Surgical repair of a resorptive defect in an anterior tooth of an adolescent: a case report

A case is described in which a 14-year-old girl was referred with external inflammatory resorption in the middle third of the root of her maxillary left lateral incisor; the resorptive defect was in continuity with the root canal and the prognosis was considered poor. After controlling the infection in the root canal and then repairing the defect surgically, the resorption ceased, and healing occurred, enabling the tooth to be retained.

A clinical study using the collagen gel Zyplast in endodontic treatment

The use of a collagen gel as a hard tissue induction material in fractured and undeveloped teeth is reviewed. Three of four cases demonstrate a modest amount of hard tissue formation within the pulp space previously occupied by the collagen gel. Limitations in positive results, compared with a previous animal study and one clinical case report, are probably due to the pre-existence of infection in the present study.

Acceptance of dental care following early extractions under rectal sedation with diazepam in preschool children

The aim of the study was to evaluate the effect of amnesia in preschool children on their later acceptance of dental care. Forty-six 4-6-year-old children, who between 2 and 4 years previously had had primary incisors extracted because of trauma, were reexamined for dental health and acceptance of dental care. The extractions had been performed under rectal sedation with diazepam (0.7 mg/kg body weight). Information about dental treatment and degree of cooperation during the intervening period was obtained from records at the referring clinic. The parents were interviewed about their child's experience of amnesia concerning the extractions, background variables, and experiences of dental care before the follow-up examination. Amnesia concerning the extractions was reported in 85% of the children. Twenty-nine percent had on some occasion exhibited behavior management problems (BMP) during the intervening period. Lack of amnesia was significantly associated with BMP (P< 0.002). Children without amnesia concerning the extractions tended to accept dental care less well at the reexamination. Parents were able to predict their child's acceptance of dental care at the follow-up with a significant degree of success (P= 0.02). In conclusion, amnesia in preschool children concerning extractions seems to be essential to facilitate positive acceptance of future dental care.

Incisal edge reattachment: literature review and treatment perspectives

Anterior crown fractures in children and adolescents are a common form of injury, affecting approximately 25% of that population. Common restorative treatments such as composite bonding, laminate veneers, or full-coverage restorations tend to sacrifice healthy tooth structure and challenge dentists to match the adjacent unrestored dentition. Incisal edge fragment reattachment, including the use of current bonding techniques, is a restorative treatment option that offers the advantages of simplicity, immediate esthetics, and conservatism in cases of dental trauma. This article presents a comprehensive literature review on this restorative technique. It also provides diagnostic and treatment algorithms to simplify and clarify the recommended diagnostic and clinical regimens.

Suture splint: an alternative for luxation injuries of teeth in pediatric patients--a case report

Stabilization of replanted tooth "splinting" is done to prevent further damage to the pulp and periodontal structure during the healing period. Suture and bonded resin splint is passive, semirigid and functional splint. It is easy to fabricate directly in mouth without lengthy laboratory procedures. A case is presented in which suture and bonded resin splint was performed on laterally luxated maxillary central incisor and avulsed lateral incisor. The splint was removed after one week and sufficient periodontal and gingival healing was observed.

Adhesive bonding of fragmented anterior teeth

This in vitro study investigated the fracture strengths of fractured incisors after reattachment to the remaining tooth structure, using either Gluma dentin-bonding agent together with 1 of 13 different experimental resins or 1 of the following dentin-bonding agents: Gluma+ (experimental modification of Gluma), Panavia21, ScotchBond1 (SingleBond), All-Bond2, Dentastic, SuperBond, Prime&Bond 2.1. No significant differences were found in the experiments with various experimental resins. The fracture strength of teeth rebonded with Gluma, All-Bond2, Dentastic, SuperBond or Prime&Bond 2.1 showed mean fracture strengths in the range of 8.7-11.2 MPa, which were significantly different in all cases from that of intact teeth (16.3 MPa). Teeth bonded with Gluma+, Panavia21 or ScotchBond1 (SingleBond) showed mean fracture strengths of 15.5, 14.6, and 14.2 MPa, respectively. These fracture strengths were not significantly different from that of intact teeth.

Traumatic injuries to the anterior teeth among South Kanara school children--a prevalence study

The present study was carried out to assess the prevalence and distribution of the traumatic injuries to anterior teeth among 4500 school children in the age group of 3 to 16 years from South Kanara District of Karnataka. Information concerning sex, age, cause of trauma, number of injured teeth, type of the teeth, lip competence, terminal plane relationship and the molar relationship were recorded. A total of 238 cases (5.29%) had incisor and canine fractures, which was more prevalent among the boys (72.27%) than the girls (27.73%). The leading cause of injury was undefined falls and the maxillary central incisors were commonly affected in both the primary and the permanent dentition. Enamel fracture was the most common form of injury noted. Class 1 Type 2 and Class 2 division 1 molar relationship cases exhibited significantly very high number of fractured teeth. Only 1.68% of the cases with traumatized teeth had undergone treatment.

Management of teeth with open apices and necrotic pulps with single visit apexification: 3 representative cases

Apexification is the most widely accepted procedure for the treatment of nonvital immature teeth. Single visit apexification is less time consuming, more economical and an easily acceptable technique with the aim of inducing the formation of a hard tissue barrier, thus allowing proper condensation of gutta percha in the root canal. Factors considered during this procedure are: i. Debridement of root canal minimizing the infection and filling the root canal space with resorbable calcification inducing material i.e. Ca(OH)2. ii. Minimal mechanical intervention to maintain the integrity and vascularity of apical region. Once filled, Ca(OH)2 was not changed again and the treated tooth was examined only radiographically till the desired apical closure was achieved. Three representative cases treated with this single visit apexification technique are discussed here. In all the cases successful apical closure of different types was achieved. Treatment was then concluded with gutta percha obturation in all the cases with successful follow up.

Emergency treatment of orodental injuries: a review

There has been an increase in the incidence of injuries to the incisor teeth in the primary and permanent dentitions over the last decade; one study reported that roughly 35% of 9-year-old children will have damaged their teeth in some way. Much has been written about dental injuries, and there may be confusion about the appropriate emergency treatment for different types. Classification and understanding of the types of injury are essential before diagnosis and treatment can be undertaken. Although dental injuries can occur singly, they more usually involve a combination of injuries to a tooth and its supporting structures. Prompt, accurate diagnosis and appropriate emergency treatment as outlined in this paper will greatly improve the prognosis for many dentoalveolar injuries. The aim must be to ensure that the third of the population of preteenage children who damage their teeth are not resigned to loss of an incisor in later life because of inaccurate diagnosis and poor treatment of the emergency condition.

Management of accidental and iatrogenic injuries to the dentition

This article discusses the restoration of teeth with extensive fractures extending beyond the attachment of the periodontal ligament, as well as the treatment of iatrogenic perforations observed during post space preparation. Various treatment procedures and their limitations are described, based on the authors' many years of clinical experience.

Surgical extrusion of a completely intruded permanent incisor

This report presents a case of a completely intrusive luxation of a mature permanent central incisor in a 10-yr-old boy. The intruded tooth was repositioned by using surgical extrusion and stabilization with interdental sutures. Endodontic treatment was performed with calcium hydroxide paste as the intracanal medication and a calcium hydroxide-based root canal sealer. This treatment mode was observed at 18 months and was successful at that time.

Management of traumatized permanent incisor teeth with horizontal root fractures

Proper management of permanent incisors with horizontal root fractures includes careful diagnosis, continued re-evaluation and a conservative treatment approach. The location of the root fracture and pulpal vitality status both play important roles in proper treatment decisions. A thorough examination, judicious treatment and follow-up on the part of both dentist and patient can result in long term retention of many of these traumatized teeth.

Strengthening immature teeth during and after apexification

The purpose of this study was to evaluate the strengthening effect of an internal resin bonding technique. One hundred central incisors were endodontically treated and divided equally into five groups. Group 1, without any cervical preparation and with access repaired with bonded resin, served as the positive control. Teeth in groups 2 to 5 were cervically prepared to simulate the thin dentinal wall of immature teeth, and obturation material was removed to 3 mm below the cementoenamel junction (CEJ). In group 2, the negative control, the access was restored with bonded composite to the level of the CEJ. In group 3, access was restored with composite resin 3 mm apical to the CEJ using a clear post system. Group 4 was treated similarly to group 3, but an opaque post replaced the clear post. Group 5 was treated like group 3, after which a metal post was cemented into the channel left after removal of the clear post. All teeth were subjected to compression testing and the force required to fracture the teeth cervically was recorded for each group and the Kruskal-Wallis analysis performed to detect intergroup differences. All of the bonded resin techniques significantly strengthened the teeth against fracture, compared with the negative control group (p < 0.05). None of the experimental groups (3-5) were significantly different from the positive control group.

Root canal treatment as a treatment modality for temporary tooth retention in adolescent patients

In certain cases root canal treatment may be an adequate intermediate therapy, mainly for severely traumatized teeth in adolescent patients that probably cannot be retained permanently. The treatment aims at temporary retention of otherwise hopeless teeth until definite treatment, for example insertion of bridges or dental implants, may be performed. This kind of treatment can help to avoid the application of removable prostheses in young patients. This treatment modality requires intensive information to be presented to the patients and their parents on the benefits and risks of the treatment procedures, endodontic treatment under aseptic conditions respecting the general guidelines for root canal treatment, and a strict recall regimen to avoid occurrence or increase of pathological conditions. Four cases (five teeth) of temporary tooth retention by endodontic treatment are presented.

Reattachment of a fractured maxillary incisor crown--case report

Management of traumatic injuries to the teeth is a challenge to the practising dentist. It has no prescriptive method for occurring, possesses no significant predictable pattern of intensity or extensiveness and occurring at times when dentists are least prepared for it. It may not only leave physical scars but also a psychological impact on its victim. Yet, more than half of all children traumatize either their primary or permanent teeth before leaving the school, coupled with the dynamic panorama of sporting activity worldwide and the significant increase in violence among the populations. Tooth trauma and its management loom as a major challenge to the dental practitioner. A case of a 11 year old boy with Ellis Class 3 traumatic injury to the maxillary left central incisor is reported. A pulpectomy was performed followed by reinforcement and reattachment of the crown fragment and restoration with composite resin.

External root resorption in orthodontics: avoiding high risk teeth. A case report

External root resorption is one of the most exasperating and least understood clinical problems in orthodontics. Numerous studies have been conducted, attempting to establish the factors causing root resorption of permanent teeth. Considerable variation exists however, in the extent and distribution of root resorption, seen in the orthodontic treatment of apparently similar cases. After an excellent review of the literature, Brezniak and Wassertein (1993) concluded that the most significant disgnostic aid in predicting whether root resorption would occur during orthodontic treatment, is the radiographic evidence of root resorption before treatment. A case is reported, describing the dilemma of orthodontically treating a patient, who had previously experienced trauma to the upper right central incisor, leading to external root resorption.