Delayed onset of tooth decay in a routine pediatric adenotonsillectomy

Adenotonsillectomy is a common pediatric surgical procedure with a well-defined safety profile. Major complications from this procedure include bleeding/hemorrhage, infection, pain leading to dehydration, and airway obstruction or edema. Though rare, oral endotracheal intubation and oral retractor placement may result in injuries to the teeth and the surrounding soft tissue. We describe a rare case of delayed tooth decay in a 3-year-old female following an otherwise routine adenotonsillectomy.

Intra-radicular reinforcement using a modified fiber post customization technique: a case report

Trauma sustained by developing anterior teeth can lead to an arrested root development and loss of structure which can complicate the endodontic and restorative management. The preservation of the anterior tooth has a definite esthetic and biologic advantage especially during the developmental years of adolescence. However, restorative treatment of such cases is met with serious biomechanical and adhesive challenges in the form of thin dentinal walls, a high configuration factor etc. This case report describes a fiber post customization technique for the intraradicular reinforcement of a maxillary central incisor in a 14-year-old patient.

Management of a Subgingivally Fractured Maxillary Central Incisor by Reattachment Technique

Reattachment of a fractured fragment to the remaining tooth is challenging but one of the best treatment protocols in regards to aesthetics, function as well as patients acceptance. If the original tooth fragment is retained following fracture, the natural tooth structures can be reattached using adhesive protocols to ensure reliable strength, durability and aesthetics. This case report will discuss a 13 years old boy with a complicated crown-root fracture of maxillary right central incisor tooth. The procedure used to repair the fracture regarding this case including flap surgery with endodontic treatment. The root canal was filled with a root canal sealer and gutta-percha. After root canal obturation, fragment was reattached with an adhesive tooth reattachment technique. After 6 months evaluation, clinical and radiographic examinations showed a stable re-attachment, good aesthetic and healthy periodontium.

Pulp Aspects of Traumatic Dental Injuries in Primary Incisors: Dark Coronal Discoloration

Dark coronal discoloration is a common outcome of traumatic dental injuries in primary incisors. However, there are only a few research studies on the mechanism that causes dark discoloration, the condition of the pulp, and the preferred treatment of such teeth. This article is a summary of the author's research studies and personal experience regarding dark coronal discoloration of traumatized primary incisors.

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.

Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted

BACKGROUND

Traumatic dental injuries are common. One of the most severe injuries is when a permanent tooth is knocked completely out of the mouth (avulsed). In most circumstances the tooth should be replanted as quickly as possible. There is uncertainty on which interventions will maximise the survival and repair of the replanted tooth. This is an update of a Cochrane Review first published in 2010.

OBJECTIVES

To compare the effects of a range of interventions for managing traumatised permanent front teeth with avulsion injuries.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 March 2018), Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 2) in the Cochrane Library (searched 8 March 2018), MEDLINE Ovid (1946 to 8 March 2018), and Embase Ovid (1980 to 8 March 2018). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We considered randomised and quasi-randomised controlled trials that included a minimum follow-up period of 12 months, for interventions for avulsed and replanted permanent front teeth.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data and assessed the risk of bias. Authors were contacted where further information about their study was required.

MAIN RESULTS

Four studies, involving a total of 183 participants and 257 teeth were identified. Each of the interventions aimed to reduce infection or alter the inflammatory response or both at the time of or shortly after the tooth or teeth were replanted. Each study assessed a different intervention and therefore it was not appropriate or possible to numerically synthesise the data. All evidence was rated as being of very low quality due to problems with risk of bias and imprecision of results. This means that we are very uncertain about all of the results presented in this review.One study at high risk of bias with 69 participants (138 teeth) compared a 20-minute soak with gentamycin sulphate for both groups prior to replantation with the experimental group receiving daily hyperbaric oxygen for 80 minutes for the first 10 days. There was some evidence of a benefit for the hyperbaric oxygen group in respect of periodontal healing, tooth survival, and pulpal healing.One study at unclear risk of bias with 22 participants (27 teeth) compared the use of two root canal medicaments, Ledermix and Ultracal. There was insufficient evidence of a difference for periodontal healing or tooth survival. This was the only study to formally report adverse events with none identified. Study authors reported that Ledermix caused a greater level of patient dissatisfaction with the colour of avulsed and replanted teeth.A third study at high risk of bias with 19 participants compared extra- or intra-oral endodontics for avulsed teeth which were stored dry for longer than 60 minutes before replantation. There was insufficient evidence of a difference in periodontal healing.The fourth study at high risk of bias with 73 participants compared a 10-minute soak in either thymosin alpha 1 or saline before replantation followed by daily gingival injections with these same medicaments for the first 7 days. There was some evidence of a benefit for thymosin alpha 1 with respect to periodontal healing and tooth survival.

AUTHORS' CONCLUSIONS

Based on the results of the included studies, there is insufficient evidence to support or refute the effectiveness of different interventions for avulsed and replanted permanent front teeth. The overall quality of existing evidence was very low, and therefore great caution should be exercised when generalising the results of the included trials. There is urgent need for further well-designed randomised controlled trials.

Incidental Finding of a Suspected Horizontal Root Fracture During Mucogingival Surgery

Periapical and bitewing radiographs lack the sensitivity to reliably diagnose horizontal root fractures, and, therefore, asymptomatic teeth with root fractures may remain undetected for years. This article reports a case in which a patient presented with a mucogingival defect on tooth No. 24 with no apparent history of dental trauma. During a free gingival graft procedure, a horizontal root fracture was observed in the apical third of the aforementioned tooth. After the clinician communicated this finding to the patient, the patient recollected two instances of trauma that had occurred to this area more than 30 years earlier. The presence of the horizontal root fracture did not affect the postoperative healing from the mucogingival procedure, and the tooth remained stable at the 1-year follow-up.

Obliteration after recurrent dental trauma in a 7-year-old patient: 4-year follow-up

Traumatic dental injuries are reported to have a high prevalence regardless of the region or the age group. Concussion injuries are considered as moderate, but very frequent injuries. They are associated with a wide spectrum of pulpal reactions. Pulp canal obliteration in spite of negative sensitivity proves ongoing pulp vitality. This case report presents multiple traumatic dental injuries in both maxillary central incisors with two different pulpal reactions during a follow-up period of 4 years in a healthy 7-year-old girl. The initial trauma with a concussion required no invasive treatment. Three days later, the child presented again with a new dental trauma. At the follow-up appointments after 3, 4, 6, 12, and 18 months, the traumatized teeth were functional and asymptomatic, but the radiograph after 1 year showed partial obliteration in the coronal part of the maxillary right central incisor. After 4 years, the periapical radiograph showed complete apical closure, and increase in root length and dentin thickness for both maxillary central incisors, with almost complete root canal obliteration in the right central incisor, whereas the left central incisor showed no signs of obliteration. Thus, this case showed different pulpal reactions to traumatic dental injury and that the loss of clinical sensitivity of the obliterated tooth does not automatically mean the loss of vitality and the need for endodontics. Regular follow-ups are essential in concussion cases to observe the pulp vitality and root formation.

Computerized three-dimensional design for accurate orienting and dimensioning artificial dental socket for tooth autotransplantation

OBJECTIVE

To present an improved, accurate, and efficient method for planning and preparing an artificial socket for autotransplantation, by using a three-dimensional (3D) surgical guide and a replica of the transplanted donor tooth. The guide and the tooth replica were fabricated using a computerized 3D simulation. A case treated with this approach is presented.

METHOD AND MATERIALS

Cone beam computed tomography (CBCT) and computerized 3D simulations (Simplant plus registration as stereolithography) were used for planning the optimal artificial socket position and dimensions, within the limitations of the alveolar bone borders and the adjacent teeth roots, and for producing a metal replica of the transplanted tooth. The replica was used to assure the correct socket preparation and orientation before extraction and replantation of the donor premolar.

RESULTS

The entire procedure time for autotransplantation of a permanent second premolar to the incisor site without the buccal plate was about 45 minutes. At 15 months' follow up, clinical examination of the transplanted tooth demonstrated both normal mobility and no sensitivity to cold stimulation. A radiographic examination revealed continuous root development and pulp obliteration. The adjacent teeth maintained their vitality with no pathologic signs.

CONCLUSION

We present an improved technique for autotransplantation based on computerized 3D simulations and guidance for accurate dimensioning and optimal locating of the artificial socket relative to the alveolar bone borders and the adjacent teeth roots. This technique may significantly simplify the autotransplantation procedure and will probably also increase its success rate and use in young patients, even in cases with absence of a buccal plate.

Manufacturing of an immediate removable partial denture with an intraoral scanner and CAD-CAM technology: a case report

BACKGROUND

Incisor loss constitutes a strong aesthetic and psychologic traumatism for the patient and it remains a challenging situation for the dental practitioner because of the necessity to rapidly replace the lacking tooth. Various therapeutic procedures have been proposed to replace the incisor concerned, for example by using a removable partial denture. However, the manufacturing of such a denture with classical procedures is often subject to processing errors and inaccuracies. The computer-aided design and computer-aided manufacturing (CAD-CAM) technology could represent a good alternative, but it is currently difficult because of the lack of dental softwares able to design easily immediate removable partial dentures.

CASE PRESENTATION

A 30-year- patient complained about pain caused by a horizontally and vertically mobile maxillary right central incisor. After all options were presented, extraction of the traumatized incisor was decided due to its very poor prognosis, and the patient selected the realization of a removable denture for economic reasons. The present paper proposes an innovative procedure for immediate removable denture, based on the use of an intraoral scanner, CAD with two different softwares used sequentially, and CAM with a 5-axis machine.

CONCLUSIONS

We show in this report that associating an intraoral scanner and CAD-CAM technology can be extended to immediate dentures manufacturing, which could be a valuable procedure for dental practitioners and laboratories, and also for patients.

Reimplantation of an avulsed mature permanent tooth after 6 days: a 1-year follow-up

Tooth avulsion in children and adolescents demands emergency treatment to increase the chances of successful reimplantation. The treatment prognosis depends on intrinsic and extrinsic factors, such as the extra-alveolar time until reimplantation, storage medium, handling, and periodontal ligament condition of the avulsed tooth as well as the patient's general health. This case report describes the treatment of an 11-year-old boy who suffered an avulsion of the maxillary right central incisor followed by delayed reimplantation after the tooth was stored in a dry medium for 6 days. Although the tooth was kept in extremely unfavorable conditions, tooth reimplantation was attempted because the patient was young and it was desirable to avoid psychological trauma as well as esthetic and functional problems. The treatment performed followed the guidelines of the International Association of Dental Traumatology for an avulsed tooth with a closed apex and extraoral dry time exceeding 60 minutes. At a 1-year follow-up appointment, the tooth exhibited clinical function, no mobility or pain symptoms, and mild signs of ankylosis. A radiographic image showed resorption by substitution. Although the long-term prognosis is uncertain, this treatment approach was advantageous for the patient because it maintained esthetics, function, and alveolar bone height.

Color Repair of a Composite Resin Restoration

Fractured teeth with both enamel and dentin involvement might be treated with adhesive composite resin restorations. In cases where a perfect color match between the composite restoration and the remaining tooth structure is not achieved, a repair might be carried out to correct the color of restoration. This procedure avoids the restoration replacement, preserving tooth structure without compromising the esthetic outcome.

Decisions on repositioning of intruded permanent incisors; a review and case presentation

Traumatic intrusion is a luxation type of injury where the tooth is displaced along the axis of the tooth, into the alveolus. This injury is regarded as serious because of the tissue damage that it causes. The traumatic movement is associated with severe damage to the periodontal ligament, pulpal tissue, root and alveolar socket. Despite its severity, the rare occurrence of this injury in permanent teeth has resulted in limited studies of immature and mature permanent incisors. The purpose of this paper is to review this luxation injury of permanent immature incisors, and to describe its diagnosis, treatment and management. In particular, we describe the repositioning strategies used in cases of intrusion injury. These include (i) monitoring spontaneous re-eruption, (ii) active orthodontic repositioning and (iii) surgical repositioning. Firstly, monitoring spontaneous re-eruption is observing and waiting for the intruded tooth to return to its original position. This process is not a normal developmental eruption and the outcome is not always predictable, nor is the time needed for this to happen. Secondly, active orthodontic repositioning is used to describe the process of rapidly moving the intruded tooth to its original position with the aid of an orthodontic appliance. Active orthodontic repositioning is often misunderstood as normal orthodontic movement. Orthodontic movement allows for periodontal ligament remodelling, using light intermittent forces. In contrast the active orthodontic repositioning used to move intruded incisors is rapid, and the primary aim is to achieve correct tooth position as rapidly as possible. Thirdly, surgical repositioning uses surgical intervention to bring the tooth back to its original position. A case of an intruded immature permanent incisor is presented, with a particular emphasis on these critical decisions on repositioning and showing the use of the three modalities of treatment in sequence, in order to achieve an outcome.

Regenerative endodontics after front tooth trauma. A case report

In the context of tooth trauma, mostly the maxillary central front teeth are involved, whereby their roots are in some cases still in the developing stage (immature). Depending on the type of trauma, a necrosis of the pulp is the consequence or at least foreseeable. In order to preserve such a tooth, an endodontic therapy is inevitable. The disadvantage of conventional endodontic therapy methods of immature teeth (apexification, apexogenesis) is the root growth stop. Alternatively, the regeneration/revascularisation of the dental pulp (RP) was suggested, that allows a further root growth. The aim of this case report is to present the procedure of a RP-therapy and to suggest a step-by-step manual.

Delayed tooth reimplantation with 4-year follow-up: the management of ankylosis during facial growth

This case report describes the consequences of delayed (24 hours) reimplantation of an avulsed maxillary central incisor, findings over a 4-year follow-up period, and the management of ankylosis during facial growth. After a traumatic event, a 10-year-old boy was taken to a hospital emergency department due to injuries to his face, including avulsion of the maxillary left central incisor. Despite the short amount of time before arriving at the hospital (10 minutes) and use of the correct storage medium (milk), the tooth was not reimplanted, and the parents did not receive instructions to seek dental treatment. The next day, the child was brought to a dental school because he objected to the loss of his tooth. The treatment chosen was delayed tooth reimplantation. At the 1-year follow-up, the reimplanted tooth was infraoccluded, and periapical radiography revealed signs of ankylosis and initial replacement root resorption. At the 2- and 3-year follow-up examinations, resorption and infraocclusion of the central incisor had progressed. In this case, the delayed reimplantation resulted in ankylosis that had a significant clinical impact due to the patient's facial growth. Direct resin restoration of the reimplanted tooth was therefore performed 3 years after trauma. Despite continued resorption and infraocclusion of the tooth observed 4 years posttrauma, the esthetic, low-cost treatment was well accepted, and the patient's quality of life was improved until definitive treatment can be performed.

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.

Decoronation of an ankylosed tooth: Postoperative restoration by means of an intermediate fixed orthodontic laboratory device

Rehabilitation of missing decoronated permanent incisors in growing children and adolescents is a major challenge. The psychologic impact of the loss of an incisor is significant due to its immediate influence on facial appearance. Final restoration is planned only after skeletal growth cessation. Consequently, the fabrication and installation of an immediate temporary restoration, which is expected to remain in place for a long period, must meet the patient's esthetic demands and be durable in the oral environment. Several proposed removable and fixed restorations have presented significant shortcomings. The purpose of this report is to suggest a comfortable dental device for restoring the missing permanent tooth with improved esthetic, functional, and psychologic benefits. An alternative fixed orthodontic laboratory fabricated appliance for permanent tooth restoration is described among children with posttraumatic tooth decoronation. Unlike removable restorative appliances, this fixed device is not dependent on the child's compliance. Esthetically, no metal part is exposed in the anterior region and the architecture is more sturdy and stable, with minimum interruption to the alveolar ridge's vertical development.

CASE REPORT

An alternative fixed orthodontic laboratory appliance is described for intermediate restoration of a missing permanent tooth.

CLINICAL RELEVANCE

A posttrauma intermediate fixed orthodontic appliance is a beneficial solution from esthetic, psychologic, functional, and economic perspectives for replacing missing anterior maxillary teeth. This device may be worn by patients for a long period until final restoration is indicated.

A Multidisciplinary Approach to Restore an Unconventional Crown Removal of Traumatized Permanent Central Incisors

A 13-year-old female presented with traumatized maxillary central incisors that had been endodontically treated. Five years later, at a different dental office, she had the clinical crowns removed, leaving subgingival margins. From the patient's history and our initial assessment, it seemed as if the teeth had been fractured and luxated but not avulsed. Endodontic posts with spot-welded orthodontic brackets were temporarily cemented to enable orthodontic extrusion. Once access to restorable margins was obtained, the temporary posts were removed and conventional fiber posts with interim composite crowns were placed. The restorations were still satisfactory at the one-year follow-up, with a healthy periodontium, intact apical seal, and no signs of external re- sorption observed. Combined specialty treatment provided an esthetically acceptable outcome in a difficult restorative situation for a growing child. The purpose of this case report is to discuss an interim treatment until the child reaches dentofacial maturity, when definitive restorations can be provided.

Maxillary Central Incisor Root Resorption due to Canine Impaction after Trauma. Is the Canine Substitution for Maxillary Incisors a suitable Treatment Option? Two Case Reports

OBJECTIVE

Canine impaction is a dental anomaly involving intraosseous displacement of the unerupted tooth. This situation is of significant importance causing orthodontic, surgical and interceptive problems. Trauma in the incisor area is a possible cause of the displacement of the tooth bud of the permanent canine resulting in the deviated eruption path. The aim of this article is to present two clinical cases with diagnosis of maxillary canine displacement and impaction in the incisor region after a traumatic injury during childhood, discussing treatment possibilities and outcomes achieved after orthodontic treatment.

MATERIALS AND METHODS

In this article ectopic maxillary canines migration in the central incisor area after a traumatic injury to the anterior upper teeth are described. The path of eruption of the canine can cause severe central incisor root resorption. Treatment strategy established for the case reports described involves orthodontic space opening, extraction of the central incisor, uncovering the impacted canine and orthodontic traction of the tooth in place of central incisor. Modification of crown morphology and color were essential to obtain an aesthetic and function outcome.

RESULTS

The patients finished treatment with normal and stable occlusion, an adequate width of attached gingiva and good aesthetic results.

CONCLUSION

Authors suggest that might have been a possible connection between the trauma of primary dentition causing the displacement of the tooth bud of permanent canine and the deviated path of eruption. For the growing patients with a combination of dental trauma and ectopic eruption, maxillary canine to replace a central incisor was a viable option, offering excellent aesthetic results without recourse to prosthetic replacement.

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.

Micro-computed Tomographic Evaluation of Dentinal Microcrack Formation after Using New Heat-treated Nickel-titanium Systems

INTRODUCTION

The aim of the present study was to evaluate the frequency of dentinal microcracks observed after root canal preparation with HyFlex CM (Coltène/Whaledent, Altstätten, Switzerland), HyFlex EDM (Coltène/Whaledent), Vortex Blue (Dentsply Tulsa Dental Specialties, Tulsa, OK), and TRUShape (Dentsply Tulsa Dental Specialties) systems using micro-computed tomographic (micro-CT) analysis.

METHODS

Forty human mandibular incisors with 1 and straight root canals were randomly assigned to 4 experimental groups (n = 10) and 1 control group for root canal preparation: group 1, HyFlex CM; group 2, HyFlex EDM; group 3, Vortex Blue; and group 4, TRUShape. The specimens were scanned using high-resolution micro-CT imaging before and after root canal preparation. Afterward, preoperative and postoperative cross-sectional images of the teeth were screened to identify the presence of dentinal defects. The number of microcracks was determined as a percentage for each group.

RESULTS

Before and after canal preparation, 36,152 cross-sectional images were examined. Four thousand four hundred fifty-two (12.31%) dentinal defects were observed. No new microcracks were observed after root canal instrumentation with the tested systems.

CONCLUSIONS

Root canal preparation with the HyFlex CM, HyFlex EDM, Vortex Blue, and TRUShape systems did not induce the formation of new dentinal microcracks on straight root canals of mandibular incisors.

Management of a Permanent Maxillary Lateral Incisor with Vital Pulp and Necrotic Dens Invaginatus Type III

This is a case report on the management of a vital lateral incisor with a radiolucent cervical area associated with the presence of necrotic pulp due to a dens invaginatus (DI) type III. A nine-year-old boy presented to a university pediatric dental clinic with dental trauma. The examination showed poor oral hygiene, an uncomplicated fracture in the permanent maxillary left central incisor, and a fistula near the permanent maxillary right lateral incisor. A radiograph showed that the right lateral incisor had incomplete root development and a type III DI. Although sensitive to thermal pulp testing, tracing of the fistula indicated that the radiolucent area was associated with the DI, extending laterally to the periodontal ligament. Endodontic treatment was performed only in the invagination, keeping the root canal of the lateral incisor vital. After two years of follow-up, complete root formation and injury repair associated with invagination were observed.