Evaluation of the effect on the permanent tooth germ and the adjacent teeth by finite element impact analysis in the traumatized primary tooth

BACKGROUND

One of the primary concerns in the paediatric emergencies is traumatic dental injuries.

OBJECTIVE

This study aimed to create trauma in primary teeth and reveal its effects finite element analysis.

DESIGN

Three-dimensional models were created using cone-beam computed tomography images, representing a maxillary primary central incisor. An impact force moving at a speed of 10 m/s was simulated on the labial tooth surface in two directions: buccal and incisal.

RESULTS

The stress and deformation experienced in the adjacent tooth due to the primary tooth were higher than those generated in the permanent tooth. Forces applied in the incisal direction resulted in higher levels of stress and deformation in the permanent tooth germ. The difference between the stress and deformation values in primary teeth in the forces applied in the buccal and incisal directions is 21% and 75%, respectively; in the permanent tooth germ, this difference was 233% and 100%, respectively.

CONCLUSIONS

Based on the findings of this study, it is crucial to thoroughly evaluate not only the affected primary tooth but also the adjacent teeth and the permanent tooth germ in traumatic dental injuries. This comprehensive examination allows for the anticipation and management of potential long-term problems.

Risk factors associated with the occurrence of avulsion in the primary incisors: A case-control study

BACKGROUND

Identifying factors associated with the occurrence of primary tooth avulsion is essential to promote prevention strategies.

AIM

To investigate the risk factors associated with primary incisor avulsion and variables associated with post-avulsion sequelae in the permanent successor.

DESIGN

This case-control study comprised 407 children (cases) with primary incisor avulsion and 407 children (controls) with other traumatic dental injuries (TDI). The association between explanatory variables and avulsion was evaluated through logistic regression. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Poisson regression analyses between potential explanatory variables and sequelae were run, from which relative risks (RR) and corresponding 95% CI were estimated.

RESULTS

TDI caused by moderate falls (OR = 2.20; 95% CI = 1.47 to 3.27), affecting lateral incisors (OR = 10.10; 95% CI = 3.89 to 26.54) and the lower arch (OR = 9.54; 95% CI = 3.15 to 28.85), were associated with primary incisor avulsion. Moreover, children with previous severe TDI, anterior open bite, and anterior crossbite had higher odds of primary incisor avulsion. Children who suffered from any primary tooth avulsion (RR = 2.68; 95% CI = 1.82 to 3.95) had a higher risk of sequelae in the permanent successors. The risk for sequelae in the permanent teeth was significantly greater for younger children under age 2 years than for children ages 3 to 5 years.

CONCLUSION

Risk factors for primary incisor avulsion are related to the severity of the fall, tooth position, history of previous TDI, and malocclusion. Furthermore, avulsion increases the risk of sequelae in the permanent successors.

Vertical root fracture detection with cone-beam computed tomography in Biodentine™ filled teeth

PURPOSE

This study aimed to evaluate the accuracy of detecting vertical root fractures in Biodentine™-filled teeth using the Promax 3Dmax cone-beam computed tomography (CBCT) unit compared to periapical radiographs. It tested hypotheses regarding CBCT's diagnostic superiority in non-root-filled and Biodentine™-root-filled maxillary central incisors and assessed the impact of smaller field of view and lower intensity settings on detection accuracy.

MATERIALS AND METHODS

Extracted maxillary incisors were divided into groups based on fracture status and root filling material, then placed in a Thiel-embalmed skull to simulate clinical conditions. The teeth were imaged using periapical radiographs and the CBCT unit under different settings. Fracture thickness was measured with microcomputed tomography for accuracy benchmarking. Multiple observers assessed the images, and statistical analyses were conducted to evaluate diagnostic performance.

RESULTS

Intra-rater reliabilities of consensus scores ranged from good to very good. Specificities were generally higher than sensitivities across all imaging modalities, but sensitivities remained constantly low. None of the Area Under the Curve scores exceeded 0.6, indicating poor overall accuracy for all imaging modalities. Paired comparisons of the area differences under Receiver Operator Characteristic curves revealed no significant differences between the CBCT and periapical radiograph techniques for detecting vertical root fractures in either Biodentine™-filled or non-root-filled teeth.

CONCLUSIONS

There was no significant accuracy improvement of the current CBCT device (Promax 3Dmax, Planmeca, Finland) over periapical radiographs in detecting small vertical root fractures in both non-root-filled and Biodentine™-root-filled maxillary central incisors. A smaller field of view with lower intensity did not enhance detection accuracy. These results highlight the challenges in accurately detecting small VRFs, emphasizing the need for further research and technological advancements in this domain.

In vitro evaluation of the accuracy of electronic apex locators and cone-beam CT in the detection of oblique root fractures

OBJECTIVES

This study aimed to compare the accuracy of cone-beam CT (CBCT) scanning and 3 different electronic apex locators (EALs) in the detection of simulated oblique root fractures (ORF) in different localizations.

METHODS

The study utilised a total of 80 human maxillary incisors, which were categorised into two groups based on the location of the ORF (apical and middle third of the root) formed on the buccal side of the root surface. The measurement of the distance between the incisal edge and the intersection of the ORF with the root canal was conducted using a stereomicroscope. This measurement is referred to as the actual working length (AWL). Additionally, three EALs-Dentaport ZX, EndoRadar Pro, and Propex II-were utilised to determine the electronic working length (EWL). Furthermore, CBCT images were employed to assess the distance, known as the CBCT working length (CWL). The differences were determined by subtracting AWL from EWL and CWL.

RESULTS

Based on the accuracy of the devices, there were no significant differences observed among Dentaport ZX, EndoRadar, Propex II, and CBCT measures in both the apical and middle third ORF groups, within the acceptable range of 0.5 and 1 mm.

CONCLUSIONS

The accuracy of Dentaport ZX, Propex II, and CBCT was higher in the middle third ORF group compared to the apical third ORF group, with a tolerance of 0.5 mm. However, there were no significant differences seen among the devices.

A Case of Anterior Single Tooth Implant with Fractured Zirconia Abutment due to Trauma

In recent years, a wide variety of materials have been used in dental implant treatment. In selecting the superstructures and abutments to be used it is important to consider their potential effect on the stability and durability of the planned implant. Excessive force applied to an implant during maintenance commonly results in complications, such as fracture of the superstructure or abutment, and loosening or fracture of the screws. This report describes a case of implant treatment for a 23-year-old man with esthetic disturbance due to trauma to the maxillary anterior teeth. The left maxillary central incisor could not be conserved due to this trauma, which had been caused by a traffic accident. After extraction, the tooth was restored with an anterior bridge. The crown of the left maxillary lateral incisor was fractured at the crown margin and, at the patient's request, implant treatment was selected as the restorative treatment for the missing tooth. A thorough preoperative examination was performed using placement simulation software. One titanium screw-type implant was placed in the maxillary left central incisor under local anesthesia. An all-ceramic crown with a zirconia frame was placed as a screw-fixed direct superstructure. At one year postoperatively, however, the superstructure and abutment became detached due to trauma. The fractured zirconia abutment was removed and replaced with a remanufactured abutment and superstructure. The patient has reported no subsequent dental complaint over the last 11 years. In this case, a surface analysis of the fractured zirconia abutment was performed. The scanned images revealed a difference in the fracture surfaces between the tensile and compressive sides, and electron probe microanalysis demonstrated the presence of titanium on the fracture surface. It was inferred that the hard zirconia abutment had scraped the titanium from the internal surface of the implant.

The risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment: a systematic review and meta-analysis

PURPOSE

To identify the factors affecting the risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment.

METHODS

The study protocol followed the best practices of evidence-based medicine and was registered in PROSPERO. A comprehensive literature search was performed electronically in six databases (PubMed, Embase, SCOPUS, Web-of-Science, Lilacs, and Cochrane) on 18-09-2023. It was saved in EndNote-online and duplicates were removed. Selection of articles was performed in two stages, followed by data-extraction, risk of bias assessment, data-analysis, and meta-analysis. The quality of evidence for the outcomes was assessed by the GRADE-approach.

RESULTS

The study included six articles that had similar selection protocols with variations in duration from trauma to treatment and the observation period. Only one study employed pre-attachment fragment preparation and three performed post-attachment reinforcements. Overall loss of fragment was 20% (95%CI-13,30%). When the risk ratio for loss of restoration or fragment was compared, it was found to be 2.21 (95%CI-1.52,3.21) in uncomplicated crown fractures, 2.54 (95%CI-1.35,4.79) in complicated crown fractures. The risk of bias was found to be low in two and moderate in four studies. Grade of evidence for all the outcomes was very low.

CONCLUSION

Fragment loss was lowest in uncomplicated crown fractures where reinforcement had been performed, and highest when bonding was done in complicated crown fractures without reinforcement. The risk of fragment loss was higher than the loss of composite restorations.

Effect of wire diameter and extent of wire composite splint on the mobility of luxated and anchor primary teeth: A typodont study

BACKGROUND/AIMS

The recommendations for splinting are well established for the injuries of permanent dentition; however, ambiguity still exists for the injuries in primary dentition. Hence, this study aimed to determine the most appropriate dimensions of stainless steel wire and its extent, for achieving the physiologic mobility in primary dentition.

MATERIAL AND METHODS

This study was designed as an in vitro experiment by using a typodont model of primary dentition. The baseline mobility of primary maxillary incisors was calibrated to the physiologic mobility of natural primary incisors by using a Teflon tape wrapped around the roots of resin teeth. Splinting was done using a stainless steel wire of 0.2 mm (Group I), 0.3 mm (Group II), and 0.4 mm (Group III). These groups were subdivided (a, b, and c) on the basis of the extent of the splint, and pre splint mobility (Pre-PV) and post-splint mobility (Post-PV) were tested by Periotest M. The splint effect was calculated by subtracting Post-PVs and Pre-PVs.

RESULTS

The normal values of mobility in healthy human volunteers ranged from 10.5 to 13. The overall splint effect was higher in Group III irrespective of the extent of the splint, whereas it was found to be the lowest in Group I (b and c). The splint effect increased with the extent of the splint in all the groups. Among all the groups, the splint effect on the anchor teeth was observed to increase with the extent of the splint and the diameter of the wire.

CONCLUSION

The mobility of the injured and anchor teeth splinted with 0.2-mm stainless steel wire was similar to the pre-splint and physiologic mobility. The most favorable extension was one tooth adjacent to the injured tooth on each side for both 0.2- and 0.3-mm wires.

Traumatic dental injuries and molar incisor hypomineralization: a cross-sectional study of schoolchildren from southern Brazil

PURPOSE

To describe the prevalence and the variables associated with TDIs in schoolchildren aged 8 to 14 years in Estância Velha city in southern Brazil, placing emphasis on molar incisor hypomineralization.

METHODS

Students enrolled in public schools of a medium-sized city in the southern Brazil were selected using cluster random sampling. Clinical examinations assessed molar incisor hypomineralization-MIH (European Academy of Pediatric Dentistry criteria), dental caries (DMFT index), and TDIs (O'Brien's criteria). Socioeconomic and demographic variables were assessed using a standardized questionnaire. Prevalence ratios were estimated using Poisson regression (p < 0.05).

RESULTS

513 students (54.8% female), with a mean age of 11.6 (± 1.9) years, participated in the study. The prevalence of TDIs was 11.3%, with enamel fracture representing 90.4%. The high prevalence of traumatic dental injuries was associated with MIH (PR: 2.22 CI: 1.27; 3.87; p < 0.01) and overjet > 3 mm (PR: 2.03 CI 1.19; 3.45; p < 0.01).

CONCLUSION

The sample of schoolchildren from southern Brazil had a low prevalence of traumatic dental injuries. Molar incisor hypomineralization and increased overjet were associated with the higher prevalence of traumatic dental injuries.

Management of oblique root fracture in the middle third of two maxillary immature central incisors with severe caries in mixed dentitions: a case report

Mid-root fractures are rare injuries in young permanent teeth and tend to have poor prognoses. This study presents a case of oblique root fracture of both maxillary immature central incisors in the middle third accompanied by delayed dental visit and severe caries of all primary teeth. After restoring all the primary and permanent teeth that needed stabilization, the coronal fragments were repositioned and stabilized with a flexible splint consisting of orthodontic wire and composite resin. A comprehensive and sequential dental treatment for other oral diseases and oral hygiene instructions were provided. A 16-month follow-up revealed that the two injured young permanent incisors were healed, surrounded by hard tissues and continued to grow both in length of the root and thickness of the root canal wall, with significant improvement in oral hygiene. Based on the outcome of this case, initial stabilization without endodontic therapy could be considered a successful treatment modality for young permanent teeth with oblique root fracture due to the growth of fractured teeth with vital pulp and the maintenance of natural dentition.

Effect of temperature on rehydration and fracture resistance of reattached tooth fragments after crown fracture: An in vitro study

BACKGROUND

Uncomplicated crown fractures of maxillary anterior teeth are common dental injuries, and the bonding of fractured fragments is recommended for management. Rehydration of fragments improves bonding and fracture resistance. Therefore, the aim of this study was to compare the fracture resistance of the reattached tooth fragment of the incisor crown after rehydration using either a steamer or a humidifier.

MATERIALS AND METHODS

Bovine teeth were used as a model. Fractured fragments were divided into three groups: Group I (no rehydration), Group II (rehydration by humidifier), and Group III (rehydration by steamer). Fragments were reattached using a standard bonding protocol. Fracture resistance was tested using a universal testing machine. Statistical analysis was performed using analysis of variance and Chi-square tests.

RESULTS

The force required to fracture the reattached fragments was significantly higher in Group II (humidifier) compared to Group I (no rehydration) (P = 0.005). Group III (steamer) had a force value similar to Group I, indicating no significant improvement in fracture resistance with steamer rehydration. The temperature inside the steam-based chamber reached an average of 95.7°C with 95% humidity, whereas the conventional humidification chamber had an average temperature of 39.2°C and 84% humidity.

CONCLUSION

Within the limitations of the present study, the rehydration protocol using a steam-based chamber was found to have a significantly lower force required to fracture the reattached fragments as compared to humidifier-based chamber. This was not significantly different from the fragments which were reattached without rehydration.

Ex vivo investigation on the effect of minimally invasive endodontic treatment on vertical root fracture resistance and crack formation

The evidence base on minimally invasive endodontic (MIE) treatment is limited. This study investigated the influence of MIE shaping on vertical root fracture (VRF) resistance and crack formation of root canal filled teeth. Human maxillary central incisors were randomized into six groups (n = 18, power = 0.9) and embedded in acrylic blocks with artificial periodontal ligaments. The root canals were either instrumented to size #40 and 0.04 taper (+MIE) or enlarged to ISO size #80 (-MIE). The canals were filled with cement-based (C) or adhesive resin-based (A) sealers in single-cone technique. The controls received no treatment or were left unfilled. After chewing simulation (staircase method, 25-150 N, 120,000×), the crack formation on the root surface was analyzed using stereomicroscope/digital imaging and classified (no defect, craze line, vertical crack, horizontal crack). Subsequently, the samples were loaded until fracture. The incidence of defects (56% vertical cracks) was not significantly different between the groups (p ≥ 0.077). VRF resistance was significantly higher in untreated teeth than in +MIE/C (p = 0.020) but did not significantly differ between the other groups (p ≥ 0.068). Minimal canal shaping did not reduce the risk of vertical root fracture and defects of root canal filled teeth.

The influence of zirconia and fiber posts with different lengths on the fracture strength of maxillary central incisors restored with zirconia crowns: an in vitro study

AIM

Endodontically treated teeth are more susceptible to fractures than vital teeth because of significant coronal and radicular dentin loss during endodontic therapeutic procedures. The objective of the present in vitro study was to estimate and compare the influence of the post length and type on the fracture strength of endodontically treated maxillary central incisors.

MATERIALS AND METHODS

Sixty extracted human maxillary central incisors were decoronated 2 mm above the cementoenamel junction. The teeth were selected and subjected to standard endodontic treatment, resulting in three groups with different preparation lengths: 5, 7.5, and 10 mm. Each group was randomly divided into two subgroups according to the post type: zirconia or fiber. After appropriate surface treatment, they were cemented with adhesive resin cement and restored with zirconia crowns. Thermocycling (5°C to 55°C, 60 s, 1500 cycles) was performed after cementing the zirconia crowns onto each tooth. Prepared samples were subjected to a compressive static load of 0.5 mm/min, at an angle of 130 degrees to the long axis of the roots, using a universal testing machine (Matest) at a crosshead speed of 0.5 mm/min, until fracture. The significance of the results was assessed using two-way analysis of variance (ANOVA) and the Tukey-Kramer test (α = 0.05).

RESULTS

The ANOVA analysis indicated significant differences (P < 0.05) between the groups. The Tukey-Kramer test revealed no significant differences among the zirconia posts with lengths of 5 mm (26.5 N ± 13.4), 7.5 mm (25.2 N ± 13.9), and 10 mm (17.1 N ± 5.2). Also, in the fiber post group, there was no significant difference when the posts with lengths of 7.5 mm (13.4 N ± 11.0) were compared with those of 5 mm (6.9 N ± 4.6) and 10 mm (31.7 N ± 13.1). The 10-mm-long post displayed superior fracture strength, and the 5-mm-long post showed significantly lower mean values (P < 0.001).

CONCLUSIONS

The fracture strength of zirconia posts (with lengths of 5 and 7.5 mm) was found to be significantly higher than that of fiber posts (with lengths of 5 and 7.5 mm). The 10-mm-long fiber post group demonstrated significantly higher fracture strength values, and the 5-mm-long fiber post group showed the lowest values for the force resulting in root fracture; these groups were significantly different from each other (P < 0.001). The fracture strength analysis with a universal testing machine is the only method that enables the estimation of the differences between zirconia and fiber posts with different lengths in endodontically treated teeth.

Comparing fracture resistance on bovine incisors restored by tooth fragment reattachment versus direct composite restoration techniques

BACKGROUND/AIM

Anterior teeth are prone to traumatic dental injuries (TDIs). Although a number of techniques ranging from original tooth fragment reattachment (TFR) to direct composite restoration (DCR) can be used to restore uncomplicated crown fractures, there is no consensus on which method is best. The purpose of this study was to investigate the fracture resistance of bovine incisors restored by two different techniques (TFR and DCR) in three different fracture models.

MATERIALS AND METHODS

Sixty extracted bovine lower incisors were randomly divided into three groups (n = 20). Angle, oblique, or transverse sections of all the teeth in a group were prepared by using a disk. The cut surfaces were scanned, and the cross-sectional areas (CSA) of the enamel and dentin were measured. Half the teeth in each group were restored by DCR (n = 10) and the other half by TFR (n = 10). The forces required to fracture the restored teeth were then measured using a Universal testing machine, and the fracture modes were analyzed (cohesive, adhesive, or mixed).

RESULTS

No statistically significant differences between the TFR and DCR restorations were detected for total and enamel CSAs in any of the restoration shapes (p > .067). The fracture forces required to break DCR angle and transverse restorations were significantly greater than for the corresponding shapes restored with TFR (p < .033). However, the difference in the forces needed to fracture oblique section restorations by DCR or TFR was not statistically significant (p = .239), despite a similar trend (143.4 ± 51 N and 120.9 ± 25 N, respectively).

CONCLUSION

This study revealed that a greater force is required to fracture teeth restored by the DCR than by the TFR technique, especially for a transverse section. This demonstrates that restoring a fractured tooth provides a superior outcome compared to reattaching the fractured fragment.

Endodontic and restorative management of an adult with avulsion of multiple teeth: A case report with 5 years and 9 months of follow-up

Simultaneous avulsion of four or more teeth is a rare event. This case report examines the dental care given to an adult who, during a bicycle accident, experienced the avulsion of a mandibular incisor as well as all of his maxillary incisors. In the immediate aftermath of the accident, four out of the five incisors were located, promptly collected, and stored in a tooth rescue box, all within a 20-min window. Replantation and splinting were performed on the day of the accident. Endodontic treatment involved sequential intracanal dressing with an antibiotic-corticosteroid paste followed by calcium hydroxide prior to root canal obturation. 3 months post-accident, signs of external replacement resorption (ERR) began to appear in all the replanted teeth. The gap created by the missing maxillary central incisor was managed with a three-unit fixed dental prosthesis, despite the onset of ERR in the incisors used as abutment teeth. Regular follow-ups showed a relatively slow ERR progression rate over a span of nearly 6 years. The patient expressed satisfaction with both the esthetic and functional outcomes. This case, marked by multiple avulsions, underscores the importance of immediate and appropriate intervention alongside the imperative for carefully considered long-term management strategies. Given the decelerated bone remodeling rate in adults, ERR generally progresses at a slower pace than in children. Accordingly, this case demonstrates the viability of retaining replanted teeth over the long term, even when these teeth have been subjected to nonphysiological storage for extended durations, a factor known to impede periodontal healing.

Unconventional Dental Implant Placement Through an Impacted Maxillary Central Incisor in Stable Contact With Enamel and Dentin: A Case Report

When edentulism is accompanied by an impacted tooth, conventional treatment usually involves traumatic tooth extraction, which would inevitably destroy the surrounding alveolar bone and cause unfavorable esthetics, especially for anterior teeth. Recently, implant placement through the impacted tooth or residual root has been proposed as an alternative to invasive extraction. A particular type of integration has been observed between dentin/cementum and titanium implant, while enamel-implant contact has not been reported. In this article, an implant was placed through the impacted maxillary central incisor, thereby avoiding an invasive extraction surgery. The buccal section of the tooth, including crown enamel, was retained in situ for buccal alveolar ridge preservation. The follow-up results were satisfactory, and a stable enamel-implant contact was observed. Combining with previous similar studies, this technique opens intriguing possibilities and brings fresh insight for the concept of dentointegration. More histological and clinical studies with long-term follow-up are warranted before endorsing this technique in routine application.

Computer-aided design and computer-aided manufacturing poly (methyl methacrylate) interim veneers for immediate esthetic restoration of autotransplanted teeth

Autotransplanted teeth in the maxillary anterior region should be restored or reshaped as soon as possible for functional and esthetic reasons as well as the well-being of the patient. However, such tooth restorations are frequently not carried out immediately after tooth transplantation because the process could have a negative impact on the healing process. The development of a simple, immediate, and atraumatic esthetic interim restoration would be of great benefit to both the clinician and patient and address all the concerns caused by immediately preparing the tooth postoperatively and cementing a permanent restoration. This report describes the use of CAD-CAM technology to create poly (methyl methacrylate) veneers preoperatively that can be cemented extraorally on the extracted donor tooth for the immediate and interim recontouring of autotransplanted anterior teeth.

Fracture resistance and failure mode of three esthetic CAD-CAM post and core restorations

BACKGROUND

The rising demand for improved aesthetics has driven the utilization of recently introduced aesthetic materials for creating custom post and core restorations. However, information regarding the fracture resistance of these materials remains unclear, which limits their practical use as custom post and core restorations in clinical applications. AIM OF THE STUDY: This study aimed to evaluate the fracture resistance of three non-metallic esthetic post and core restorations and their modes of failure.

MATERIALS AND METHODS

Thirty-nine single-rooted human maxillary central incisors were endodontically treated. A standardized post space preparation of 9mm length was performed to all teeth to receive custom-made post and core restorations. The prepared teeth were randomly allocated to receive a post and core restoration made of one of the following materials (n=13): glass fiber-reinforced composite (FRC), polyetheretherketone (PEEK) and polymer-infiltrated ceramic-network (PICN). An intraoral scanner was used to scan all teeth including the post spaces. Computer-aided design and computer-aided manufacturing (CAD-CAM) was used to fabricate post and core restorations. Post and core restorations were cemented using self-adhesive resin cement. All specimens were subjected to fracture resistance testing using a universal testing machine. Failure mode analysis was assessed using a stereomicroscope and SEM. The data was statistically analyzed using One-Way ANOVA test followed by multiple pairwise comparisons using Bonferroni adjusted significance level.

RESULTS

Custom PEEK post and core restorations displayed the least fracture load values at 286.16 ± 67.09 N. In contrast, FRC exhibited the highest average fracture load at 452.60 ± 105.90 N, closely followed by PICN at 426.76 ± 77.99 N. In terms of failure modes, 46.2% of specimens with PICN were deemed non-restorable, while for PEEK and FRC, these percentages were 58.8% and 61.5%, respectively.

CONCLUSIONS

Within the limitation of this study, both FRC and PICN demonstrated good performance regarding fracture resistance, surpassing that of PEEK.

One case of complicated crown root fracture of upper anterior teeth managed by multidisciplinary joint approaches

Complicated crown root fracture is a serious combined fracture of the enamel, dentin, and cementum in dental trauma. The treatment method is complicated. During the procedure, the condition of pulp, periodontal, and tooth body should be thoroughly evaluated, and a multidisciplinary approach combined with sequential treatment is recommended. This case reported the different treatment and repair processes of one case of two affected teeth after complicated crown root fracture of upper anterior teeth, including regrafting of broken crown after flap surgery at the first visit, direct resin repair to remove broken fragments, and pulp treatment and post-crown repair at the second visit. After 18 months of follow-up, the preservation treatment of the affected teeth with complicated crown root fracture was achieved. Therefore, fragment reattachment and post-crown restoration are feasible treatment options for children with complicated crown root fracture.

Polychromatic Restoration of Anterior Fractured Teeth Using a Custom-made Silicone Matrix

When restoring anterior teeth using resin composites, the use of silicone guide matrices obtained from diagnostic wax-ups is recommended, as this technique facilitates layering and optimizes working time. This is particularly important in polychromatic layering and when more than one anterior tooth is to be restored with resin composites. However, in cases of fractured anterior teeth, it is often not feasible to perform a previous impression and waxing. In these cases, due to trauma and related psychological aspects, patients usually seek immediate esthetic solutions. Therefore, an interesting restorative approach that can simplify the restorative technique is the creation of a silicone guide matrix obtained from the patient's fractured tooth, without the need for prior waxing. This type of personalized matrix was initially proposed by Bertholdo, Ricci, and Barrote. Thus, the purpose of the present work is to demonstrate a modification of the technique for making this type of custom-made matrix for the restoration of two upper central incisors of a 14-year-old patient who fractured his teeth in a bicycle accident.

The consequences of orthodontic extrusion on previously intruded permanent incisors-A retrospective study

AIM

The aim of this study is to compare the adverse effects that occur after orthodontic extrusion of teeth that have been traumatically intruded with those of similar teeth that have not experienced any trauma.

BACKGROUND

The outcome of incisors intrusion can be affected by the patient's age, extent of injury, root development, and malocclusion. Orthodontic extrusion is a potential solution, but it may also cause complications.

MATERIALS AND METHODS

A retrospective study of the effects of extrusion of traumatically intruded teeth was carried out. The study group included 21 teeth in 14 patients. The control group included 32 teeth in 10 patients that underwent orthodontic extrusion with no history of trauma. Patients' age, gender, and stage of root development were recorded. The severity of the intrusion was classified as mild (<3 mm), moderate (3-6 mm), and severe (≥7 mm). A comparison of signs of pulp necrosis and root resorptions between the groups was made.

RESULTS

The central incisor is the tooth that is most injured in 80.9% of cases. A majority of these incidents involve severe intrusion, which was found in 42.9% of cases. 90% of the traumatized teeth had already lost their vitality prior to orthodontic treatment. Various forms of root resorption were observed in the study group. In the control group, 31.2% of teeth showed signs of external root resorption, but no endodontic intervention was carried out during the follow-up period, as these teeth remained vital.

CONCLUSIONS

Following intrusion, there is a high risk for root resorption and pulp necrosis. Orthodontic repositioning should be carried out with caution and mild force to prevent complications. Long-term follow-ups are required to ensure the best possible outcome.

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.

Restoration of Complicated Crown-Root Fracture in a Primary Incisor with Fragment Reattachment

In traumatic dental injuries in children, due to a lack of maturity to cope with the situation, pain intolerance, amount of treatment procedure, and parental anxiety, simplified and non-invasive treatment procedures, such as biologic restorations, are useful. Using advanced adhesive material for fragment reattachment provides excellent esthetic results and a positive attitude from the patient and family. The purpose of this case report is to describe the biological restoration of a complicated crown-root fracture of a primary maxillary central incisor with the fragment reattachment technique.

Long-term prognosis after decoronation of avulsed teeth with replacement resorption: a report of three cases

The complications of replacement resorption following tooth injury in growing children include infrapositioning of the tooth, tilting of the adjacent teeth, and alveolar ridge deformity. Decoronation is a conservative treatment method that facilitates bone preservation. The current case report focuses on the long-term preservation of alveolar ridge dimension following decoronation in three patients. Decoronation was performed prior to occurrence of the pubertal growth spurt, and the patients' ridge width and vertical apposition were monitored for at least 4 years. Timely intervention and regular monitoring are essential for maximization of the benefits of decoronation, a simple procedure that preserves esthetics and minimizes the need for further treatments. The importance of space management for prosthetic treatment has also been highlighted. The findings of this study show that infrapositioned teeth in growing children can be treated successfully using decoronation.

Long-Term Clinical and Radiographic Observation of Previously Regenerated Treated Incisors Subjected to Orthodontic Movement. A Case Series

INTRODUCTION

With an increasing number of anterior traumatized teeth treated with regenerative endodontic procedures (REPs) nowadays, orthodontic movement of such teeth is expected to become a common scenario in everyday clinical practice. However, little is known about the clinical implications and the response capacity of regenerated tissues to orthodontic forces.

METHODS

The aim of this clinical article was to report on 4 cases of REP-treated immature anterior permanent teeth subjected to orthodontic forces, and to describe the long-term response of the regenerated apical and intracanal tissues.

RESULTS

Signs of orthodontic-induced external root resorption were observed in 2 of the 4 presented cases without, however, the presence of any associated adverse events. No other complications were observed, either clinically or radiographically, throughout the observation period. In the long-term, all 4 cases responded favorably to orthodontic forces, maintaining healthy apical tissues and structural integrity of both intracanal as well as apically regenerated tissues.

CONCLUSIONS

The orthodontic movement of REP-treated teeth seems feasible, nevertheless, special care should be implemented. Lightly acting orthodontic forces, short duration of active movement, and close monitoring of the patient seem to be prerequisites to limit complications to a minimum and achieve a favorable healing of REP-treated teeth in the long-term following orthodontic treatment completion.

[Surgical extrusion, an alternative to a dental implant?]

Unfortunately, accidents do happen. Dentoalveolar injury to the front teeth resulting from trauma can sometimes be so problematic that an (adhesive) restoration seems almost impossible to make, let alone saving the tooth. In this contribution the case of a 17-year-old patient whose upper incisor suffered severe dentoalveolar trauma in a traffic accident is presented. His upper incisor was fractured deeply subgingivally, at bone level, and at first glance, appeared to be lost. Surgical extrusion, however, in this patient represents a full alternative to a prosthetic solution, such as a dental implant.