were randomly divided into three groups. In group A, the pulp was removed before replanted, and calcium hydroxide was filled in root canals and condensated routinely after half a year. In group B, the pulp was removed one week after being replanted. In group C, the pulp was removed until pulp disease.

RESULTS

The effect of group A(81.25%) and B (94.44%) was better than group C (53.33%), P<0.05. And the effect of group A and B was similar.

CONCLUSION

It's an ideal method to replant luxated tooth within 3 hours with removal of pulp tissue, root canal filling with calcium hydroxide one week after replantation of tooth and condensated routine root canal therapy after half a year.

Management of traumatic facial injuries

Whether minor or major, traumatic injuries to the maxillofacial area have far-reaching physical and emotional effects. Because the dentition dictates facial form and function, the oral and maxillofacial surgeon, a dental specialist with a minimum of four years of hospital-based surgical training, is uniquely qualified to manage these injuries. At times, the expertise of the general dentist and other dental specialists may be needed to provide definitive care. Several cases are provided to illustrate management of facial trauma.

[Dentoalveolar traumatology]

The dentist will be confronted unexpectedly with a dentoalveolar trauma patient. This patient has to be seen immediately and has to be treated adequately. The risk of overlooking trauma-related signs when examining these patients, can be minimized by following a strict protocol. This article describes a protocol for examination and treatment of a patient with a dentoalveolar trauma. The prognosis after treatment of the trauma is discussed. Also some recommendations regarding aftercare and prevention are presented.

[Dental tours de force 6. Autotransplantation in case of agenesis or traumatic tooth loss]

Autotransplantation of a tooth is probably the most natural method to replace a missing or lost tooth. This treatment has been performed successfully already for more than twenty years. The prognosis of a transplanted tooth is determined by tooth type, stage of root formation at the time of transplantation, surgical technique used, and duration and way of splinting. Determining the optimal stage of root formation of the tooth is very important in planning the autotransplantation. If the transplantation is carried out successfully, the transplanted tooth behaves at its new location just like before: it erupts, the root formation is continuing, it shows physiological mobility and it can be displaced by orthodontic forces. Most cases of autotransplantation require teamwork between oral surgeon, orthodontist, and dentist.

Parent satisfaction with emergency dental treatment at a children's hospital

PURPOSE

This study evaluated parental satisfaction with emergency dental treatment.

METHODS

One hundred twenty-two parents of children requiring emergency extraction of 1 or more primary teeth completed a survey designed to test the effect of provider, treatment, and demographic variables on parental satisfaction.

RESULTS

Most parents (>80%) indicated satisfaction with the treatment provided. Parents were most satisfied with treatment during clinic hours, treatment provided by an attending pediatric dentist, and treatment provided by male dentists. Satisfaction was correlated with the clarity of the provider explanation. Explanations by male dentists were perceived most positively. Parents of children receiving molar extraction(s) were more satisfied than parents of children with incisor extraction(s). Satisfaction did not correlate with ethnicity of the parent or patient, parent education level, funding sources, or use of an immobilization device. Parents preferred sedation for behavior management of the emergency patient.

CONCLUSIONS

To address the expectations and concerns of parents, dental professionals need to be attentive to the quality of dentist-parent communication and parental expectations during emergency services.

[Use of osteoconductive materials in pediatric dental medicine]

Osteoconductive materials are well known to have the ability to form a characteristic scaffold for bone replacement. The use of these agents is mostly described in periodontal procedures. The present study deals with the use of two different osteoconductive materials used for repairing bone defects following traumatic injuries. The materials used were Bio-Oss (Geistlich) an allogenic demineralised bone and Fisiograft (Ghimas) a synthetic co-polymer of polyglicolic and polylactic acid. These materials were used in five different clinical cases with the objective to compare their typical properties during application and to evaluate radiographically and clinically their healing ability. In three cases filling of the alveolus was performed after extraction of traumatised incisors as a consequence of root resorption or fracture; two patients suffered from periodontal defects. All cases were followed every three months for at least two years and maximum 6 years. Regarding the handling of the materials all products were well accepted. From our clinical experience all modalities are found to be suitable. After clinical and radiographical evaluation normal bone formation was found in all cases without any complaints nor clinical symptoms. These clinical findings support the use of osteoconductive agents in the field of Paediatric Dentistry in well-defined indications.

Long-term observation of endodontic surgical intervention to treat root perforation and apical periodontitis: a case report of an amalgam-restored tooth

A case of crestal root perforation and periapical lesion in a maxillary left lateral incisor is reported. Teeth with root perforation present technical difficulties in their clinical management because of their complex defects. In the present case, surgical endodontic treatment was chosen. The apical and lateral pathology was curetted, the tooth root was resected, and a retrograde root restoration of amalgam was placed in a root-end cavity and perforation site. A 10-year follow-up clinical and radiographic examination showed an asymptomatic tooth with osseous healing proceeding.

[An experiment study on repairing residual dental root with a horn-shaped orifice by different materials]

When a traditional method is used to repair residual dental root with horn-shaped orifice, this kind of dental root often has to be extracted since the success rate in clinic is very low. The main reason is that the stress often concentrates on the neck and root apex, therefore the wall at the orifice is too thin to bear this kind of pressure. A new repairing method is proposed trying to preserve the residual dental root with horn-shaped orifice. Then compare the anti-fracture ability of this kind of tooth with that of no repairing. The results show that it is very effective to prevent the fracture of residual dental root repaired by chemical hard synthetic resin followed by making the post and core. However, there is no obvious difference between non-repaired and residual dental root groups repaired by traditional glass ionic adhesives. The results also provide the great possibility to preserve the residual dental root with horn-shaped orifice in clinic.

Treatment and prevention of alveolar fractures and related injuries

Dentoalveolar trauma does not pose a significant morbid risk for the trauma patient. However, the long-term consequences of mismanagement can be devastating. Early, correct diagnosis, and appropriate referral of these injuries can affect the success of treatment. Failure to recognize or obtain appropriate consultation can result in premature tooth or alveolar bone loss, resulting in problematic prosthetic rehabilitation. The purpose of this article is to review the concepts of recognition, management, and prevention of dentoalveolar trauma. In situations where the possibility of trauma is likely, such as in athletics, dentoalveolar and related fractures can be prevented through the use of mouthguards fabricated by health care professionals.

Management of acute dento-alveolar trauma--from the viewpoint of an oral surgeon

Oral and maxillofacial surgeons often deal with acute dento-alveolar trauma in hospital or practice surroundings. They are often called upon by dental colleagues to give their advice or help in a given situation of the acute trauma patient with dental or oral injuries. In this article, the practical viewpoints and clinical experiences of an oral surgeon are offered based upon many years of work in hospital emergency rooms around the world.

Reasons for dental extractions in children

PURPOSE

The purpose of this study was to investigate the principal reason for primary tooth extraction and the tooth type most frequently extracted in children aged 3-13 years.

METHODS

The patients selected for this retrospective study were identified by analyzing dental records of children receiving treatment at Franciscan Children's Hospital & Rehabilitation Center, Boston, MA (FCH & RC). In total, 2,000 records were reviewed, and 567 extracted primary teeth were analyzed from 277 patients who had at least one primary tooth extracted under local anesthesia. The criteria for inclusion in this study included children between the ages of 3 and 13 years.

RESULTS

First primary molars were the most common tooth type extracted and comprised 30% of teeth removed. Central incisors were the next common tooth type extracted and accounted for 25% of the extractions. There was no difference, by gender, in the extraction of tooth type but there were striking differences according to age. Almost half of the primary teeth extracted in subjects 3 to 5 years were incisors, and in patients 6 to 9 years the first primary molar was the most common tooth type extracted. Molars were the tooth type most frequently extracted from those patients aged 10 to 13 years. There were significant differences in the reasons for extraction of various tooth types, and, while extractions due to caries predominated overall, this was not the case for all tooth types.

CONCLUSIONS

This study has concluded that despite the dramatic improvements in pediatric oral health over the last decades, caries and the resulting pulpal pathology remains the most common reason for extraction of primary teeth.

[A comparative analysis of the efficacy of different types of filling materials in the surgical elimination of tooth perforations (experimental morphological research)]

Based on the experimental morphological findings, the authors compare the efficiency of tooth perforation repair in experimental animals by surgical method using Dyract compomer, Base Line glass ionomeric cement, and Ostim-100 osteoplastic material. The data indicate a high efficiency of this method. Base Line material is preferable for filling the perforation in dental wall, as it reliably performed the isolating function under experimental conditions.

Intranasal midazolam as an alternative to general anaesthesia in the management of children with oral and maxillofacial trauma

The study assessed the dosage, clinical sedative effect, and safety of intranasal midazolam in 32 children. Data were complete for 29 patients (21 with lacerations and 8 cases of dental trauma). Sedation was adequate to ensure successful completion of treatment under local with or without topical anaesthetic in 22 of the 29 cases (76%). They became sedated at a mean (SD) of 14 (5) minutes, with completion of treatment at 20 (13) minutes. Sedation was achieved with a mean (SD) of 5 (2)mg of midazolam. There were no signs of respiratory depression or of oxygen desaturation below 94% on pulse oximetry. No supplemental oxygen was required and there were no other complications. We conclude that intranasal midazolam is a safe and effective alternative to general anaesthesia in the definitive treatment of children with oral and maxillofacial injuries.

Endodontic perforation repair with resin-ionomer: a case report

Root perforations are significant complications of endodontic treatment. However, when teeth are of strategic value, perforation repair is clearly indicated. The successful utilization and placement of a subgingival resin-ionomer restoration to repair an endodontic root perforation is demonstrated. Sustained tissue health and minimal probing depths at the surgical site demonstrate clinical success.

Risk evaluation and type of treatment of multiple dental trauma episodes to permanent teeth

Studies have shown that some children and adolescents are effected only once with a dental trauma, while others seem to be accident-prone and suffer from multiple dental trauma episodes (MDTE). Studies have also shown that dental traumas mostly affect upper permanent and medial incisors. Less is known about treatment consequences related to teeth with repeated dental trauma episodes. The aim was therefore to evaluate the risk of MDTE to permanent teeth among children and adolescents by age and gender and to compare types of dental treatment modalities used for patients with one episode and those with MDTE and with single and repeated traumatized teeth. The study was based on a random sample of 83 Danish 6-18-year-old children and adolescents born in 1970 who suffered from dental trauma episodes. All patients were followed during a 12-year period (1976-1988). Forty-one of the patients were registered with MDTE with a range of 2-7 episodes and a mean of 2.9 episodes/patient (SD = 1.1). The mean age at single and MDTE was 11.4 years (SD = 3.6) and 8.6 years (SD = 2.1), respectively. No significant differences were found between age at first episode and the number of MDTE per patient. The number of patients with MDTE was significantly higher among those who suffered their first trauma episode in the age interval 6-10 years than in the age interval 11-18 years (P < 0.001). A survival analysis showed that the risk of sustaining another trauma episode increased by 14.9-30.3% when the first trauma occurred before the age of 11, compared to 0-7.4% after the age of 10. The risk of sustaining multiple injuries was 8.4 times higher when the first trauma episode occurred at 9 years of age, compared with those occurring at age 12. The survival analysis also showed that for every new trauma episode, the interval between them became closer. Forty-five per cent of the MDTE affected teeth had already sustained an injury. With an increased number of trauma episodes per patient followed an increase in the number of follow-ups, filling therapy, information and prosthetics, whereas the rates of endodontics, surgery, and consultations were unchanged or even decreased.

Maxillofacial injuries in the pediatric patient

Approximately 22 million children are injured in the United States annually. Children are uniquely susceptible to craniofacial trauma because of their greater cranial-mass-to-body ratio. The pediatric population sustains 1% to 14.7% of all facial fractures. The majority of these injuries are encountered by boys (53.7% - 80%) who are involved in motor vehicle accidents (up to 80.2%). The incidence of other systemic injury concomitant to facial trauma is significant (10.4% - 88%). The management of the pediatric patient with maxillofacial injury should take into consideration the differences in anatomy and physiology between children and adults, the presence of concomitant injury, the particular stage in growth and development (anatomic, physiologic, and psychologic), and the specific injuries and anatomic sites that the injuries affect. This comprehensive review, based on the last 25 years of the world's English-speaking surgical literature, presents current thoughts on the anatomic and physiologic differences between adults and children, a synopsis of childhood growth and development, and an overview of state-of-the-art management of the pediatric patient who has sustained maxillofacial injury.

An analysis of 58 traumatically intruded and surgically extruded permanent teeth

Fifty-eight traumatically intruded and mainly surgically extruded permanent teeth were followed up for 3 years and 4 months (mid-term results: 29 teeth) and 9 months (short-term results: 29 teeth) on average. Statistically, the mid-term results showed more cases of severe crown discoloration (54%) than the short-term results (9%), but no difference in pulpal and periodontal healing. Three teeth (5%) were lost. Factors which positively influenced pulpal healing were shallow intrusion depth, intact crown and immaturity of the root. Factors which positively influenced periodontal healing were shallow intrusion depth and minimal surgical manipulation. Alveolar bone healing was positively influenced only by shallow intrusion depth.

Surgical management of sports-related traumatic injuries

The increasing popularity of all sporting events results in increased potential for injury. Despite helmet, facemask, and mouthguard use, the face often remains an exposed area at risk in many sports. Dentists rehabilitating patients after facial injuries should understand their patients' previous injuries and treatment.

Enhanced fixed prosthetics with a connective tissue ridge augmentation

Augmentation of the partially edentulous ridge can significantly improve the final prosthetic result. The subepithelial connective tissue graft is the treatment of choice to enhance soft tissue contours. The major advantage of the connective tissue graft is the preservation of the existing gingival coloration and tissue characteristics. A case is described that utilizes the subepithelial connective tissue graft for augmentation of a maxillary anterior ridge prior to prosthetic rehabilitation.

Causes and pattern of tooth extraction in children treated at the University College Hospital, Ibadan

A study of 429 children age 0-15 years who attended the paedodontic clinic of the Department of preventive Dentistry for treatment from January 1995 to December 1995 with a view of assessing causes and pattern of tooth extraction was carried out. 51.52% of the children had extraction. Dental caries and its sequelae accounted for the highest indication for extraction (57.47%) while periodontal disease accounted for the least (0.45%). Deciduous teeth were mostly extracted with the deciduous molars being the teeth frequently extracted. The frequency of extractions shows that a challenging situation exists for those engaged in the organisation of dental health education and emphasis should be on prevention.

Furcation involvement in posterior teeth

This article presents two cases in which different treatments were used for mandibular molars with furcation lesions. In the first case, a conventional amputation treatment of the distal root was performed to save the mesial root as a terminal tooth, which was used as a partial denture abutment. The second case describes a relatively new technique in which a root perforation was filled with graft material (synthetic bioglass) and covered with a resorbable membrane to treat an iatrogenic furcation lesion adjacent to the mesial root. Twelve months after surgery, periapical radiographs of both treated cases showed increased bone density. Follow-up in both cases--30 months in the first case and 12 months in the second--showed no pathological recurrence or clinical dysfunction. Root amputation may provide an alternative to extraction in periodontally involved molars. Synthetic bone replacement materials combined with guided tissue regeneration may also help to correct osseous defects incurred by recent furcation perforations with associated bone loss.

Repair of a root perforation with a resin-ionomer using an intentional replantation technique

The repair of a root perforation can be accomplished using different materials and techniques. When the defect is surgically inaccessible, the tooth can be carefully extracted, repaired extraorally, and placed back into the socket. This procedure, known as intentional replantation, is often a measure of last resort in an heroic effort to save a hopeless tooth. This case report describes the treatment of a tooth with an iatrogenic root perforation and the subsequent healing of the surrounding periodontium using an intentional replantation technique and resin-ionomer to repair the root defect.

Treatment of root perforation by intentional reimplantation: a case report

Intentional reimplantation is defined as a procedure in which an intentional tooth extraction is performed followed by reinsertion of the extracted tooth into its own alveolus. In this paper, intentional reimplantation is described and discussed as a treatment approach to root canal instrument separation in conjunction with root perforation. An 8-year follow-up case report is presented. The reimplanted tooth is now a fixed bridge abutment. Although successful in this case, the intentional reimplantation procedure should be considered a treatment of last resort, that is, when another treatment option is not viable for the treatment of root perforation/instrument retrieval.