Perceptions associated with dentists' decisions to report hypothetical cases of child maltreatment

The purpose of this study was to examine case-specific perceptions associated with dentists' decisions to report hypothetical cases suggestive of child maltreatment. Surveys were mailed to 500 general dentists (GDs) in Georgia and all 200 pediatric dentists (PDs) in Georgia and Florida. The GDs were chosen from a pool of 1500 by a stratified randomization scheme. Each survey contained two brief vignettes suggestive of, but not conclusive for, child neglect and abuse. Identical questions followed each vignette that were designed to assess five perceptions of the incident and whether the respondent would be likely to report the case. Responses were received from 185 GDs (37%) and 103 PDs (51.5%), for a total of 288 (41.1%). A majority of respondents considered each vignette to be serious, but only a minority believed that they were required to report the neglect (7.3%) and the abuse (33.7%) vignettes. The percentages of likely reporters of the neglect (n = 28) and abuse (N = 103) vignettes were 9.7 and 36%, respectively. No significant differences were noted in the response patterns of GDs and PDs. Decisions to report child maltreatment described in the vignettes were associated with perceptions of 1) the seriousness of the incident, 2) the incident being defined as neglect or abuse, and 3) a requirement to report. The possibility that a maltreatment report would have a negative impact on the child was associated with a decision not to report. The perception that a report would have a negative impact on the family was common among likely reporters and nonreporters.

Growth considerations in planning treatment of avulsion in an adolescent

Reimplantation failure of avulsed anterior teeth in an adolescent patient requires removal of the attempted-reimplanted teeth and consideration of several restorative options. These options may include a removable partial denture, as well as a transitional bridge or permanent fixed prosthesis. In all cases, the potential effects of the adolescent's expected amount and directions of maxillary and mandibular growth must be considered. A case is presented examining how maxillary growth may affect the restorative treatment options for avulsed anterior teeth replacement for an adolescent boy. Unfortunately, the patient and family were unable to complete treatment due to financial considerations. Consequently, the case presented here is submitted as a treatment planning exercise.

Treatment of a horizontal root fracture by vital root submergence

Cervical third horizontal root fractures in immature permanent teeth often present complicated and unpredictable treatment options. This case report describes the successful management of a horizontal root fracture in an open apex tooth by vital root submergence and subsequent nonsurgical root canal therapy.

[Incidence of injuries to deciduous teeth]

An analysis of 191 primary incisors damaged by acute mechanical trauma on 108 children, ranging in age from 2 to 6 years, has showed that most of the patients were between 2 and 3 years of age (67%) when the accidents occurred. According to this clinical study the most frequent type of injury was partial luxation (42.93%). In 53.7% of cases the accident involved two teeth. The upper central primary incisors were damaged most frequently (82%). The ratio of boys to girls was 3:2.

Preimplant guided bone regeneration in the anterior maxilla

Guided bone regeneration is a clinical procedure aimed at promoting bone formation at sites where there is severe bone loss. The purpose of this article was to demonstrate reconstruction of deformations of the alveolar process resulting from traumatic injuries to maxillary incisor teeth by guided bone regeneration procedures followed by insertion of dental implants. In both cases, submembranous space-making was stabilized by human demineralized freeze-dried bone. Implant insertion at the sites of bone augmentation resulted in successful restorations. Histologic examination of biopsy samples from the submembranous hard tissue revealed particles of demineralized freeze-dried bone allografts partially surrounded by uninflamed connective tissue and by vital bone adjacent and adhered to the demineralized freeze-dried bone allograft particles.

Reattachment of coronal fragments: operative considerations for the repair of anterior teeth

The maxillary incisors occupy an extraordinary position in the dental arch. They set the aesthetic tone, and their influence on the overall well-being of the individual cannot be overemphasized. However, their eruptive pattern and dominance carries a significant risk for trauma, particularly in childhood. More than half of all traumatic dental injuries involve the central incisors. In the past, fractured teeth were either extracted, trimmed and leveled, or restored with cast restorations. The learning objective of this article is to stimulate a shift in treatment strategy towards aesthetic reattachment of fractured segments. Indications and limitations for reattachment are outlined, including the primary and secondary restorative efforts. Innovative operative techniques that improve the aesthetic, biologic, and mechanical variables of the reattachment treatment option are presented.

Indirect composite restorations in the anterior region: a predictable technique for complex cases

The indirect composite inlay technique demonstrates excellent aesthetic results in the posterior regions, achieved by reproducing the shape, color, and contour of the natural tooth on a cast model rather than using the free-hand composite restorative modality. The utilization of the indirect technique can be adapted for the anterior regions as well, and it offers a valid treatment alternative that is predictable with optimal restorative results. The evaluation, planning, and accuracy of implementation of the various phases of this methodology allow a more precise achievement of the result; any potential error in the restoration can be corrected prior to final cementation. This technique increases the quality of composite restorations that have always been considered unpredictable and extensively dependent upon the skills of the operator. The learning objective of this article is to familiarize the reader with the clinical and laboratory phases of this indirect treatment modality of the anterior dentition.

Tooth avulsions resulting from basketball net entanglement

The authors conducted a survey of dentists reporting tooth avulsions from basketball net accidents. Although the number of people injured was small, the dental injuries were serious. In many cases, multiple teeth were avulsed as a result of the maxillary anterior teeth becoming entangled in the basketball net while the patients were attempting to slamdunk a basketball either on a lowered backboard or from a raised take-off area. The authors present recommendations for preventing tooth avulsions resulting from basketball net entanglement.

Trans-surgical restoration of extensive Class IV defects in the anterior dentition

Direct bonding is the most commonly utilized treatment for conservative aesthetic restoration of the anterior dentition. Class IV defects require special attention due to their high incidence, particularly in young patients. One of the major challenges for the clinician in treating defects in this category is selecting the appropriate restorative composite resin material that emulates the physical and optical characteristics of dentin and enamel and conceal the fracture line at the tooth/composite interface. Class IV defects with margins violating the biologic width present another concern, since this violation often impedes the attainment of the correct anatomic contours. The learning objective of this article is to describe a technique for achieving a correct integration of the periodontium, the tooth structure, and the restorative composite resin material to achieve a high level of aesthetic excellence.

Conservative approach to posttraumatic treatment of maxillary anterior teeth: a clinical report

This clinical report emphasizes that comprehensive treatment planning, whether simple or complex, requires interdisciplinary knowledge. Conservative treatment was implemented for this patient, a 29-year-old woman with a posttraumatic anterior open occlusal relationship, crowding, and a shifted midline. The treatment plan involved selective occlusal grinding, adjunctive orthodontics, periodontal surgery, and cosmetic dentistry and proved to be highly successful.

Long-term follow-up of conservative treatment of severely traumatized maxillary incisors

We present the case of a 26-year-old man who at the age of 9 suffered severe trauma to both maxillary central incisors. The underlying malocclusion was skeletal and classified as dental Class II/1 with severe crowding. Both the maxillary central incisors and the two lower first premolars were extracted and the patient was treated with an edgewise appliance for 2 years. Acceptable occlusal relationships were achieved following orthodontic and adjunctive treatment which consisted of reshaping the maxillary lateral incisors with composite materials and grinding the canines to resemble lateral incisors. A critical evaluation of the esthetic and functional results at the age of 26 years is presented.

Replantation of avulsed primary anterior teeth: treatment and limitations

In addition to the successful replantation of avulsed permanent teeth, the replantation of primary anterior teeth may also be indicated. The decision is based on age and stage of tooth development, development of dentition, storage of the avulsed tooth and the way it is transported to the treatment site, the appropriate in vitro treatment of the tooth before reinsertion, and the willingness of the child to cooperate. A method involving retrograde filling of the primary tooth root with calcium hydroxide after resecting the root apex has proved successful. Other commercially available root filling materials and pins are not indicated. Calcium hydroxide allows the tooth to heal in place without reaction and prevents the development of apical periodontitis. As regards any surgical intervention, the attending dentist in this case has to weigh the benefits against the risks.

Pulp calcifications in traumatized primary incisors. A morphological and inductive analysis study

The purpose of this study was to investigate histopathological changes in primary teeth following trauma, and to look for possible correlations between the morphology of pulpal calcification and clinical findings. The material consisted of 123 primary teeth from 98 Danish children aged 9-108 months (mean age 33.5 +/- 19.7 months) at the time of injury. The specimens were analyzed by means of light and scanning and transmission electron microscopy. Data from the clinical investigation and from predetermined ranked parameters from the histological analysis were processed in a computerized inductive analysis program. The results, describing patterns of co-variation, are presented as a decision tree. The most common diagnosis was intrusion luxation (54%). In 41% of all teeth, the degree of obliteration was less than 1/4 of the pulpal lumen. In most cases (79%), no denticles were visible. When present, 80% of the denticles had a bone-like appearance. Tissues occluding the pulpal lumen were either dentin-like (49%), bone-like (19%), or fibrotic (9%). It could be concluded that these varying responses could not be correlated with explicit clinical diagnoses. However, in certain combinations, histological parameters could be correlated to clinical findings.

Periodontal healing of extracted dogs' teeth air-dried for extended periods and soaked in various media

The aim of this study was to determine the periodontal healing of replanted dogs' teeth which, after extended extra-oral dry times, had been soaked in various media before replantation. Incisors and premolars of beagle dogs were root canal treated, extracted and bench dried. The teeth were grouped according to dry times of 30, 45 and 60 minutes. Each group of teeth was soaked in one of three media, Hank's balanced salt solution, ViaSpan (Belzer UW-CSS, Dupont Pharmaceuticals), or Conditioned Medium (supernatant of confluent culture of human gingival fibroblasts) for 30 minutes before replantation. Controls consisted of teeth extracted and replanted without drying on soaking (negative control), and bench-dried teeth replanted without soaking in the media (positive control). The dogs were killed 6 months after replantation of the teeth, which were prepared for histologic evaluation. Five microns cross-sections (every 70 microns) of the root and surrounding tissue were evaluated for healing/resorption according to Andreasen's criteria. The best healing occurred for the roots which had been immediately replanted. Healing in the positive control groups decreased with increased dry time. For the 30-minute dry time groups, soaking in media had no beneficial effect on periodontal healing compared with the controls. Soaking in ViaSpan resulted in an increased healing incidence for both the 45- and 60-minute bench-dried groups while soaking in the other media had no consistent beneficial effect. It appears from this study that an avulsed tooth that has been left dry for 30 minutes should be replanted immediately without soaking. However, teeth that have been dry for 45 or 60 minutes would benefit from soaking for 30 minutes in ViaSpan.

Orthodontic extrusion--a new simplified aesthetic technique

Various techniques have been described to extrude the roots of fractured teeth to facilitate prosthetic restoration. Many of these have the disadvantage of poor aesthetics, they require skill in fabrication and fitting, and there is often inadequate control over the amount of extrusion. With the technique described, root canal therapy is completed initially and a cast gold post is cemented into the root canal. The post has a channel extending from the labial to the palatal aspect. A temporary acrylic crown is fitted to restore aesthetics, and the channel is extended though the palatal and labial surfaces. An orthodontic wire framework with a horizontal strut at the level of the original incisal edge of the fractured tooth is then bonded to the adjacent abutment teeth. The amount of extrusion required is estimated and a corresponding reduction is made in the length of the acrylic temporary crown. An elastic threaded through the channel and looped over the horizontal strut of the framework provides the extrusive force. A 6 week retention period is required following the extrusion. Periodontal surgery is then carried out if necessary, and a new provisional crown is placed. The final porcelain restoration is fitted after 6 months.

Modified partial-coverage ceramics for anterior teeth: a new restorative method

A new restorative method, (the Edge Up technique) enables the correction of defects in the anterior tooth area with a maximum preservation of tooth substance. The basis of this technique is a special preparation method (a circular extended shoulder preparation in the enamel or an angle preparation) and a preparation kit matched to the peculiarities of this preparation technique.

Resin-bonded retainer for replacement of an avulsed primary incisor: a case report

A 4-year-old boy who suffered avulsion of a primary maxillary central incisor was treated with an all-porcelain, resin-bonded retainer. Although prosthetic replacement of primary teeth with resin-bonded prostheses is not common, the method may be beneficial in certain cases.

Essix appliances. Provisional anterior prosthesis for pre and post implant patients

Missing anterior teeth are being replaced by implant-supported restorations quite frequently in modern dentistry. Providing the patient with a temporary prosthesis prior to or following implant fixture placement must satisfy established esthetic and functional criteria. When orthodontic treatment is included as part of the overall treatment effort, additional considerations include the retention and stabilization of newly established tooth positions. This article describes the fabrication, use and advantages of a provisional anterior prosthesis that replaces missing teeth prior to or following implant placement.

Concomitant intrusive luxation and root fracture of a central incisor--report of a case

A case of a 9-year-old boy who presented with intruded maxillary central incisors, one of which had also sustained a middle third root fracture, is reported. The root fracture was diagnosed after orthodontic extrusion was started, which resulted in separation of the apical and coronal fragments. The hypermobile coronal fragment was stabilised by passing a K file through a palatal access cavity into the root canal of the apical fragment. Orthodontic alignment was completed and the fractured incisors were restored with the file left in situ. At a 10-year follow-up, the incisors were clinically healthy and continued to satisfy aesthetic and functional demands.

Reeruption and extrusion of a traumatically intruded immature permanent incisor: case report

A case report of treatment for a traumatically intruded maxillary central incisor is described. An attempt at accelerating eruption via surgical exposure of the embedded tooth was only partially successful. Orthodontic extrusion of the partially erupted tooth brought the tooth into correct position.