The prevalence of crown injuries to frontal teeth at schoolchildren aged 6 to 14 and their effects on the periodontal tissue

The research aims at emphasizing the interrelation between the social impact and the self-esteem of schoolchildren with dental crown fractures in the frontal group. Dental traumatic injuries are frequently met to schoolchildren, therefore, the prevention and interception of traumatic pathology within parents, teachers and children is more than necessary. Our statistical study intends to determine the prevalence of dental trauma to southwestern Romanian schoolchildren aged 6 to 14. The survey included a number of 1684 schoolchildren attending public schools, randomly chosen. Data were collected from October 2012 to December 2013. Clinical examination was conducted to assess the dental traumatic injuries. Age and gender distribution, etiological factors, risk factors and the cause of injuries were the parameters taken into consideration. The data collected was processed and analyzed using the SPSS (Statistical Package for the Social Sciences) statistical software. The overall prevalence of dental trauma was 4.63% amongst the subjects examined. The maxillary central incisor was the most commonly affected tooth (85.19% in boys and 97.87% in girls). We observed a significant statistical difference in the number of children with one, two or three fractured teeth from the urban and rural areas. The percentage of schoolchildren with crown fractures that we examined was of 3.09% in the urban area and 1.54% in the rural area. The traumatic injuries of the maxillary upper teeth were most prevalent. Since the dental trauma of incisors has a strong impact on the quality of life of children and their families, health preventive policies are needed in order to avoid psychological implications on the lifelong existence of children affected.

Management of Traumatized Permanent Incisors. Revascularization and Delayed Replantation

This article reports a clinical case of a 9-year-old boy with a traumatic injury to the maxillary central incisors 24 hours after a fall in his schoolyard. The upper left central incisor was avulsed and was kept in saliva for four hours from the moment of trauma until its replantation. The right one was necrotized after one month. We describe successful revascularization treatment of right necrotic immature upper incisor and delayed replantation of left one. After 18 months, radiolucent lesions in the periapical areas of both maxillary central incisors had healed, and root apex development was noted with thickening of the walls in tooth #8.

Resin-bonded fixed dental prosthesis with a modified treatment surface in a zirconia framework: a case report

Although resin-bonded fixed dental prostheses (RBFDPs) were developed almost 40 years ago, their implementation in clinical practice did not achieve success due to biomechanical failures of the restorative materials. Nowadays, the evolution of ceramic materials and bonding procedures has allowed for the revival of the dental prosthesis. Zirconia is the dental ceramic with the highest flexural strength under compression. However, there are still some concerns regarding the bonding strength of zirconia to enamel that require further research. In this article, through the presentation of three clinical cases, the authors show how modifying the surface of zirconia frameworks by applying a feldspathic veneering on the retainer's buccal surface allows for a bonding procedure to dental structures. The goal of this treatment method is to simultaneously improve structural strength, esthetic integration, and bonding optimization to enamel. In a 3-year prospective evaluation, this framework modification shows promising results, with a survival rate of 100% and no biological or mechanical complications.

Current Applications and Future Prospects of Stem Cells in Dentistry

Stem cells are defined as clonogenic, unspecialized cells capable of both selt-renewal and multi-lineage differentiation, contributing to regenerating specific tissues. For years, restorative treatments have exploited the lifelong regenerative potential of dental pulp stem cells to give rise to tertiary dentine, which is therapeutically employed for direct and indirect pulp capping. Current applications of stem cells in endodontic research have revealed their potential to continue root development in necrotic immature teeth and transplanted/replanted teeth. Successful application of pulp revascularization is highlighted here with support of a clinical case report. This article also discusses the role of dental stem cells as a promising tool for regeneration of individual tissue types like dentine, pulp and even an entire functional tooth.

Interventions for treating traumatised ankylosed permanent front teeth

BACKGROUND

Teeth that have suffered trauma can fuse to the surrounding bone in a process called dental ankylosis. Ankylosed permanent front teeth fail to erupt during facial growth and can become displaced, thus resulting in functional and aesthetic problems. Dental ankylosis is also associated with root resorption, which may eventually lead to the loss of affected teeth. Different interventions for the management of ankylosed permanent front teeth have been described, but it is unclear which are the most effective.

OBJECTIVES

To evaluate the effectiveness of any intervention that can be used in the treatment of ankylosed permanent front teeth.

SEARCH METHODS

The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 3 August 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2015, Issue 7), MEDLINE via OVID (1946 to 3 August 2015), EMBASE via OVID (1980 to 3 August 2015) and LILACS via BIREME (1982 to 3 August 2015). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing any intervention for treating displaced ankylosed permanent front teeth in individuals of any age. Treatments could be compared with one another, with placebo or with no treatment.

DATA COLLECTION AND ANALYSIS

Two independent review authors screened studies independently. Full papers were obtained for potentially relevant trials. Although no study was included, the authors had planned to extract data independently and to analyse the data according to the Cochrane Handbook for Systematic Reviews of Interventions.

MAIN RESULTS

No randomised controlled trials that met the inclusion criteria were identified.

AUTHORS' CONCLUSIONS

We were unable to identify any reports of randomised controlled trials regarding the efficacy of different treatment options for ankylosed permanent front teeth. The lack of high level evidence for the management of this health problem emphasises the need for well designed clinical trials on this topic, which conform to the CONSORT statement (www.consort-statement.org/).

Prevalence and unmet treatment need of traumatized incisor among Cameroonian schoolchildren in North West Province

OBJECTIVE

To determine the prevalence and unmet treatment need of traumatized incisor in 12-13 years old among Cameroonian Schoolchildren in the North West Province.

MATERIALS AND METHODS

This cross-sectional survey among 12-13 years old children of selected rural and urban secondary schools in North West province of Cameroon was conducted between March and November, 2010.

RESULTS

The majority of the 2287 studied children were females (50.2%) and urban dwellers (51.8%). Of the 2287 studied children, 45 of them exhibited evidence of incisor trauma giving a prevalence of 2.0%. This prevalence was higher in males than females (2.3% versus 1.7%) and also higher in urban than rural schools (2.2% versus 1.7%). Upper central incisor was the predominantly traumatized tooth and enamel fracture constituted 62.2% of incisor trauma. Fall and sports were the leading cause of incisor trauma in this study. Some minor variations in the causes of incisor trauma were found among gender and location. The prevalence of unmet treatment need was 91.1% which were mainly acid etch restoration. Males and rural dwellers had more unmet treatment need.

CONCLUSION

Data revealed a low prevalence of traumatized incisor with high prevalence of unmet treatment needs among Cameroonian Schoolchildren in North West Province. Findings of this survey provide baseline information on prevalence and unmet treatment need for traumatized incisor among Cameroonian Schoolchildren in the North West Province.

Multi-disciplinary management of a patient with a post-traumatised incisor presenting concurrent replacement and inflammatory resorption: a case report

This case report describes the multidisciplinary management of a young male who presented with a Class I incisor relationship and bi-maxillary dento-alveolar protrusion on a Class I skeletal base. The occlusion was complicated by an ankylosed and moderately infra-positioned upper left permanent central incisor, an anterior crossbite, crowding, a reduced overbite and centreline discrepancy. The incisor was traumatised and avulsed when the root was immature and the tooth was reimplanted with delay. On referral for orthodontic treatment at age 11 .5 years, the upper left central incisor was experiencing ankylosis-related (osseous replacement) resorption and external root resorption simultaneously. Aside from the orthodontic aims, it was important to address the disrupted alveolar development to facilitate later prosthodontic replacement of the upper left permanent central incisor by idealising the inter-coronal and inter-radicular spaces. Treatment consisted of fixed orthodontic appliances in conjunction with the extraction of all second premolars and the upper left permanent central incisor with episodic surgical curettage. An upper Hawlix retainer was provided immediately at debond and a cantilevered resin-retained bridge was placed four months later.

Agreement Among Dental Students, Peer Assessors, and Tutor in Assessing Students' Competence in Preclinical Skills

The aim of this study was to determine the level of agreement regarding assessments of competence among dental students, their student peers, and their clinical skills tutors in a preclinical skills program. In 2012-13 at the University of Edinburgh, second-year dental students learned to perform the following seven cavity preparations/restorations on primary and permanent Frasaco teeth: single-surface adhesive occlusal cavity; single-surface adhesive interproximal cavity; single-surface adhesive labial cavity; multi-surface adhesive cavity; multi-surface amalgam cavity; pre-formed metal crown preparation; and composite resin buildup of a fractured maxillary central incisor tooth. Each student, a randomly allocated student peer, and the clinical skills tutor used standardized descriptors to assign a competency grade to all the students' preparations/restorations. The grades were analyzed by chi-square analysis. Data were available for all 59 second-year students in the program. The results showed that both the students and their peers overestimated the students' competence compared to the tutor at the following levels: single-surface adhesive occlusal cavity (χ(2)=10.63, p=0.005); single-surface adhesive interproximal cavity (χ(2)=11.40, p=0.003); single-surface labial cavity (χ(2)=23.70, p=0.001); multi-surface adhesive cavity (χ(2)=12.56, p=0.002); multi-surface amalgam cavity (χ(2)=38.85, p=0.001); pre-formed metal crown preparation (χ(2)=40.41, p=0.001); and composite resin buildup (χ(2)=57.31, p=0.001). As expected, the lowest levels of agreement occurred on the most complicated procedures. These findings support the need for additional ways to help students better self-assess their work.

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.

Oral Health-Related Quality of Life and Traumatic Dental Injuries in Young Permanent Incisors in Brazilian Schoolchildren: A Multilevel Approach

BACKGROUND

Traumatic dental injury (TDI) during childhood may negatively impact the quality of life of children.

OBJECTIVE

To describe the association of oral health-related quality of life (OHRQoL) and domains (oral symptons, functional limitation, emotional- and social-well-being) of children with individual and contextual variables.

METHODS

A cross-sectional study was performed using a representative sample of 1,201 schoolchildren, 8-10 years-old, from public and private schools of Belo Horizonte, Brazil. The CPQ8-10 was used to assess OHRQoL, dichotomized in low and high impact. Sociodemographic information was collected through questionnaires to parents. Children were examined at schools, using the Andreasen criteria. Individual variables were gender, age, number of residents in home, parents/caregivers' level of education, family income, and TDI (dichotomized into without trauma/mild trauma and severe trauma). Dental caries and malocclusion were considered co-variables. Contextual variables were the Social Vulnerability Index and type of school. Ethical approval and consent forms were obtained. Data were analyzed using SPSS for Windows 19.0 and HLM 6.06, including frequency distribution, chi-squared test and multilevel approach (p < 0.05).

RESULTS

The prevalence of a negative impact on OHRQoL in children with severe trauma was 55.9%. The TDI negatively impacted emotional and social domains of OHRQoL. A multilevel analysis revealed a significant difference in OHRQoL according to the type of school and showed that 16% of the total variance was due to contextual characteristics (p < 0.001; ICC = 0.16). The negative impact on OHRQoL was higher in girls (p = 0.009), younger children (p = 0.023), with severe TDI (p = 0.014), those from public schools (p = 0.017) and whose parents had a lower education level (p = 0.001).

CONCLUSION

Severe trauma impacts OHRQoL on emotional and social domains. Contextual dimensions add information to individual variability to explain higher impact, emphasizing socioeconomic inequalities.

Evaluation of a possible association between a history of dentoalveolar injury and the shape and size of the nasopalatine canal

OBJECTIVES

Maxillary incisors (MI) are often affected by dentoalveolar injury resulting in tooth devitalization and apical periodontitis. The aim of the present study was to analyze any association between a history of dentoalveolar injury and the shape and size of the nasopalatine canal (NC) using cone beam computed tomography (CBCT).

MATERIAL AND METHODS

Patients were allocated to the trauma group if they had a history of dentoalveolar injury and a root filling in at least one MI and/or one missing MI. As controls, 100 matched-controlled (age and gender) patients were selected. NC dimensions including length, width at midway, and diameter of incisal and nasal foramen were measured in sagittal and axial CBCT planes. Furthermore, an evaluation of NC bulging signs, apical osteolysis of MI, and its fusion with NC was performed.

RESULTS

In the trauma group (n = 96), 31.3 % had at least one missing MI, and 95.8 % had a root filling in a MI. The antero-posterior dimension of the incisive foramen (p = 0.02) and of the NC at midway (p = 0.04) was significantly larger in the trauma group. Significantly more cases with a bulging sign were found in the trauma (n = 19) than in the control group (n = 3, p = 0.001). An apical osteolysis was identified in 5.1 % of MI, and 12/38 did show a fusion with the NC.

CONCLUSION

Wider dimensions of the NC and a bulging sign may suggest a former dentoalveolar injury to the anterior maxilla. Periapical osteolysis of central MI over 5 mm in diameter tends to fuse with the NC.

CLINICAL RELEVANCE

In patients with a history of dentoalveolar injury and/or apical periodontitis, the NC should be evaluated on available CBCT images. Any inflammatory processes in the neighboring teeth should be recognized and eliminated as they may initiate bulging of the NC and/or the formation of a nasopalatine duct cyst (NPDC). NC with bulging signs should be monitored clinically and radiographically to diagnose a NPDC in an early stage.

Traumatic Intrusion of a Maxillary Canine Tooth: 3 Cases

Of the six recognized types of tooth luxation injuries, intrusion generally carries the most guarded long-term prognosis due to the high risk of complications, including root resorption, ankylosis, marginal bone loss, and pulp canal obliteration or necrosis. The degree of traumatic intrusion and stage of root development affects the outcome and treatment planning. This report describes the clinical history, oral and radiographic examination findings, and rationale for surgical extraction in 2 dogs and 1 cat with traumatic intrusion of a maxillary canine tooth.

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.

Full Mouth Rehabilitation Determined by Anterior Tooth Position

When patients seek cosmetic dentistry, their main concern is how their new smile is going to appear. In trying to achieve a patient's desire for a more beautiful smile, a careful and comprehensive analysis must be completed to insure the desired outcome is achievable and will function for many years to come. The clinician's primary goal is to restore the patient's dentition to ideal form and function. Full mouth rehabilitations need to be done in a systematic way to ensure all the parameters of an esthetic and functional outcome are achieved.

Challenges in treating traumatically intruded and ankylosed permanent incisors: a case report with a multidisciplinary approach

This report discusses the challenges, complications and management of traumatic intrusion injuries affecting the permanent dentition. A case is described where trimming of the incisal edge of a severely intruded and ankylosed upper lateral incisor resulted in an unexpected re-eruption of the tooth. It is suggested that the vibrations from drilling may have disrupted the ankylosis, initiating spontaneous re-eruption and this approach could provide a minimally invasive and conservative pathway to treating ankylosed teeth. Clinical Relevance: To date no effective treatment has been described to reverse the development of replacement root resorption leading to the loss of the affected tooth. The hypothesis proposed here suggests that mechanical vibrations, if strong enough, may disturb the ankylosis and allow re-eruption of the intruded tooth.

The diagnostic and treatment challenges associated with traumatized intruded permanent incisors: a case report

Intrusions are considered among the most severe forms of dental trauma and are associated with severe late complications. Usually general dental practitioners are the first to see and treat these children. The present case describes the challenges associated with the diagnosis and treatment of late complications of complete intruded maxillary incisors accompanied by profound buccal displacement in an 8-year-old patient. The treatments performed included root-canal treatment of right central incisor using mineral trioxide aggregate (MTA) and a combination of surgical and orthodontic repositioning of the intruded left incisor. Clinical and radiographic examinations at 2 years' follow-up revealed intact lamina dura and no sign of ankylosis in both incisors, apexogenesis of the right central incisor, and positive response to pulp testing of the left central incisor. The present report emphasizes the need to follow a child with severe dental injury and to consult with trained specialists when needed.

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.