Pulp survival and hard tissue formation subsequent to dental trauma. A clinical and histological study of uncomplicated crown fractures and luxation injuries

Traumatic injuries in children and adolescents are a common problem, and the prevalence of such injuries has increased over the last 10-20 years. The purpose of the present investigation was to evaluate long-term results following uncomplicated crown fractures and luxations involving subsequent pulp canal obliteration. A total of 198 patients with 488 injured permanent teeth were available for clinical examination (15 year follow-up), of which 102 also answered a questionnaire and were interviewed before oral examination. Further, 82 permanent incisors presenting with pulp canal obliteration (PCO) were followed for a period of 7 to 22 yr. (mean 16 yr.). The histological evaluation of luxation injuries was performed on 123 primary teeth from 98 patients. In the experimental study (crown fractures), 64 monkey permanent maxillary and mandibular central incisors and canines were subjected to different treatment alternatives at the time of fracture. The findings in the follow-up study showed very little pulpal response to crown fracture and subsequent restorative procedures as long as there was no concomitant periodontal injury. Approximately every fourth resin composite restoration was rated unacceptable at the clinical examination. The interview showed that half of the individuals were dissatisfied with the color and/or anatomic form of the composite restoration. PCO was found in all luxation categories, and according to the survival curve, the 20-year pulp survival rate diagnosed with X-ray was 84%. Although the risk for pulp necrosis (PN) increased with time, routine endodontic intervention of teeth with ongoing PCO of the root canal did not seem justified. The histological study showed that changes in dentin were represented by occlusion of the dentinal tubules and deposition of tertiary dentin. The tertiary dentin were classified as either dentin-like, bone-like or fibrotic. In the experimental study, few changes were observed in the pulp 3 months after crown fractures, irrespective of treatment alternative.

Use of a resin-ionomer in the treatment of mechanical root perforation: report of a case

A perforated root represents a difficult challenge to the clinician, and treatment of such defects often involves surgical and/or advanced restorative techniques. This typically requires a series of lengthy, often stressful appointments, may compromise esthetics, and invariably involves additional costs to the patient. This case report describes the nonsurgical treatment of separate mechanical perforations that resulted from the removal of a failed prefabricated post. The tooth was restored in a minimum number of visits through the use of a novel application of a resin-ionomer material originally designed for routine restorative procedures.

Complicated crown fracture of an unerupted permanent tooth--a case report

Trauma to primary teeth may result in direct damage to underlying developing permanent teeth because of the close relationship that exists between the apices of the primary teeth and their permanent successors. Injuries to developing teeth have been classified into ten different categories, using a classification that is largely based on developmental alterations to the permanent teeth. However, this classification does not include other types of trauma that may occur to developing teeth, such as crown fractures. Although apparently rare, such injuries can occur by direct contact of the impacting object with a developing tooth, as illustrated by the following case report.

Combined endodontic-orthodontic and prosthodontic treatment of fractured teeth. Case report

A case history of a 10 year old patient who accidentally injured his maxillary left central incisor is presented. The fracture of the crown extended about 4 mm below the crest of the alveolar bone. After pulpectomy and root canal therapy, a screw was cemented into the canal of the incisor. By means of a removable orthodontic appliance, the fractured tooth was extruded and the fracture line was brought above the level of the alveolar bone. The tooth was then restored with a veneer crown over a post core. A tooth that would have been extracted routinely was thus saved and restored through the use of a collaborative approach.

Applications of Scanora multimodal maxillofacial imaging in orthodontics

The principles of the Scanora multimodal radiography system are described. This self-contained unit of X-ray generator, patient chair, and imaging elements incorporates the two basic principles of narrow beam radiography and spiral tomography. Conventional panoramic images or magnified images of the dentition can be produced. In orthodontics, the application of spiral tomography in order to obtain cross sectional images has proved helpful in the assessment of a number of patients. Four cases are reported in which the images obtained using this system has substantially contributed to their management.

[Sickle cell anemia patients in oral medicine. What treatment? Apropos of a case and review of the literature]

We report a case of a cyst of maxillary in a patient suffering from sickle-cell anemia. A review of literature and therapeutic management is exposed.

Esthetic, biologic and restorative considerations in coronal segment reattachment for a fractured tooth: a clinical report

Reattachment of a fractured clinical crown involving minimal invasion of the biologic width can be accomplished without conventional ostectomy and crown lengthening so that satisfactory esthetics can be achieved. Adhesive techniques sometimes in conjunction with traditional mechanical retention, such as a post, can be used to reattach the fractured segment. An esthetic result can be obtained with a minimal number of procedures and cost to the patient.

Sequelae of trauma to primary maxillary incisors. I. Complications in the primary dentition

Two hundred and eighty-seven children with a total of 545 traumatized primary upper incisors were followed using standardized procedures until the age of 10. Extraction was the only treatment offered when intervention was necessary. The immediate as well as the long-term consequences of trauma were studied on the basis of this material. Consequences in the primary dentition comprised: color changes (53%), pulp necrosis (25%), pulp canal obliteration (36%), gingival retraction (6%), permanent displacement after luxation (5-22%), pathological root resorption (1-10%) as well as disturbances in physiological root resorption (4%) and, lastly, premature tooth loss (46%). In a multivariate analysis of the development of pulp necross in primary teeth after trauma, the following decisive factors were found: age of the patient at the time of injury, degree of displacement of the tooth as well as the degree of loosening and presence of crown fracture. The factors found to influence development of pulp canal obliteration were: displacement of the tooth at time of injury as well as detectable physiologic root resorption at time of trauma. The presence of crown fracture seemed to decrease the risk of obliteration. The need for scientifically based treatment strategies for managing and reducting complications after trauma in the primary dentition is stressed.

The use of an orthodontic thermoplastic retainer as a provisional anterior restoration: a case report

Children who present with extensive fractures of anterior teeth pose a difficult clinical problem. Pulpal and periodontal injuries must be carefully assessed and managed. Rapid restoration of the form and contour of the extensively fractured tooth is advisable, not only to improve esthetics but also to prevent unwanted tipping or tilting of adjacent teeth and overeruption of opposing teeth. A modified Essix retainer, simply constructed in the laboratory, can be used to provisionally restore the extensively fractured anterior tooth.

Osseointegration treatment of transverse root fractures in the region of the alveolar crest

A method of using osseointegrated implants as an alternative treatment modality for transverse root fractures near the osseous crest is presented. A 15-mm Branemark implant was placed immediately after extraction of a maxillary central incisor with transverse root fracture. Five months after stage I surgery, the implant was uncovered. Custom fabrication of a substructure core cast directly to the titanium single tooth abutment was necessary due to the palatal inclination of the fixture. An overcasting porcelain fused to gold crown was fabricated to avoid an unesthetic labial access for the abutment screw. This treatment indicates that the use of osseointegrated implants seems to provide an effective solution to replacing teeth with transverse root fractures.

An unusual seat belt injury in a 7-year-old boy

A luxation injury of a lower primary incisor in a 7-year-old boy was caused by the shoulder component of a seat belt. This highlights the increased risk of injury in children who are too large for safety seats but still too small for adult seat belts.

Interdisciplinary concepts in treating adult patients

Pre-prosthetics, as a part of orthodontic treatment in adults has gained increasing importance during recent years. Through coordinated orthodontic, prosthetic and periodontal treatment plans, patients with partial dentition can be offered further treatment possibilities. Such planning would allow for fixed prosthetic treatment possibilities and the survival of critical teeth. They would provide for better aesthetics and avoid functional disturbances. The aim of the present study was to present reports of patients treated by coordinated work at the Dental School of Hamburg University. In patients with partial dentition, premolars were uprighted and distally moved and molars were extruded to be used as abutments for fixed prosthetic reconstructions. Following trauma, the position of the remaining anterior teeth was improved to provide for optimal aesthetics after prosthetic treatment. Extraction of a subalveolarly fractured tooth is avoided through root extrusion and post-core reconstruction. The results demonstrate the advantages of pre-prosthetic treatment as regards stability, aesthetics and function. With the help of pre-prosthetic orthodontic treatment, complicated treatment situations could be handled more successfully than would have been the case without such treatment.

An immediate adhesive bridge using the natural tooth

There are several methods available for the replacement of missing anterior teeth. These include a removable prosthesis, a conventional fixed bridge, an adhesive bridge or a dental implant. The choice of the most suitable technique depends on several factors, such as the condition of the adjacent teeth, the occlusion, the patient's wishes and the financial implications of the proposed treatment.

A comparison of a hybrid light-cured glass-ionomer base and liner vs. a light-cured resin tooth fragment attachment

PURPOSE

The purpose of this study was to compare the dislodgement strengths and fracture types for reattached tooth fragments using a light-cured composite resin material, a hybrid light-cured glass ionomer base, and a hybrid light-cured glass ionomer liner.

METHODS

Seventy-five bovine incisor teeth were fractured, randomly divided into three groups of equal number, and then luted back together with three different materials (Universal Bonding Agent/TPH Composite Resin; VariGlass VLC Base; and VariGlass VLC Liner: LD Caulk Div Dentsply Int Inc, Milford, DE). The reattached fragments were subjected to thermocycling with a 40 degrees C differential and then were loaded until the force required to dislodge the fragment was reached.

RESULTS

The mean dislodgement strengths were 36.8 (+/- 25.6) kg for the composite resin, 36.4 (+/- 26.7) kg for the glass ionomer base, and 31.4 (+/- 29.5) kg for the glass ionomer liner. Cohesive fractures occurred in 73% of the dislodgements.

CONCLUSIONS

There was no statistically significant difference demonstrated (P < 0.05) between the three groups in terms of both dislodgement strength and fracture type.

Survival of avulsed permanent maxillary incisors in children following delayed replantation

The purpose of this study was to identify the variables that significantly influenced the survival of incisors replanted after extended extra-alveolar duration at The Hospital for Sick Children, Toronto, Canada, between June 1988 and December 1993. Survival analysis was used to identify variables that significantly influence the retention of replanted incisor teeth. Survival was defined as the time that elapsed between the replantation of an avulsed incisor and the time it was finally lost. Information on 9 variables was collected for 38 patients (25 males; 13 females) and 52 replanted permanent maxillary incisors. The mean extra-alveolar duration for the sample was 123 min. The mean follow-up interval was 942 days (range: 364-2126 days). Incisors replanted with open apices had a significantly decreased survival compared with teeth with mature apices (P = 0.04; relative risk 4.2). There was also a significant association between increased survival and obturation of the root canal with gutta-percha and sealer (P = 0.006; relative risk 10.0). A trend towards improved survival of replanted incisors was found for children older than 11 years old at the time of replantation (P = 0.09; relative risk 2.8). These results are consistent with previous studies and may assist clinicians and parents in the decision-making process associated with the management of avulsed teeth in children.

Paediatric dentistry avulsion: case reports

Children may present at a dental surgery for management of oro-facial injuries. Most general dental practitioners are able to handle straightforward cases but referral may be required for complex injuries. Successful healing following tooth avulsion depends on the amount of damage to teeth and supporting structures, emergency treatment, and follow-up treatment. All of these play a role in the long-term prognosis of avulsed teeth.

Delayed endodontic and orthodontic treatment of cross-bite occurring after luxation injury in permanent incisor teeth

A case is presented in which combined endodontic and orthodontic therapy was performed in traumatically injured teeth 12 months after an accident. Calcium hydroxide treatment was used to halt any possible resorption during orthodontic treatment. The teeth were repositioned in a desirable manner without any complication by orthodontic treatment. Root canal obturation was accomplished after the completion of active orthodontic treatment. Recall examination 12 months after completion of root canal treatment showed clinical and radiographic evidence of healing.

Periapical repair and apical closure of a pulpless tooth using calcium hydroxide

A case with a wide-open apex and a large cystlike periapical lesion in an adult is presented. The lesion formed as a result of necrosis from trauma to a maxillary central incisor 12 years ago. After nonsurgical endodontic treatment with calcium hydroxide paste and a calcium hydroxide-containing root canal sealer, apical closure and significant healing of the periapical lesion within 15 months were observed. This report suggests that even large periapical lesions (likely cystic) could respond favorably to nonsurgical treatment.

Repair of fractured incisors using a 4-META luting material

The strength of bonds of resin-composite materials to dentine using dentine bonding systems have improved greatly within the past five years. It may therefore be possible to attempt repair of a fractured incisor tooth if the patient retrieves the fractured fragment and attends for treatment. Little long-term data on the effectiveness of this treatment is available but, as materials improve, this approach to treatment of fractured incisor teeth should increasingly be considered.

Aesthetic ridge and extraction site augmentation for anterior implant placement without barrier membrane

Augmentation of the alveolar ridge to facilitate implant placement in a single tooth extraction site or a completely edentulous arch is currently a well-accepted and routinely performed therapeutic procedure. This article describes a method for augmenting extraction sites and ridges, without primary closure or the use of barrier membranes over bone grafts. The technique retains or enhances gingival architecture while creating bone for placement of an implant in the most optimal position. The tooth is extracted, demineralized freeze-dried bone allograft or another augmentation material of choice is placed, and a provisional mucoadhesion partial denture is delivered. When the implant is uncovered and the healing abutment is placed, a flap design is utilized to create papillae and proper labial contour. The learning objective is familiarity with this technique, which is particularly useful for maxillary anterior implant placement. A case report is used to document the clinical procedure.