International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth

Delayed replantation of avulsed teeth: two case reports

This case report presents two cases of delayed replantation of avulsed maxillary central incisors after an extended dry extra-alveolar period. Eight-year-old boy and 10-year-old boy presented with avulsed maxillary central incisors due to trauma occurring 27 and 7 hours earlier, respectively. Treatment guidelines for avulsed mature/immature permanent teeth with prolonged extra-oral time were carried out for the teeth and the extra-oral endodontic treatment was completed. After having been repositioned, the teeth were stabilized for 4 weeks and prophylactic antibiotic was prescribed. Clinical and radiographic controls were done after 18 months for Case I and 12 months for Case II. During the follow-up periods the teeth reported in these cases have remained in a stable, functional position but revealed clinical initial replacement resorption and ankylosis.

Stress distribution in delayed replanted teeth splinted with different orthodontic wires: a three-dimensional finite element analysis

AIM

The aim was to evaluate the biomechanical behavior of the supporting bony structures of replanted teeth and the periodontal ligament (PDL) of adjacent teeth when orthodontic wires with different mechanical properties are applied, with three-dimensional finite element analysis.

MATERIALS AND METHODS

Based on tomographic and microtomographic data, a three-dimensional model of the anterior maxilla with the corresponding teeth (tooth 13-tooth 23) was generated to simulate avulsion and replantation of the tooth 21. The teeth were splinted with orthodontic wire (Ø 0.8 mm) and composite resin. The elastic modulus of the three orthodontic wires used, that is, steel wire (FA), titanium-molybdenum wire (FTM), and nitinol wire (FN) were 200 GPa, 84 GPa, and 52 GPa, respectively. An oblique load (100 N) was applied at an angle of 45° on the incisal edge of the replanted tooth and was analyzed using Ansys Workbench software. The maximum (σmax) and minimum (σmin) principal stresses generated in the PDL, cortical and alveolar bones, and the modified von Mises (σvM) values for the orthodontic wires were obtained.

RESULTS

With regard to the cortical bone and PDL, the highest σmin and σmax values for FTM, FN, and FA were checked. With regard to the alveolar bone, σmax and σmin values were highest for FA, followed by FTM and FN. The σvM values of the orthodontic wires followed the order of rigidity of the alloys, that is, FA > FTM > FN.

CONCLUSION

The biomechanical behavior of the analyzed structures with regard to all the three patterns of flexibility was similar.

Dental problems in athletes

Orofacial injuries and diseases occur in athletes, and they may not always have access to dentists. Therefore team physicians should be aware of the common injuries and initial management. Treatment of dental injuries will depend on whether the teeth are primary or permanent. The most common type of fracture is crown fracture, but there are other dental injuries that can lead to future complications if not treated promptly and monitored closely. Tooth avulsions need to be handled properly, and athletes should see a dentist as soon as possible. Despite the urgency of some injuries, other orofacial injuries or diseases, such as lacerations and caries, should not be overlooked. Proper education and use of mouth guards can assist athletes in reducing their risk of orofacial injuries.

Ear, Nose, and Throat Disorders

This chapter reviews Otolaryngology conditions most commonly seen by pediatricians. Included are issues involving the ears, nose and nasopharynx, sinuses, throat, mouth and oropharynx, and the neck. The most common surgical Otolaryngological procedures will also be discussed. Many of the disease discussed can be effectively identified, diagnosed, and treated by primary care physicians. However, for certain conditions, prompt identification and timely referral to Otolaryngology are required.

Delayed replantation of avulsed tooth with 15-hours extra-oral time: 3-year follow-up

BACKGROUND

Avulsion is one of the most serious injuries of the tooth which is most commonly seen in young children and occurs in the upper front teeth. Immediate transplantation of the avulsed tooth is recommended treatment and results in good prognosis although this may not be always possible.

CASE REPORT

The present case highlights the 3-year follow-up of delayed replantation (after 15h) of maxillary central incisor which was avulsed due to trauma. The complications seen in the present case were ankylosis and inflammatory resorption, but clinically the tooth was asymptomatic and maintains the esthetics of the individual signifying the importance of delayed replantation even after prolonged extra-oral time.

CLINICAL IMPLICATIONS AND CONCLUSION

Although complications like ankylosis or root resorption may be unavoidable, delayed replantation of avulsed tooth may be a good alternative to prosthesis (implant or fixed partial denture) till the growth is completed due to preservation of the alveolar bone and psychological benefit to the patient. Also efforts should be made to educate and update children, teachers and parents regarding management of avulsed tooth at accident site and also the dentists regarding its management in dental office.

Healing complications of traumatized permanent teeth in pediatric patients: a longitudinal study

BACKGROUND

Traumatic dental injuries (TDI) can affect soft and hard dental tissues and supporting structures in different ways and severity.

AIM

This study describes the complications associated with health in traumatized permanent teeth (TPT) over a 12-month period and assesses the relationships between TDI, involved tissues, and root development (RD).

DESIGN

The study enrolled 294 patients with 548 TPT. Data were collected on the TDI, RD, and the healing complication (HC) and when they were examined (03, 06, and 12 months). Frequencies are described and analyzed using the chi-squared test, relative risk (RR), and Mantel-Haenszel analysis (P≤0.05).

RESULTS

Healing complications were present in 201 (36.68%) teeth and were more frequently diagnosed 3 months (63.68%) after the TDI. Pulp necrosis was the most common HC (38.3%), and it was significantly associated with avulsion (P=0.023). Teeth with complete RD showed a tendency of developing HC over time, independent of TDI (P=0.05). HC in teeth with complete RD related to support tissue trauma (P=0.005) and avulsion (P<0.001) appeared more frequently after 3 months.

CONCLUSION

Healing complications are more common in teeth that have suffered trauma in supporting tissues and avulsion, especially in teeth with complete RD. The HC occur more frequently in the first 3 months, and a necrotic pulp was the most common complication.

Continued root formation after delayed replantation of an avulsed immature permanent tooth

Introduction. Tooth avulsion in the young permanent dentition is a frequent finding, and its prognosis depends on the treatment of the avulsed tooth before replantation, the extra-alveolar time, the storage medium, and the patient's general health. The present report describes management of an immature avulsed lower central incisor 90 minutes after the accident. Methods. A right lower central incisor of a 7-year-old girl was avulsed, and it was soaked in a glass of milk. 90 minutes after avulsion, replantation was performed, and the tooth was splinted; but after two weeks the replanted tooth's pulp was necrotic. Thus, endodontic treatment was performed and root canal was filled using a calcium hydroxide and iodoform paste (Metapex). Three months later, the intracanal medication was washed out and the canal was sealed using an apical plug of calcium enriched mixture (CEM) cement. Results. 20 months after replantation the tooth was completely asymptomatic, with physiologic mobility. Also, continued root formation including an apical segment beyond the artificial apical plug was observed. Conclusion. Creation of an appropriate apical barrier following the disinfection of root canal system promoted continued root-end growth in a replanted immature permanent tooth.

Knowledge about tooth avulsion and its management among dental assistants in Riyadh, Saudi Arabia

BACKGROUND

Studies evaluating dental assistants' knowledge about tooth avulsion and its management are rare. The purpose of this study was to evaluate the level of knowledge about tooth avulsion and its management among dental assistants in Riyadh, Saudi Arabia and to assess its relationship with their educational background.

METHODS

A convenience sampling methodology was employed for sample selection. Over a period of four months starting in February, 2013, 691 pretested 17-item questionnaires were distributed. A total of 498 questionnaires were returned for an overall response rate of 72.1%. Six questions were related to knowledge about permanent tooth avulsion and one question was related to knowledge about primary tooth avulsion. Correct answers to these questions were assigned one point each, and based on this scoring system, an overall knowledge score was calculated. An analysis of covariance was used to test the association between the level of knowledge (total score) and the educational qualifications of the respondents (dental degree and others). A P-value of 0.05 was considered the threshold for statistical significance.

RESULTS

The majority of the respondents (n = 387; 77.7%) were non-Saudis (377 were from the Philippines), and 79.1% (n = 306) of the Filipinos had a dental degree. The question about recommendations for an avulsed tooth that is dirty elicited the highest number of correct responses (n = 444; 89.2%), whereas the question about the best storage media elicited the lowest number of correct responses (n = 192; 38.6%). The overall mean score for knowledge about tooth avulsion was 6.27 ± 1.74. The mean knowledge score among the respondents with a dental degree was 6.63 ± 1.37, whereas that among the respondents with other qualifications was 5.71 ± 2.08.

CONCLUSIONS

The educational qualifications of the surveyed dental assistants were strongly correlated with the level of knowledge about tooth avulsion and its management.

Knowledge of emergency management of avulsed tooth among Japanese dental students

BACKGROUND

The management of the avulsion of deciduous and permanent teeth in children is well outlined in the guidelines of the International Association of Dental Traumatology and the American Academy of Pediatric Dentistry. However, little information is available about the level of knowledge in the management of dental trauma among undergraduate dental students in Japan. The objective of this study is to explore dental students' level of educational knowledge in the management of avulsed teeth.

METHODS

A three-part questionnaire was used to gather demographic data and evaluate the knowledge of students at Kyushu Dental University.

RESULTS

Questionnaire data were collected from 121 (53 first-year, 68 sixth-year) students. Regarding the immediate emergency management of a case in which a 9-year-old girl had fallen down the stairs and lost a maxillary incisor but remained conscious, 55.9% of sixth year students and 28.3% of first-year students suggested the immediate transportation of the tooth to a dentist. The answer selected by the largest number (50.9%) of first-year respondents was "sideline the injured girl and get her to bite on a tissue paper for several hours". In a case in which a boy had an avulsed tooth after falling down on a road, only 13.2% of first-year students suggested the transportation of the tooth in his mouth to the clinic. Most the largest number of respondents believed that the best way to transport an avulsed tooth to the dental clinic was to "wrap it in dry tissue paper".

CONCLUSIONS

These results suggest that education in first aid for accidents that occur outside dental clinics or hospitals is insufficient. Japanese dentists and dental educations must immediately improve the utilization of the guidelines for dental trauma and the education of undergraduate students and patients in the management of dental trauma using an integrated approach.

Knowledge and attitude of parents with regard to avulsed permanent tooth of their children and their emergency management--Chennai

BACKGROUND

Dental avulsion is defined as the complete displacement of tooth out of socket along with severed periodontal ligament with or without fracture of the alveolar bone. Reimplantation of the avulsed tooth is considered as a best treatment modality due to its biological and psychological advantages. The viability of periodontal ligament cell on the root surface determines the prognosis of reimplanted tooth. The knowledge of parents regarding important steps to be taken immediately after dental avulsion is considered crucial for success of the treatment.

AIM

The study was conducted to evaluate the knowledge and attitude of parents in Chennai with regard to avulsed permanent tooth of their children and their emergency management using a questionnaire.

MATERIALS AND METHODS

The study included 529 parents who accompanied their children, aged between 6 years and 12 years, to the Department of Pedodontics, Saveetha Dental College and Hospitals. Chi-square test was done to evaluate the association between the results and the genders, educational level, and geographical status of the respondents.

RESULTS

The study revealed even though 90.7% of parents knew that saving an avulsed permanent tooth is important, but almost one third of the population thought ice water was the best media to transport an avulsed teeth.

CONCLUSION

There is an imperative need for educating the parents regarding management of avulsed tooth for which 87.9% showed interest.

New treatment option for an incomplete vertical root fracture--a preliminary case report

Instead of extraction this case report presents an alternative treatment option for a maxillary incisor with a vertical root fracture (VRF) causing pain in a 78-year-old patient. After retreatment of the existing root canal filling the tooth was stabilized with a dentine adhesive and a composite restoration. Then the tooth was extracted, the VRF gap enlarged with a small diamond bur and the existing retrograde root canal filling removed. The enlarged fracture line and the retrograde preparation were filled with a calcium-silicate-cement (Biodentine). Afterwards the tooth was replanted and a titanium trauma splint was applied for 12d. A 24 months clinical and radiological follow-up showed an asymptomatic tooth, reduction of the periodontal probing depths from 7 mm prior to treatment to 3 mm and gingival reattachment in the area of the fracture with no sign of ankylosis. Hence, the treatment of VRF with Biodentine seems to be a possible and promising option.

Temporary preservation of avulsed tooth in oral submucosal tissue: an experimental study in cat

OBJECTIVE

The purpose of this study was to determine the ability of oral submucosal tissue to serve as a temporary storage medium for the maintenance of periodontal ligament (PDL) cell viability of avulsed teeth.

MATERIALS AND METHODS

Thirty cats were divided into five groups. After extraction of three teeth in each cat, one tooth was put in the depth of cat's oral submucosal tissue and the other two teeth were put in Hanks' balanced salt solution (HBSS) and tap water. The teeth were removed after 8, 24, 48, 72, and 168 h from their mediums and sent for laboratory processing and counting of vital periodontal cells.

RESULTS

Statistical analysis demonstrated that submucosal tissue kept PDL cells viable as good as HBSS.

CONCLUSION

This animal study showed that the efficacy of oral submucosal tissue in maintaining the viability of human PDL cells is similar to that of HBSS.

Tetracycline: a cure all?

Tetracyclines are used to treat a range of oral conditions. Their efficacy in the treatment of periodontitis is well established, and they are authoritatively recommended in the management of avulsed teeth. There is a growing evidence base to support the use of tetracycline to treat recurrent aphthous stomatitis, but its use in white spongy naevus is limited to a handful of case reports. The mechanism of action in these conditions is either unknown or indicated to be through the inhibition of matrix metalloproteinases (MMP). The use of a single agent to treat diverse oral conditions has important implications for oral medicine.

A survey on Hong Kong secondary school students' knowledge of emergency management of dental trauma

Objectives

To investigate Hong Kong secondary school students' knowledge of emergency management of dental trauma.

Method

A questionnaire survey on randomly selected secondary school students using cluster sampling.

Results

Only 36.6% (209/571) of the respondents were able to correctly identify the appropriate place for treatment of dental injury. 55.2% of the respondents knew the suitable time for treatment. Only 24.7% of the respondents possessed the knowledge of how to correctly manage fractured teeth. Only 23.6% of them knew how to manage displaced teeth. 62.5% of them correctly answered that knocked-out deciduous teeth should not be replanted to the original position, but few of them (23.6%) knew that permanent teeth should be replanted. Moreover, 37.1% of the respondents correctly identified at least one of the appropriate media for storing a knocked-out tooth. First-aid training and acquisition of dental injury information from other sources were significant factors that positive responses from these questions would lead to higher scores.

Conclusion

Hong Kong secondary school students' knowledge of emergency management of dental trauma is considered insufficient. An educational campaign in secondary schools dedicated to students is recommended. Prior first-aid training and acquisition of dental injury information from other sources positively relate to the level of knowledge. Dental trauma emergency management is recommended to be added to first-aid publications and be taught to students and health professionals.Trial Registration: Hong Kong Clinical Trial Centre

HKCTR-1344

Impact of audiovisual method in educating children facing dental avulsion

INTRODUCTION

Dental trauma is a major problem in oral health in childhood especially if the result is a tooth avulsion. Subsequently, an appropriate management is essential to preserve the avulsed tooth.

AIM

The goal of this study is to evaluate the knowledge of children concerning dental trauma and to highlight the importance of audio and visual methods in educating viewers in the management of such accident.

MATERIALS AND METHODS

Three hundred and forty four children, aged between 8 and 11 years old, participated in this study. Half of them answered a questionnaire about the management of a tooth avulsion. Then, they watch an educational movie played by a speaker. Three months later, they answer the same questionnaire. The remaining 172 children are divided into two equal groups A and B. Group A watches the movie, and group B listens to the story and answers the same questionnaire. One more time, both groups watch the film and listen to its verbal interpretation, then both answer the same questionnaire again. The answers are analyzed.

RESULTS

Before watching the movie, 4 of 172 children answer correctly the question related to the conservation of the avulsed tooth. Three months after watching the movie, the correct answers increase to 52. For the second part of the study, after audiovisual information, the full score in group A increases from 20 to 58, and in group B from 49 to 67.

CONCLUSION

The study highlights the importance of audiovisual method in transmitting an educational message and improving the knowledge of a large 'target audience'.

Taking the trauma out of trauma: an easy to follow guide for the management of trauma to the permanent dentition

Treatment of dental trauma can be an infrequent, unpredictable and stressful experience for a dental practitioner. Correct diagnosis and management of such cases is of primary importance in the prognosis of the affected dentition. We have therefore constructed a number of easy to follow algorithms in management, both short and long term, for the range of traumatic injuries that can affect the permanent dentition.

CLINICAL RELEVANCE

Immediate as well as longer term management of dental trauma cases can be difficult, therefore a clear treatment plan is of great importance in successful results.

Histologic and micro-computed tomographic analyses of replanted teeth stored in different kind of media

INTRODUCTION

Coconut water (CW) and soy milk (SM) have been proposed as storage media for avulsed teeth because of their nutrients that preserve cell viability. The present study investigated the periodontal healing process of dog teeth replanted after storage in CW, SM, and whole milk (WM) using micro-computed tomographic (μCT) and histologic analyses compared with immediate tooth replantation.

METHODS

Forty roots of 10 adult beagle dogs were extracted and subjected to the following protocols: immediate replantation after extraction (control), stored in CW with an adjusted pH, and SM and WM for 50 minutes before replantation. The animals were euthanized 28 days postoperatively, and the obtained specimens were scanned using a μCT scanner and subjected to routine processing for histometric analyses under an optical microscope.

RESULTS

CW and SM performed similarly to WM; however, SM showed significantly higher ankylosis than the control group.

CONCLUSIONS

Additionally, this study showed that the combined use of histologic analysis and μCT is a promising method to better identify tooth resorption and the repair process and to evaluate the total extension of the periodontium. CW as a storage medium is a promising transport media for avulsed teeth.

Enamel matrix derivative for replanted teeth in animal models: a systematic review and meta-analysis

OBJECTIVES

To investigate the effect of enamel matrix derivative (EMD) on periodontal healing of replanted teeth in animal models.

MATERIALS AND METHODS

The authors searched MEDLINE, PubMed, EMBASE, Cochrane Library, Web of Knowledge and Scopus for articles published up to Oct 2012. Animal studies in which EMD was applied in transplanted or replanted teeth with adequate controls and histological data were considered. Normal periodontal healing or root resorption determined by histology after EMD was applied in replanted teeth with adequate controls was used as outcome measures. The following search strategy was used: ('Emdogain' OR 'enamel matrix proteins' OR 'enamel matrix derivative') AND ('avulsion' OR 'transplantion' OR 'autotransplantation' OR 'replantation').

RESULTS

Six animal studies were included in the final review. There was great heterogeneity in study design among included studies. Two studies with similar study designs were identified and analyzed by a meta-analysis. The pooled estimates showed a significantly higher normal healing and surface resorption and significantly less inflammatory and replacement resorption in EMD-treated groups compared with non-EMD-treated groups.

CONCLUSIONS

With the limitations of this systematic review, the use of EMD led to greater normal periodontal healing and surface root resorption and less inflammatory and replacement root resorption in the presence of periodontal ligaments. However, no definite conclusion could be drawn with regard to the effect of EMD on periodontal healing and root resorption when no periodontal ligaments exist.

Validation of the cone beam computed tomography-based stereolithographic surgical guide aiding autotransplantation of teeth: clinical case-control study

OBJECTIVE

To compare the outcome of cone beam computed tomography (CBCT)-based surgical planning and transfer technique for tooth autotransplantation versus conventional autotransplantation.

STUDY DESIGN

The study material comprised 40 pediatric subjects in whom 48 teeth were transplanted following a case-control design. While the study group (mean age 11 years) underwent CBCT imaging for surgical planning and transfer via stereolithographic tooth replica fabrication, the historical control group (mean age 12 years) was subjected to conventional autotransplantation.

RESULTS

The CBCT-based preoperative planning and the use of a tooth replica decreased the extra-alveolar time and reduced the number of positioning trials with the donor tooth. In the control group, 6 patients showed 1 or more complications, while this was noticed for only 2 study patients.

CONCLUSION

CBCT-based surgical planning of tooth autotransplantation may benefit from a shorter surgical time, while being a less invasive technique, causing fewer failures than a conventional approach.

Host tissue reactions of non-demineralized autogenic and xenogenic dentin blocks implanted in a non-osteogenic environment. An experimental study in rabbits

Dentoalveolar ankylosis with osseous replacement is often seen after replantation of avulsed teeth, and this process may be used for preservation of alveolar crests after trauma. Its exact mechanisms with regard to osteoinductive properties are not yet fully understood and need to be systematically investigated. Dentin can possibly act as a slow-releasing carrier of bone morphogenic proteins (BMP), and this property of dentin has been proposed to be used as an alternative or supplement to bone grafting in the maxillofacial region. We aimed to initially asses host tissue reactions to dentin by implanting dentin blocks of autogenic and xenogenic human origin in rabbit connective tissue of the abdominal wall and femoral muscle. Animals were sacrificed after a period of 3 months, and histological processing, sectioning and examinations were carried out. Bone formation, cell counts and thickness of capsule surrounding the grafts were evaluated. Only minor signs of heterotopic bone formation were seen. There were no significant differences between autografts and xenografts or grafts implanted in connective tissue or muscle with regards to tissue reactions except for a significant difference (P = 0.018) in findings of more local inflammatory cells in relation to grafts placed in connective tissue in the autograft group. We conclude that during the time frame of this study, non-demineralized dentin, whether autogenous or xenogenic did not have the potential to induce bone formation when implanted in non-osteogenic areas such as the abdominal wall and abdominal muscle of rabbits.

Preservation of coronal tooth fragments prior to reattachment

BACKGROUND

Reattachment of the tooth fragment is a well-accepted treatment option in dealing with crown fractures. Hydration of the fragment is an important aspect in this treatment. The present study evaluated the effect of storing fragments in different storage media prior to reattachment.

METHODS

Sixty bovine incisors were randomly divided into five groups. The teeth were fractured and the fragments were dried for 48 hours and then immersed in one of the four experimental media (distilled water, milk, egg white, or 50% dextrose solution) for 2 hours. Tooth fragments in the control group were kept dry. The apical segments of the fractured teeth were stored in physiological saline. Fragments were reattached and force was applied on the labial side of the teeth at a 1 mm/min rate until failure.

RESULTS

One-way ANOVA indicated that the storage medium affects bond strength (p = 0.002). Multiple comparison tests showed that the teeth preserved in the 50% dextrose solution and the egg white exhibited significantly higher bond strengths compared to the control group (p < 0.05).

CONCLUSIONS

Preservation of the fractured tooth fragment in egg white or hypertonic solutions results in a higher strength of the bond between the restoration and the tooth as compared to storage in water or dried conditions.

Massachusetts emergency departments' resources and physicians' knowledge of management of traumatic dental injuries

BACKGROUND

Hospital emergency departments (ED) are confronted with triaging and managing dental emergencies of both traumatic and non-traumatic origin. However, the literature suggests that there exists inadequate knowledge of the management of traumatic dental injuries (TDI) among medical professionals who must be knowledgeable and have the appropriate resources needed to triage or treat patients presenting with TDI.

AIM

The aims of this study were to (i) evaluate the resources of Massachusetts emergency departments (MEDs) for TDI, (ii) determine the knowledge of management of TDI among MED physicians, and (iii) investigate potential factors that affect their knowledge.

MATERIALS AND METHODS

Surveys were mailed to MED directors and their physicians. The director survey contained questions regarding institutional information for each emergency department (ED). The physician survey contained questions about physician characteristics and tested their knowledge of managing dental trauma.

RESULTS

A total of 72 surveys (16 MED directors and 56 physicians) were returned and included in the analysis. Only 50% of the MEDs had on-site dental coverage, 43.8% had 24-h off-site dental coverage, and none had a formal written dental trauma protocol. MED physician's knowledge of the appropriate management of luxations and avulsions was generally good, but poor for dental fractures. The MED physician's knowledge for the emergent nature of the various injuries was generally good with that of avulsions being the best. Physicians were more likely to have a better knowledge of managing dental trauma if they were specialists in pediatric emergency medicine (P = 0.001) or their hospitals had an academic affiliation (P = 0.05).

CONCLUSIONS

Based on the findings from this study, educational campaigns must be undertaken to improve both the resources available to the ED, and the knowledge of physicians regarding emergency management of TDI. In addition, efforts should be made by local dental organizations to provide ED with lists of dentists who are knowledgeable and willing to be available 24 h day⁻¹ to consult with and, if necessary, treat TDI. These efforts would enhance the long-term outcomes for patients sustaining dental trauma who present to hospital ED.

Occurrence of dental avulsion and associated injuries in patients with facial trauma over a 9-year period

INTRODUCTION

This retrospective study aimed to assess the occurrence of dental avulsions in patients with facial trauma over a 9-year period.

MATERIALS AND METHODS

Data was collected from records of patients attended to at the Division of Oral and Maxillofacial Surgery at Piracicaba Dental School-State University of Campinas, Piracicaba (SP), Brazil.

RESULTS

Two hundred three patients with 387 avulsed teeth were evaluated, the central incisors being the most common teeth involved (42 % of permanent and 61 % of primary teeth). Thirty-four percent of the cases occurred on weekends, mainly on Saturdays (20 %) and the distribution in relation to the time of year was similar with slight peaks in January. The most prevalent associated dentoalveolar injury was lateral luxation (26 %) and 19 % of the patients presented with an associated facial fracture. The most common sign presented was laceration (23 %), and the main symptoms found were pain (58 %). Associated general trauma was present in 139 patients (68 %), and the most prevalent was the upper limb (41 %).

DISCUSSION

Special emphasis should be given not only to diagnosis and treatment of dental avulsion but for prevention, too. An understanding of the etiology, severity, and distribution of associated traumatic injuries can help for future studies and for an effective prevention of these injuries.

New bone formation around xenogenic dentin grafts to rabbit tibia marrow

PURPOSE

From traumatology, it is well known that dentoalveolar ankylosis results in osseous replacement and formation of new bone. This principle is used after decoronation for preservation of the height and width of the alveolar bone crest after trauma. Dentin possesses bone-forming properties and may possibly also be used as a bone augmentation material prior to implant placement. The aim of this study was to investigate whether xenogenic dentin particles inserted into the marrow space of rabbit tibia, a space where there is no solid bone tissue initially, would contribute to new bone formation.

MATERIALS AND METHODS

Dentin chips from human teeth were inserted into tibias of ten New Zealand rabbits. The tibial bones were processed for histology after 6 months, and new bone formation was quantified.

RESULTS

Bone formation was ranging from 0 to 86% on the dentin fragments, and there was minor inflammation. Bone formation was seen to a larger extent on dentin grafts located close to the native tibial bone wall. There was a significant correlation (r = -0.579, P < 0.001) between the amount of bone formation around the dentin graft and distance to the tibial cortical wall.

CONCLUSION

Dentin promotes new bone formation when located close to native cortical bone and may have a potential as a bone augmentation material.

Effect of skimmed pasteurized milk and Hank's balanced salt solution on viability and osteogenic differentiation of human periodontal ligament stem cells

BACKGROUND/AIM

The purpose of this study was to compare the effect of skimmed pasteurized milk and Hank's balanced salt solution on the viability and osteogenic differentiation potential of the human periodontal ligament stem cells at room temperature in vitro.

MATERIAL AND METHODS

Human periodontal ligament stem cells were obtained from extracted healthy third molars and conserved in skimmed pasteurized milk and Hank's balanced salt solution for 1, 2, and 4 h at room temperature to detect the viability of the cells and their osteogenic differentiation potential.

RESULTS

The efficacy of skimmed pasteurized milk on cell viability at 4 h was significantly higher than that of HBSS (P < 0.05), and cells stored in skimmed pasteurized milk showed significantly higher levels of mineralization than those in HBSS at 2 and 4 h (P < 0.05).

CONCLUSIONS

Skimmed pasteurized milk was more effective than Hank's balanced salt solution in maintaining the viability and osteogenic differentiation potential of PDLSCs at room temperature in vitro.