Healing and long-term prognosis of root-fractured permanent teeth: a retrospective longitudinal study

AIM

The purpose of the present study was to evaluate permanent teeth with post-traumatic transversal root fractures, for their initial healing modality, the effect of candidate predictors and their long-term prognosis.

METHODOLOGY

A retrospective longitudinal clinical study was conducted to evaluate records from patients bearing transversal root fractures in permanent teeth in order to radiographically assess short-term healing and non-healing events in the fracture line, their prognostic factors and their relationship with long term outcomes. The inter-fragmentary tissues were classified as healing: hard tissue (HT), connective tissue (CT) or connective tissue and bone (CT + B) and non-healing: interposition of granulation tissue (GT). A competing risk survival analysis was conducted to estimate the hazards of healing and non-healing events in the short-term and the effect of demographic, clinical, and treatment variables was assessed using the subdistribution regression model (Fine & Gray).

RESULTS

Radiographic findings showed 61.4% of healing in the short-term being strongly influenced by the presence and type of concomitant injuries to the coronal fragment. Teeth with concomitant crown fractures (sHR 24.38, 95% CI [3.16-188.3], p = 0.0022), luxations with dislocations (sHR 10.58, 95% CI [1.37-81.9], p = 0.0240) and subluxations (HR 9.66, 95% CI [1.14-81.7], p = 0.0370) were more likely to present non-healing of root fractures in the short-term. The healing rate in the long-term was of 75.9%, most of them with interposition of bone and connective tissue. Kappa statistics demonstrated an overall agreement of 67.1% between short and long-term healing patterns, in special HT and CT + Bone modalities.

CONCLUSION

Healing at the fracture site was the most frequent outcome, both in the short-term and in the long-term. Short-term healing modality was strongly influenced by the presence and type of concomitant injuries to the crown fragment, being the worst prognosis observed in root-fractured teeth with concomitant crown fractures, followed by concomitant luxations with dislocation.

CLINICAL RELEVANCE

Post-traumatic transversal root fractures have a positive prognosis supporting therefore, a more conservative approach for these teeth before considering more radical treatments.

Guided Autotransplantation of an Immature Premolar to the Maxillary Incisor Region with Immediate Restoration of Esthetics: A Case Report

This case report describes the treatment of two maxillary central incisors following a traumatic injury with tooth #8 developing replacement resorption and #9 developing inflammatory root resorption. A 10-year-old girl presented complaining of pain in her maxillary central incisors. Upon clinical examination, teeth #8 and #9 were tender to percussion and palpation of the buccal soft tissues. Thermal and electrical pulpal sensitivity tests for teeth #8 and #9 were negative. An intraoral periapical radiograph revealed resorptive defects in tooth #8, which were filled with bone-like tissue, while tooth #9 had radiolucent resorptive defects along the root surface and a periapical radiolucency. A diagnosis of replacement resorption was made for tooth #8 and external inflammatory root resorption for tooth #9. Tooth #8 was treated with a multidisciplinary approach utilizing a guided template for premolar autotransplantation with an immediate veneer restoration, while tooth #9 was managed with root canal treatment using a tricalcium silicate cement to fill the canal. At the 1, 4, 8, 12, and 24-month follow-ups, the patient remained asymptomatic, and there was no radiographic evidence of root or periapical pathosis on either tooth. The root-end of the donor tooth transplanted to the #8 site continued to develop. This case report highlights successful interdisciplinary management of two forms of root resorption using modern treatment strategies that provided immediate function and esthetics to the maxillary central incisors in a young patient following trauma.

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.

The risk of healing complications in primary teeth with root fractures: A retrospective cohort study

BACKGROUND/AIM

Primary teeth are frequently affected by traumatic dental injuries. Root fractures are rare and have a reported incidence of 2% in the primary dentition. Hence, there is limited evidence on this topic. This study aims to evaluate the risk of healing complications in primary teeth with root fracture and to identify possible sequelae in the permanent dentition following root fracture in the primary dentition.

MATERIALS AND METHODS

A retrospective analysis of a cohort of 53 patients with 74 root fractured primary teeth. The standard follow-up program included clinical and radiographic examination after 4 weeks, 8 weeks, 6 months, and 1 year after the trauma and when the patient was 6 years of age. The following complications were registered: pulp necrosis (PN), pulp canal obliteration (PCO), ankylosis with replacement root resorption (ARR), infection-related root resorption (IRR), premature tooth loss (PTL), and repair-related resorption (RRR).

STATISTICS

The Kaplan-Meier and Aalen-Johansen estimators were employed. The level of significance was 5%.

RESULTS

A total of 74 teeth were included. 42 teeth were extracted at the initial examination. Risks estimated after 3 years: PTL 45.9% [95% CI: 28.8-63.0], PCO 12.9% [95% CI: 2.3-23.4], PN 14.9% [95% CI: 3.9-25.9], RRR 2.6% [95% CI: 0.0-7.5]. No teeth showed ARR or IRR. All complications were diagnosed within the first year. Most common sequelae in the permanent dentition was demarcated opacities, with an estimated risk of 20% [95% CI: 8.2-41.3].

CONCLUSIONS

There is a low risk of healing complications following a root fracture in the primary dentition. Root fractures often result in early extraction of the coronal fragment. The remaining apical fragment will undergo a physiological resorption. Aside from opacities, there is a low risk of sequelae in the permanent dentition.

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.

Tooth Complications after Orthodontic Miniscrews Insertion

Orthodontic miniscrews (OM) are widely used in modern orthodontic clinical practice to improve skeletal anchorage and have a high safety profile. A complication at the time of OM insertion is tooth root perforation or periodontal ligament trauma. Rarely, OM injury can cause permanent damage, such as ankylosis, osteosclerosis, and loss of tooth vitality. The aim of this work was to analyze potential risks and dental complications associated with the use of OMs. A search of the PubMed, Cochrane, Web of Science, and Scopus databases was conducted without a time limit using the keywords "orthodontic mini-screw" and "dental damage", resulting in 99 studies. After screening and eligibility, including articles obtained through a citation search, 13 articles were selected. Four studies revealed accidental injuries caused by OM. Most of the damage was localized at the root level and resolved spontaneously with restorative cement formation after prompt removal of the OM, while the pain disappeared. In some cases, irreversible nerve damage, extensive lesions to the dentin-pulp complex, and refractory periapical periodontitis occurred, requiring endodontic and/or surgical treatment. The choice of insertion site was the most important element to be evaluated during the application of OMs.

Tooth root resorption: A review

Tooth root resorption is multifactorial, leading to progressive destruction and eventual loss of tooth root dentin and cement. There are internal and external types of root resorption, each having its variety. The etiology and pathogenesis of tooth root resorption are poorly understood, and the most significant etiological factors are trauma, pulpal infection, tooth bleaching, and orthodontic treatment. Tooth root resorption is primarily asymptomatic; thus, it is revealed accidentally by radiographic examination. Progressive clinical manifestations are pain, tooth discoloration, tooth mobility, and other conditions. Awareness of the causes and risk factors allowing tooth root resorption, and regular radiographic examination, in case of necessity, make it possible to reveal resorption at an early stage and to prevent its further development. Thus, the aim of this study is to present etiopathogenesis, a clinical course, and diagnostic peculiarities of internal and external types of tooth root resorption, enabling practicing dentists to timely diagnose root resorption and take appropriate measures to avoid further complications. Within the limitation of this review, even though the etiopathogenesis of tooth root resorption is yet not fully understood, it is suggested that the etiological factors fall into two groups (endogenic and exogenic) to enhance further understanding of the possible causes and mechanisms of root resorption and allow practitioners to monitor high-risk patients and make timely diagnoses. Moreover, radiographic examination and CBCT are indispensable for the diagnosis of root resorption.

Multidisciplinary Approach to Complicated Crown-root Fracture Treatment: A Case Report

Treatment of complicated crown-root fractures is one of the most challenging within the various types of dental trauma and requires a multidisciplinary approach. This paper reports the complicated crown-root fracture of a maxillary right central incisor, in which there was esthetic, functional, and biologic (endodontic and biologic width invasion) involvement. A 15-year-old male patient presented to the dental clinic one month after suffering trauma with a complicated crown-root fracture on tooth 8. The patient had previously undergone endodontic treatment and was sent to have periodontal surgery to reestablish the biological width on the palatal surface. Following the surgery, a fiberglass post was cemented, and the fragment was reattached. This approach allows the exposure of the cervical margin, adequate isolation, and subsequent fragment reattachment in the same clinical appointment. Fragment reattachment is a viable approach as it is a simple and conservative procedure that restores the natural esthetic of the tooth and has superior resistance compared to a composite restoration. The patient's cooperation in understanding the limitations of the treatment and maintaining adequate oral hygiene are very important to achieving a good prognosis of the case. After a 2-year clinical and radiographic follow-up period, the clinical protocol was found to be successful, and the tooth remained functional, esthetically favorable and asymptomatic.

Endodontic mishaps during root canal treatment performed by undergraduate dental students: An observational study

Endodontic mishaps during root canal treatment (RCT) are considered to be one of the most commonly encountered errors, which affect the quality of treatment and may have dangerous health implications for patients.The present study was conducted to assess the frequency and types of endodontic mishaps in root canal-treated teeth performed by undergraduate dental students.A total 404 endodontically treated teeth were performed by undergraduate dental students of King Khalid University College of Dentistry, Abha, Kingdom of Saudi Arabia. The radiographs of the endodontically treated teeth were studied for a period of 6 months, and the related demographic data were collected from patient files.The most commonly identified mishaps were related to obturation, where the maximum number of cases (68.1%) had under-obturated root canals. More endodontic mishaps were performed by students in level 9 education. The upper left 2nd molar teeth had a higher frequency of mishaps, and molars were found to have more access-related mishaps. Lastly, access-related and instrument-related mishaps had a low frequency of occurrence.The majority of endodontic mishaps found in the study sample were related to root canal obturation. The undergraduate students at level 9 were less proficient in conducting RCTs with many endodontic mishaps when compared to the cases performed by students at higher levels. The study suggests relevant guidance for dental students while performing RCTs, especially during obturation of the root canals.

Microcracks on the Rat Root Surface Induced by Orthodontic Force, Crack Extension Simulation, and Proteomics Study

Root resorption is a common complication during orthodontic treatment. Microcracks occur on the root surface after an orthodontic force is applied and may be related to the root resorption caused by the orthodontic process. However, the mechanisms underlying root resorption induced by microcracks remain unclear. In this study, a rat orthodontic model was used to investigate the biological mechanisms of root resorption caused by microcracks. First, the first molar was loaded with 0.5-N orthodontic force for 7 days, and microcracks were observed on the root apex surface using a scanning electron microscope. Second, to describe the mechanical principle resulting in microcracks, a finite element model of rat orthodontics was established, which showed that a maximum stress on the root apex can cause microcrack extension. Third, after 7 days of loading in vivo, histological observation revealed that root resorption occurred in the stress concentration area and cementoclasts appeared in the resorption cavity. Finally, proteomics analysis of the root apex area, excluding the periodontal ligament, revealed that the NOX2, Aifm1, and MAPK signaling pathways were involved in the root resorption process. Microcrack extension on the root surface increases calcium ion concentrations, alters the proteins related to root resorption, and promotes cementoclast formation.

A novel approach to radiographic detection of bucco-palatal/lingual dilacerations: A preliminary study with ImageJ

The purpose of our study is to determine whether bucco-palatal/lingual (BPL) root dilacerations (RD), especially in single root teeth, can be determined using the ImageJ program through only one periapical radiography. Extracted teeth without any RD (n = 8) were determined as the control group (Group 1) and with RD in apical 1/3 part at least 20° with the longitudinal axis in the BPL direction (n = 8) as the study group (Group 2). With the help of a simple holder system prepared, digital periapical radiographs of all teeth were taken in an anteroposterior position. Histogram analysis of all periapical radiographs was performed using the spectrum feature of ImageJ software. It was aimed to make a dilaceration analysis by comparing the groups using mean, standard deviation, minimum, maximum, and bin width values. As a result of the Mann-Whitney U test, all mean and maximum values showed a statistically significant difference between the study and control groups (p < 0.05). This pilot study revealed that the ImageJ software can be used to diagnose BPL dilaceration in the apical 1/3 part of the root. It is important for dentists and patients that it can contribute to limiting the radiation dose to which patients will be exposed.

In Vivo Detection of Subtle Vertical Root Fracture in Endodontically Treated Teeth by Cone-beam Computed Tomography

INTRODUCTION

The purpose of this study was to evaluate the diagnostic accuracy of cone-beam computed tomographic (CBCT) imaging in the detection of subtle vertical root fractures (VRFs) in endodontically treated teeth in vivo and to discuss direct and indirect evidence for the diagnosis of subtle VRFs.

METHODS

Twenty-nine endodontically treated teeth with suspected VRFs from 29 patients were examined using CBCT imaging. CBCT images were scored based on evaluation of the fracture line and vertical buccopalatal (lingual) bone loss. VRF was diagnosed only when a definite fracture line was detected on CBCT images, and findings of periodontal exploration or surgical extraction were considered the gold standard. The diagnostic sensitivity, specificity, and accuracy were assessed.

RESULTS

Of the 29 teeth, 27 were positive and 2 were negative for VRF according to the gold standard. Sensitivity, specificity, and accuracy were 33.3%, 100%, and 37.9%, respectively, based on the direct finding of a fracture line on CBCT images. However, vertical buccopalatal (lingual) bone loss was found in 25 of 27 teeth with VRFs.

CONCLUSIONS

Although the accuracy of CBCT imaging for the diagnosis of subtle VRFs in endodontically treated teeth in vivo was poor, vertical buccopalatal (lingual) bone loss is an important indirect sign for the diagnosis of VRFs, which can be found on CBCT images.

Horizontal root fracture in a maxillary central incisor: a case report

An 80-year-old patient fell while jogging, hitting his face on the concrete trail and causing a horizontal root fracture of his maxillary right central incisor. The fracture separated the root into 2 halves about 0.60-0.84 mm apart, resulting in extrusion of the incisal half. The patient had severe lip swelling and facial injury but no tooth pain. Various options for care were evaluated, but, other than reducing the extrusion, placing local antibiotics, and prescribing periodontal medication, the dentist did not provide or recommend further treatment. At the most recent recall, 8 years after the accident, the root exhibited good bone repair, there was no evidence of abscess, and the patient reported no discomfort. This report aims to remind clinicians that no or minimal treatment may be the best option in certain cases.

Prevention and management of life-threatening complications during dental implant surgery: a clinical case series

Complications can occur during implant placement; thus, clinicians should be aware of all potential outcomes, and staff members should be fully prepared to respond in case of emergency. A thorough medical history, precise surgical technique, knowledge, and skill are essential to prevent complications. The most serious complications, which could threaten the patient's life, are airway obstruction, bleeding, aspiration of the implant or its parts, infection, cavernous sinus thrombosis, nerve injury, and mandibular fracture.

A direct metal laser sintering (DMLS) root analogue implant placed in the anterior maxilla. Case report

BACKGROUND

Modern cone beam computed tomography (CBCT) acquisition and three-dimensional (3D) image processing, combined with direct metal laser sintering (DMLS), allows custom-made, root-analogue implants (RAIs).

PURPOSE

To demonstrate how DMLS permits customized titanium RAI production, with immediate insertion and restoration in a fresh extraction socket of the anterior maxilla.

MATERIALS AND METHODS

A titanium RAI perfect copy of the radicular unit needed for replacement was created by customized DMLS, and inserted into a fresh extraction socket of the esthetic area of the anterior maxilla.

RESULTS

Follow-up after 1 year: the DMLS RAI implant showed a satisfactory functional and esthetic integration, with no bone resorption or soft tissue recessions.

CONCLUSIONS

The production of customized DMLS RAIs opens new interesting perspectives for immediate implantation.

KEY WORDS

Direct metal laser sintering, Root analogue implant.

Evaluation of Crack Formation and Propagation with Ultrasonic Root-End Preparation and Obturation Using a Digital Microscope and Optical Coherence Tomography

OBJECTIVE

This study is aimed at determining (1) the effect of root-end resection, ultrasonic root-end preparation, and root-end filling on the incidence of crack formation and propagation by using a digital microscope (DM) and optical coherence tomography (OCT) and (2) the performance of OCT on the detection of cracks by comparing with microcomputed tomography (micro-CT) as a reference standard.

METHODOLOGY

Thirty extracted lower incisors were endodontically treated and subjected to root-end resection and ultrasonic root-end cavity preparation. Then, the teeth were divided into three groups (n = 10, each), and the root-end cavity was either left unfilled or filled with mineral trioxide aggregate (MTA) or super-EBA. The resected surface was observed with OCT and DM after the root-end resection, ultrasonic root-end preparation, and root-end filling, and the frequency of incomplete and complete cracks were recorded. The observation was repeated after two weeks, one month, and two months, and micro-CT scans after two months were taken as the gold standard.

RESULTS

The DM results show dentinal crack formation in 47% of the samples following root-end resection and in 87% following ultrasonic preparation. After the ultrasonic preparation, no existing crack propagated to a complete crack, but new cracks were formed. MTA and super-EBA had no effect on crack formation. The Spearman correlation coefficient between OCT and DM was 0.186 (very weak correlation; p = 0.015). Sensitivity and specificity in comparison to micro-CT were 0.50 and 0.55 in OCT and 1.00 and 0.35 in DM, respectively. McNemar's test showed a significant difference between OCT and DM (p < 0.05).

CONCLUSION

Apical resection and ultrasonic preparation could form dentinal cracks. OCT and DM showed different detection frequencies of cracks with very weak correlation. DM showed superior sensitivity compared with OCT.

Management of After-Hours Pediatric Dental Emergencies Among Pediatric and General Dentists

Purpose: Assess how pediatric dentists (PD) and general practitioners (GP) manage after-hours pediatric dental emergencies according to perceived urgency. Methods: A survey was e-mailed to PD and GP in North Carolina. Participants responded to management of 18 cases (primary and permanent dentition) according to perceived urgency. Repeated-measures logistic regression was used to analyze factors influencing perception of clinical scenarios. Results: Response rates for PD and GP were 45.5% and 36.3%, respectively. Perceived urgency varied by clinical scenarios, dentition (primary vs. permanent), and practitioner (PD vs. GP) (P<.001). Practitioners with fewer years in practice or seeing fewer pediatric patients managed more cases as urgent. Traumatic injuries in primary dentition (intrusion, pulp exposure, palatal displacement, avulsion) were managed as more urgent by GP than PD (P<.001). Emergencies related to infection and permanent dentition were perceived similarly by PD and GP. Conclusions: Clinical scenarios highlighted disagreement in the management of after-hours pediatric dental emergencies between GP and PD, especially trauma in primary dentition. General practitioners tended to refer to an ED or see urgently, and PD tended to defer care. By identifying needs for improved education in dental trauma management, we can increase utilization of the dental home, avoiding use of overburdened EDs.

Use of high resolution computed tomography to diagnose ante-mortem dental root fractures in archaeological samples

Dental root fractures are rarely documented in past human populations, but when they are observed, diagnosing ante-mortem events as causal factors can be difficult due to postmortem alteration. Can high resolution X-ray computed tomography (CT) improve our ability to diagnose if a dental fracture was caused ante- or post-mortem? To test this, a case study of two individuals with previously diagnosed dental root fractures were re-examined with high resolution CT to confirm or refute the original diagnoses. For individual 4170, use of high resolution CT supported the original diagnosis of an ante-mortem root fracture on the right mandibular central incisor that was made based on planar X-ray. With the new analyses, the root fracture was found to be associated with evidence of calcification, and with radicular and alveolar bone resorption, which are positive correlates of an ante-mortem origin. Resolving this level of detail of bone modification was not possible without using high resolution CT. For individual 4172, the use of high resolution CT enabled visualisation of fracturing and cracking throughout several molars and crowns of other teeth that were not evident in planar X-ray, suggesting that these fractures were likely produced by post-mortem taphonomic processes rather than ante-mortem events as originally diagnosed. In this case study, high resolution CT offered critical advantages compared to a planar X-ray approach, such as using 3D multiple slice views without superimposing alveolar bone and teeth as in planar X-ray imaging. This study demonstrates the potential of high resolution CT in confirming and refuting ante-mortem processes, and that visualisation of 3D structures is crucial for arriving at definitive diagnoses.

Autotransplantation: An Alternative to Dental Implants- Case Report With 4-Year Follow-Up

Autotransplantation can be a viable alternative to dental implant placement for partially edentulous patients when case selection and surgical procedures are performed properly. Moreover, in the event of a failed autotransplantation, implant placement may still be possible. Autotransplantation offers several benefits compared with dental implants, however the surgical procedure is technique sensitive. This case report demonstrates the clinical steps and healing process of an autotransplanted third molar tooth with complete root formation with a 4-year follow-up.

Conservative Treatment of a Complicated Crown-root Fracture Using Adhesive Fragment Reattachment and Composite Resin Restoration: Two Year Follow-up

Crown-root fracture is one of the most challenging fracture types in the dental traumatology literature. Traumatized anterior teeth require quick functional and esthetic repair. In the case of a complex crown fracture of the maxillary left central incisor, requiring endodontic treatment, a fiber-reinforced post was used to create a central support stump to restore the dental morphology. This report describes the clinical procedures involved in the treatment. After two years of follow-up, the clinical and radiographic findings demonstrated that the adopted clinical protocol was successful and yielded healthy periodontal tissues with no signs of periradicular pathology.

12 years' preservation of maxillary permanent incisors with cervical root fractures adjacent to aggressive periodontitis: Report of a case

This case report presents long-term results following horizontal root fracture of both maxillary central incisors in a 19-year-old woman with aggressive periodontitis. Due to extensive marginal bone loss and the close proximity of the fracture lines to the bottoms of the periodontal pockets, the prognosis of both teeth was uncertain at the time of the accident. Nevertheless, a conservative treatment strategy consisting of splinting and nonsurgical periodontal therapy was initiated. Follow-up at 12 years after the start of treatment revealed a stable situation from clinical and radiologic perspectives. Permanent fixation to the adjacent teeth and regular supportive periodontal care were the basis for a favorable long-term prognosis.

[Impact of apical preparation diameter on fracture resistance of mandibular premolar roots]

OBJECTIVE

To compare the fracture resistance of roots of mandibular premolar with different apical preparation diameters.

METHODS

Sixty single-rooted single canal permanent mandibular premolar teeth extracted newly for orthodontic reason without immatureness, fracture or cracks were selected, with a curvature less than 10°, and internal length: short diameter of less than 2 at a level 5 mm from the apex. All the teeth were decoronated, leaving roots 13 mm in length. The initial apical file size for the teeth was ≤15#. The roots were assigned to 6 groups based on weights with random block design. Group A: blank control group, no instrumentation was performed. Groups B-F: the master apical file (MAF) was 40#, 45#, 50#, 55# and 60#, respectively. In the five experimental groups the roots were instrumented using hand files with step-back technique at 1 mm increments, resulting in a taper of 0.05. The irrigant used was distilled water. After mounted in acrylic resin, all the teeth were subject to vertical loading using an Instron testing machine until fractured. The occurrence of fractures was detected when the applied load suddenly decreased. The fracture load values and fracture modes were recorded. One-way ANOVA and post-hoc Tukey test were used to determine the difference of fracture load values between the groups (P<0.05). Chi-square tests were used to compare the modes of root fracture.

RESULTS

Five experimental groups exhibited lower fracture load values than that of control group [(1 444±155) N]. The mean fracture load values for roots instrumented to an apical diameter of 50# [(1 027±128) N], 55# [(994±150) N] and 60# [(983±166) N] were significantly lower than that of control group and 40# group [(1 339±131) N] and 45# [(1 287±144) N] (P<0.05). Buccal-lingual fracture, mesio-distal fracture and compound fracture occurred 55%, 13% and 32%, respectively. No difference of fracture mode was detected in the six groups.

CONCLUSION

The fracture resistance reduced significantly when the roots were instrumented to an apical diameter of 50# or larger.

Numb chin syndrome associated with vertical root fracture and odontogenic infection

Numb chin syndrome (NCS) is a multifactorial neuropathic disorder associated with paresthesia to the chin, lip, and oral mucosa, particularly arising as a sequela to various dental-related procedures or infections in the mandible. Timely elucidation of the underlying etiology is of paramount importance as the presentation of NCS could serve as a harbinger of malignancy or metastatic disease. This report describes an unusual case of NCS developing synchronously with a vertical root fracture and odontogenic infection in a mandibular first molar. Clinicians should consider the inclusion of a vertical root fracture as plausible cofactor for the development of NCS.

Evaluation of Root Fracture in endodontically treated Teeth using Cone Beam Computed Tomography

AIM

Our objective was to perform an in vitro evaluation of root fracture in endodontically treated teeth using two cone beam computed tomography (CBCT) machines.

MATERIALS AND METHODS

The sample comprised 86 single-rooted human premolars that had been fractured by a universal testing machine. The tomographic images were acquired using an Orthopantomograph OP300^® and an Orthophos XG 3D^® and evaluated by three examiners, by means of specific software. The teeth were classified into presence or absence of root fracture, then the root third where the fracture occurred, was determined. With regard to the detection of the fracture, the Kappa statistic was used for intra and interexaminer repro-ducibility at two distinct points in time. Chi-squared test was employed to analyze the sensitivity and specificity of the two tomographs (p < 0.05).

RESULTS

The results showed a good or excellent Kappa index between examiners. As for the absolute frequency, the sensitivity (0.6) of the Orthophos XG 3D^® equipment was superior, while specificity (0.91) was higher with the Orthopantomograph OP300^®. On the receiver operating characteristics curve, moderate performance was found with an accuracy of 0.73 (OrthopantomographOP300^®) and 0.74 (Orthophos XG 3D^®) respectively. As far as the location of the root fracture is concerned, moderate agreement was verified using the Kappa statistic (k = 0.56).

CONCLUSION

Although the regular CBCTs represent the imaging examination of choice for assisting root fracture diagnosis in endodontically treated teeth, their performance in this study demonstrated an imprecise diagnosis of fractures in a good many cases, irrespective of the tomography machine used.

CLINICAL SIGNIFICANCE

An early and precise detection of root fractures is of the utmost clinical importance, but the radiopaque and/or metallic filling materials in the CBCT viewing field may generate artifacts, known as the beam-hardening effect, which could compromise root fracture detection.

Vertical root fractures of endodontically treated posterior teeth: A histologic analysis with clinical and radiographic correlates

Vertical root fractures (VRFs) usually develop slowly, unnoticed by the patient until clinical signs and symptoms become apparent. In endodontically treated teeth, a VRF is a typical cause for extraction. The objective of the present study was the histologic analysis of VRFs in extracted, endodontically treated premolars and molars. In addition, clinical and radiographic findings of these VRF-affected teeth were retrospectively evaluated. Thirty extracted teeth with a clinically diagnosed VRF were embedded in methylmethacrylate. Serial ground sections (perpendicular to the longitudinal axis of the root) were stained with toluidine blue and basic fuchsin. The specimens were photographed and assessed with regard to the vertical and horizontal extent as well as to the course of the VRF. Most VRFs ran from the cervical to the apical region (81.3%). In the axial plane, 50% of VRFs traversed the root completely from buccal to oral. Another 40.6% of VRFs were limited to the buccal root portion. 84.4% of the evaluated roots presented an isthmus. Overall, the VRF was associated with the isthmus in 56.3%, but bypassed the isthmus in 28.1%. The most frequently observed clinical findings included pain (in 60% of the evaluated cases), presence of a fistula (46.7%) and an isolated periodontal pocket with ≥6 mm probing depth (40%). A periapical radiolucency (53.3%) was the most frequent radiographic finding in VRFs. “J-shape” lesions were seen in eight cases (26.7%).

Surgical resolution of an aggressive iatrogenic root perforation in a maxillary central incisor: a case report with a 4-year follow-up

The prognosis of teeth with root perforations depends on several factors, including size, location, and time since occurrence. Root perforations are clinical situations that can be solved by either nonsurgical or surgical approaches. The purpose of this article is to present a case of an aggressive iatrogenic root perforation in a maxillary right central incisor solved surgically using mineral trioxide aggregate (MTA). Even in an unfavorable situation, MTA was able to induce new bone formation and reestablish gingival and periodontal health, as confirmed in follow-up examinations at 2 and 4 years.

THE PECULIARITIES OF TREATMENT OF UNCOMPLICATED AND COMPLICATED DENTAL INJURIES CAUSED BY TRAUMA

Trauma related injuries of permanent teeth occur frequently and are the most pressing issue the dentists are facing today. In different age groups the same type of trauma affects the teeth with different frequencies. For instance, accident related dental trauma in children and adults affected permanent teeth in 30% and deciduous teeth in 20%, respectively. It should also be noted that front teeth are more susceptible to traumatic injuries compared to the incisors. Upper front teeth were injured in 72% of cases, while lower central, upper lateral incisors, canines and premolars only in 6-8%. The severity of dental injury depends on the type and extent of the trauma. Dental injury can be result of either direct or indirect trauma. A strong, «fast as lightning» impact most often affects the dental crown. A weak and dull impact (thump) extends toward the root apical direction resulting in avulsion of the tooth and root fracture. Dental injury caused by trauma has been always considered as an emergency condition. It requires prompt complex treatment methods from maintaining pulp vitality to tooth extraction option. Treatment plan always depends on the type and severity of the injury and on current clinical condition of tooth. In all cases, the combined treatment includes: care of visible wound, fixation of teeth, performance of surgical manipulations, determining of the need of endodontic treatment, restorations and orthodontic consultation. The recorded clinical cases include descriptions of dental injuries of various types, as well as performed diagnostic and treatment procedures. In both cases root was fractured by impact. In Clinical Case 1 the tooth 2.1 vertical partial displacement of the tooth (extrusion) with root fracture in the apical third was observed; Clinical Case 2 - 1.1 dental root fracture in its middle third and vertical extrusion. Treatment strategy is dictated by pulp condition (Assessment of pulp vitality and status). In both cases, the complex treatment protocol included repositioning of the teeth back into the alveolar socket and their fixation. In tooth 2.1 treatment endodontic therapy was necessary treatment of choice, while in another case (tooth 1.1) endodontic intervention was not indicated. X-ray visiographic diagnostics and clinical examinations of the teeth (after 1 and 3 years monitoring) revealed positive outcomes. Patients are under monitoring of clinical condition.

Management of Cervical Root Fracture in Mandibular Central Incisor: A Case Report

Root fractures are relatively uncommon injuries, but they represent a complex healing pattern due to concomitant injury to the pulp, periodontal ligament, dentin and cementum. This report presents a case of successful treatment of cervical root fracture in a mandibular central incisor with the help of guttapercha and MTA Filapex sealer.

Full-Contour Zirconia Fixed Partial Dentures as Chairside Applications: A Case Report

Clinical application of zirconia has been expanding due to the high strength properties it offers. Initial use of zirconia was as a coping or substructure material replacing cast metal. More recent formulations have been introduced for monolithic zirconia contour designs. New chairside computer-aided design and computeraided manufacturing (CAD/CAM) technology has made it possible for dentists to deliver 3-unit bridges in a single appointment. This case report will present such a clinical application.

Root Fracture of Abutment Teeth for Partial Removable Dental Prostheses

PURPOSE

Root fracture is a common and serious cause of abutment tooth loss. No studies to date have comprehensively assessed the individual contributions of the factors that increase stress on abutment teeth. The purpose of this study was to analyze the stress distribution in abutment teeth based on a three-dimensional finite element model and to analyze the factors that affect stress distribution.

MATERIALS AND METHODS

Models were generated from the computed tomography data of a single patient, consisting of a mandibular second premolar abutment tooth, bone, residual mucous membrane, and a partial removable dental prosthesis (PRDP). Four models were prepared using different types of endodontic posts and cores. Akers clasps were used for the simulated PRDPs, and a vertical load was applied to the occlusal surface of the PRDPs. Debonding between the post and root was simulated. The Young modulus of the residual ridge was reduced to simulate a poor fit between the denture base and the residual ridge. Stress distribution in the abutment tooth root was observed, and the maximum principal stress was evaluated.

RESULTS

The nonmetal post model and the mesial rest model reduced stress concentration in the root. The stress increased in models simulating debonding and poor fit. The results of the multiple linear regression analysis confirmed that debonding and poor fit were significantly associated with root stress.

CONCLUSION

Within the limitations of this study, it is suggested that the bonding integrity of posts and adequate fit of the denture base are important factors affecting the longevity of abutment teeth for PRDPs.

Crown-root Fracture Restoration on a Patient with Autism Spectrum Disorder

Children with intellectual and physical disabilities including autism are susceptible to dental trauma as a sequela from falls due to poor muscular coordination. In addition, their altered muscle tonus often results in an open bite with labial flaring of the maxillary incisors and lip incompetence, predisposing these teeth to fractures. This case report describes an alternative approach of restoring a fractured maxillary permanent central incisor with a composite strip crown during surgical repositioning of the periodontium on an autistic patient. The prognosis of the incisor is guarded due to the probability of re-injury. However, the decision to maintain the tooth clinically was esthetically preferable in comparison to an extraction or decoronation.

A Case Series: The Orthodontic Management of Central Incisors with Horizontal Root Fractures

This case series illustrates the successful orthodontic management of previously root-fractured central incisors. Orthodontic treatment was carried out to correct the underlying malocclusion, remove traumatic occlusal forces and to provide a suitable occlusion for future restorative treatment should the root-fractured teeth be lost in the future. Clinical relevance: Dental trauma occurs commonly; having affected 10% of orthodontic patients. All practitioners should be able to discuss the possibility of orthodontic treatment with patients who have had previous trauma to their front teeth.

Impact of Various Irrigating Agents on Root Fracture: An in vitro Study

INTRODUCTION

Irrigating solutions are used for cleaning and removing dentinal debris, and the other remains from pulpal space during biomechanical preparation. Therefore, we evaluated the impact of various irrigating agents on root fracture at 5-minute time exposure.

MATERIALS AND METHODS

We sectioned 60 permanent maxillary premolars with fully formed root structures transversely maintaining the root length of approximately 14 mm. Five study groups were made comprising ethylenediaminetetraacetic acid (EDTA), cetrimide, citric acid, and so on as various irrigating agents. A universal force test machine was used to calculate the force which was enough to fracture each root. Analysis of variance (ANOVA) test was used to access the level of significance.

RESULTS

About 10% citric acid solution as an irrigating agent showed minimal fracture opposing results, whereas 10% EDTA solution showed the maximum fracture resistance of root portion.

CLINICAL SIGNIFICANCE

Selection of suitable EDTA concentration that has minimal adverse effect on the mechanical properties of the tooth is very important for the successful management of tooth fracture.

CONCLUSION

About 10% EDTA provided the highest fracture resistance, necessitating the use of irrigating solution in root canal therapy (RCT). Further research with higher and different study groups is required to search for more efficient irrigating solution to improve the outcome of RCT.

Fracture Strength of Endodontically Treated Teeth Restored with Composite Overlays with and without Glass-fiber Reinforcement

PURPOSE

To evaluate the fracture strength and the failure mode of endodontically treated teeth restored with composite resin overlays with and without glass-fiber reinforcement.

MATERIALS AND METHODS

A total of 32 extracted molars were divided into four equal groups. In the NFR-NFRC (no foundation restoration, no fiber-reinforced composite) and NFR-FRC (no foundation restoration, fiber-reinforced composite) groups, only a 5-mm-thick composite resin layer sealed the pulp chamber floors, whereas in the FR-NFRC (foundation restoration, no fiber-reinforced composite) and FR-FRC (foundation restoration, fiber-reinforced composite) groups, a 3.0-mm foundation restoration was used. NFR-NFRC and FR-NFRC groups were restored with composite resin overlays, whereas NFR-FRC and FR-FRC groups were restored with fiber-reinforced composite resin overlays. All specimens were subjected to mechanical loading in a computer-controlled masticator and then the fracture resistance was evaluated. Differences in means were compared using two-way ANOVA and Tukey's test. The level of significance was set at ɑ = 0.05.

RESULTS

All specimens successfully completed the fatigue test. The least fracture-resistant group was NFR-FRC, exceeded by FR-NFRC, NFR-NFRC, and FR-FRC, in that order, with FR-FRC being the most fracture-resistant group. Statistically significant differences were detected between the pairs NFR-NFRC/FR-FRC (p = 0.001), NFR-FRC/FR-FRC (p = 0.001), and FR-NFRC/FR-FRC (p = 0.001). Eight vertical root fractures occurred in group FR-NFRC, six in group NFR-NFRC, four in group NFR-FRC, and none occurred in group FR-FRC.

CONCLUSIONS

Within the limitations of this in vitro study, the incorporation of glass fibers and the presence of a foundation restoration were found to increase the fracture resistance and can favorably influence the fracture mode.

CBCT Use in Endodontic Diagnosis

Endodontic diagnosis and treatment planning has taken a giant leap forward due to introduction of CBCT in dentistry. While conventional 2-D radiographs remain the most cost-effective and routine method to evaluate a patient’s dentition, their diagnostic potential is limited. The 3-D manipulation of images that CBCT offers provides better insight into diagnostic dilemmas and complicate treatment decisions. Despite the advantages of CBCT imaging, it should be used complimentary to 2-D radiography, not as a replacement. The principle of ALARA (in which patients should be exposed to radiation “as low as reasonably achievable”), still applies to this technology. CBCT should not be used routinely in the absence of clinical signs or symptoms that necessitate a more in-depth view of a tooth and surrounding structures. In other words, if a conventional 2-D radiograph will suffice, then a CBCT pretreatment scan is not necessary. However, if more information is needed to make an accurate diagnosis, a 3-D CBCT image is justified and highly beneficial as shown through several case examples share in this article.

Open collagen membrane technique in socket preservation

Both hard and soft tissue undergo change after tooth extraction. In particular, the bone tissue surrounding teeth with fenestration or dehiscence defects undergoes dramatic change following tooth extraction, which can compromise further rehabilitation of the area. Adequate alveolar bone volume and keratinized mucosa are critical to the success of implant therapy. Therefore, the anatomic dimension of the alveolar ridge must be adequate to achieve an esthetically acceptable outcome of implant therapy. Previous studies have proposed many clinical techniques for preserving the extraction socket. This article presents a procedure in which an open collagen membrane technique was adopted to maintain an adequate volume of hard tissue and a sufficient width of the keratinized mucosa for further esthetic and functional implantation. Through this simple technique, an adequate volume and architecture around the implant can be achieved, with a long-term prognosis for implant therapy expected.

[Detection of vertical root fractures by cone beam CT]

The aim of the study was to assess the feasibility and precision of vertical root fracture diagnostics by cone beam CT (CBCT). Vertical root fractures were simulated in 25 sound teeth extracted because of orthodontic and periodontal reasons and examined by CBCT. The roots were then sectioned in corresponding planes and fractures were assessed microscopically. CBCT sensitivity and precision was significantly higher for visualization of vertical fractures >150 µm when compares to fractures <50 µm with no difference in specificity. CBCT is an effective tool for vertical root fractures detection.

Crown-root fracture with pulp exposure: a case report with 16-year follow-up

A 12-year-old boy presented for dental care 35 days after he fell from his bicycle. Clinical and radiographic examinations revealed a longitudinal crown-root fracture with pulp exposure in the maxillary left central incisor. The radiograph also suggested necrosis of the maxillary right central incisor. Urgent treatment of the left central incisor involved gingivectomy followed by autogenous bonding of the tooth fragment with self-curing composite resin. Immediately after bonding, coronal access was prepared, chemical and mechanical preparation was completed, and a calcium hydroxide intracanal dressing was placed. One week after the initial appointment, endodontic treatment was initiated in the right central incisor. The root canal of the maxillary left central incisor was maintained with calcium hydroxide paste (replaced at 45-day intervals) for 1 year and then definitively obturated. At the 16-year follow-up, satisfactory periodontal, esthetic, and clinical conditions were observed, and a radiograph revealed no resorption or periapical changes.

Comparison of the Resistance of Teeth Instrumented with Different Nickel-Titanium Systems to Vertical Root Fracture: An In Vitro Study

INTRODUCTION

This study compared the fracture resistance of teeth instrumented with ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Next (PTN, Dentsply Maillefer), WaveOne (Dentsply Maillefer), Twisted File (SybronEndo, Orange, CA), Mtwo (MT; VDW, München, Germany), and Revo-S (MicroMega, Besançon, France) nickel-titanium systems and obturated with compatible gutta-percha cones of finishing files using the single-cone technique and a resin sealer.

METHODS

The study included 72 mandibular premolar teeth. The roots were covered with additive silicone and placed in Eppendorf tubes, which were filled with a self-curing acrylic. The tubes were separated into 6 groups: prepared with the ProTaper Universal (F4 40/.06) (group 1), prepared with the PTN (X4 40/.06) (group 2), prepared with the WaveOne reciprocating file (40/.08) (group 3), prepared with the Twisted File (40/.04) (group 4), prepared with the MT (40/.06) (group 5), and prepared with the Revo-S (AS 40/.06) (group 6). After the preparations were completed, all the teeth were filled with the appropriate gutta-percha systems. The force (N) was applied at a 1-mm/min crosshead speed until the roots fractured. Differences among the groups were analyzed by Tukey and analysis of variance tests.

RESULTS

Group 2 was the most resistant to fracture, and group 5 was the least resistant. The difference in the fracture resistance between the 2 groups was statistically significant (P = .019). The resistance of group 3 and group 6 to vertical root fracture was similar, and the resistance of group 4 was slightly lower than that of the other groups (P = .058).

CONCLUSIONS

The roots instrumented with the MT were the least resistant, and the roots instrumented with the PTN were the most resistant to VRF.

Fixed prosthodontic treatment outcomes in the long-term management of patients with periodontal disease: a 20-year follow-up report

PURPOSE

The aim of this long-term cohort study was to evaluate the efficacy and complications of fixed partial dentures in a convenience sample of 100 patients with periodontal disease who were treated and maintained periodontal patients after 20 years.

MATERIALS AND METHODS

After active treatment, including periodontal surgery and endodontic and prosthetic treatment, patients were enrolled in a supportive periodontal care (SPC) program with 3- to 6-month recalls. All patients showed clinical data recorded at (1) the original consultation (T0), (2) the first SPC visit following the completion of prosthetic treatment (T1), and (3) at the latest SPC clinical session 20 years after T1 (T2). Multivariate analyses were performed to investigate the influence of clinical variables on the risk of prosthetic abutment (PA) loss after 20 years' visits.

RESULTS

The final sample comprised 100 patients. At T1, a total of 948 PAs represented the original sample of experimental teeth. At the 20-year follow-up, a total of 854 PAs (90.1%) were still in function, while 94 (9.9%) PAs in 41 patients (41%) were lost during SPC; 98% of lost PA were endodontically treated. Vertical root fracture (48%) was the major cause of PA loss, while progression of periodontitis caused 31% of PA loss. Age (P = .002), Full-Mouth Plaque Score (P < .0001), Full-Mouth Bleeding Score (P = .0002), and oral parafunctions (P = .0083) were associated with increased probability of PA failure. Among clinical-related factors, endodontic treatment (P = .0082), root resection/ amputation (P < .0001), multi-rooted teeth (P = .0005), and abutment associated with parafunction (P < .0001) were associated with increased risk of abutment loss after 20 years.

CONCLUSIONS

Perioprosthetic treatment in compliant patients is highly successful after 20 years of SPC.

Adhesive reattachment rehabilitating a nonvital central incisor with a complicated crown-root fracture: 1-year follow-up

Dental trauma requires immediate treatment. However, some conventional treatments (such as an implant and/or partial fixed denture) will not always be immediately possible, due to the patient's age (mainly in pediatric cases) or lack of immediate financial resources. In such situations, the technique of adhesive reattachment plays an important role as a treatment option in the interim. This case report describes the use of adhesive fragment reattachment in the rehabilitation of a maxillary central incisor with a complicated crown-root fracture. A 1-year follow-up affirmed that the adhesive reattachment efficiently resolved the crown-root fracture, allowing for the retention of the tooth structure. This more conservative multidisciplinary approach restored function, esthetics, and self-esteem to the patient, while preserving all bone and gingival architecture for future implant treatment.

Adhesive Approach Using Internal Coping for Vertical Root Fractured Teeth with Flared Root Canals

Vertical root fractures are often observed in teeth with endodontic treatment and post space preparation. Frequently, because such teeth have flared root canals with thin dentin walls, conventional treatments are disadvantageous in terms of adhesiveness, sealability and risk of refracture. Here we devised an intentional replantation method that uses internal resin coping, with a reinforcing effect on thin root canal dentin. In two patients treated with this method, satisfactory conditions have been maintained. This report suggests that an intentional replantation method in which an internal resin coping is employed may be a useful therapy for fractured teeth with flared root canals.

The use of virtual models to estimate the amount of grafting material: a case study

The authors present a case study in which a virtual model was created from a patient's cone beam computed tomographic scans that simulated a dentoalveolar defect associated with periapical pathosis. With the information provided by the virtual model, the tooth was extracted, and both defect and alveolus were virtually grafted. The virtual amount calculated was similar to the amount used in the actual site.

Loss of teeth in positions mesially adjacent to implant-supported fixed dentures: a retrospective clinical survey

The aim of this study was to investigate the loss of teeth in positions mesially adjacent to implant-supported fixed dentures (IFDs) after insertion of IFDs in unilateral free-end edentulous spaces in the mandible at dental clinics. There were a total of 157 adjacent teeth. Nine adjacent teeth (5.73%, 9 of 157), 9 opposing teeth (2.59%, 9 of 348), 38 posterior teeth (1.93%, 38 of 1,964), and 3 anterior teeth (0.22%, 3 of 1,380) were lost during the observation period. The percentage of lost adjacent teeth was higher than that of posterior teeth (P = .002). Teeth in positions adjacent to the IFDs require more attention than other remaining teeth.

Fracture resistance of weakened roots restored with different intracanal retainers

The purposes of the study were to evaluate the effect of mechanical cycling (MC) on the fracture resistance of endodontically treated weakened roots restored with different intraradicular retainers and to analyze the failure mode. Eighty bovine roots were prepared and restored: 20 roots were reconstructed with cast post-and-cores (CPCs); 20 with fiber posts (FPs); 20 with fiber posts with larger coronal diameter (FPLs); and 20 with anatomic posts (APs). Metal crowns were cemented in all the roots. Half of specimens from each restoration strategy (n = 10) were submitted to MC: CPC-MC, FP-MC, FPL-MC, and AP-MC. The specimens were subjected to a fracture resistance test. The results showed that the type of retainer used was statistically significant (P < 0.0004). The CPC specimens demonstrated a fracture resistance similar to that of the APs, but greater than that of the FPs and FPLs. MC was statistically significant (P < 0.003) and affected AP-MC fracture resistance, which was lower than that of CPC-MC and similar to those of FP-MC and FPL-MC.

Are behaviour risk factors for traumatic dental injuries in childhood different between males and females?

AIM

Examination of the risk factors for childhood traumatic dental injuries for male and female patients have been elusive. The present study aimed to examine whether males and females are differentially vulnerable to Traumatic Dental Injuries in relation to emotion regulation, attention deficiency hyperactive disorder symptomatology and behaviour problems.

MATERIALS AND METHODS

An institutional ethical review board approved the case-control study carried out at the Gazi University, Faculty of Dentistry, Turkey. A total of 80 patients with traumatic dental injuries and 80 patients with other dental problems participated in the study. Patients' parents filled in two scales: Conners' Rating Scales-Revised Attention Deficiency Hyperactive Disorder-Index, Oppositional Behavior, Hyperactivity, Anxious-Shy, Social Problems, Inattentive and Hyperactive-Impulsive subscales; and Emotion Regulation Checklist, with two subscales of Emotional Lability and Emotion Regulation. Multiple logistic regression analyses were performed separately for male and female patients.

RESULTS

Oppositional behaviour, hyperactivity and social problems were found to be risk factors for male patients. Being anxious/shy was the protective factor for both males and females. Classification accuracy for males and females were calculated to be 79.2% and 85.2% respectively.

CONCLUSION

Several risk factors for childhood traumatic dental injuries were found to differ for male and female patients.

Post-traumatic treatment of maxillary incisors by immediate dentoalveolar restoration with long-term follow-up

Replacing both missing maxillary anterior teeth is particularly challenging, especially in compromised sockets. This case report describes the management of an 18-year-old female patient, who suffered avulsion of both maxillary central incisors at 7 years of age. This multidisciplinary implant technique, called Immediate Dentoalveolar Restoration (IDR), included extraction of the injured teeth and a single procedure for immediate implant placement and restoration of the compromised sockets after root fracture and periapical lesion development were detected during orthodontic treatment. Successful esthetic and functional outcomes and reestablishment of the alveolar process after bone reconstruction were observed during the 3-year follow-up period. The predictable esthetic outcomes and soft- and hard-tissue stability that can be achieved following IDR are demonstrated.

Hybrid materials offer new perspectives

Dental materials, especially in restorative dentistry, must not only be cost-effective, they must also meet many other requirements: biocompatibility, durability, excellent shade and light effects, abrasion resistance, hardness, mechanical strength under pressure, chemical resistance, surface density, ease of manufacture, and easy intraoral maintenance.