An 11-year review of dental injuries associated with maxillofacial fractures in Turin, Italy

Patterns and Characteristics of Midface Fractures in North-Eastern Romania

Midface fractures are common injuries that are the result of interpersonal violence, traffic accidents, falls, work-related accidents, sports-related accidents, or animal aggression. In the northeastern part of Romania, these injuries are a significant health concern that, if left untreated, may lead to functional and esthetic sequelae. Background and Objectives: This study aims to update the statistical data available to help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence. Materials and Methods: This research was conducted over five years and included 651 patients of both sexes, with ages between 3 and 95 years, that addressed our center for midface fracture treatment. Results: The authors of this study found that men are more predisposed to fractures of the middle third of the face, with anterior laterofacial fractures being the most common type of fracture. Interpersonal violence was the most incriminated etiology for all midface fractures. Conclusions: The present study regarding midfacial fractures shows similar results compared to the medical literature. These findings could help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence.

The evaluation of alveolar fractures of trauma patients in Iran

BACKGROUND

Alveolar bone plays a vital role in mastication and supporting the teeth. The alveolar process is one of the most challenging regions of facial bone to reconstruct due to the deformity involves both hard and soft tissues. However, the etiology, gender, and age distribution vary between different regions, cultures, and countries. This study aims to investigate the prevalence of alveolar trauma in Shahid Rajaee Hospital, Shiraz, Iran, for three years.

METHODS

In a retrospective cross-sectional study, patients with alveolar fractures referred to Shahid Rajaei Hospital in Shiraz were included in the study. Age, sex, site of alveolar fractures, and etiology factors of trauma explored. The collected data was analyzed by SPSS software. Mean [Formula: see text] SD calculated for the inferential statistics, and the data compared using Chi-square and Exact Fisher. A p-value of < 0.05 was considered statistically significant with a 95% reliability.

RESULTS

A total of 165 patients had alveolar fractures in this study. We found that the most common cause of alveolar fracture was road accidents (32.3%) and the lowest reason was violence (9%). Most people with alveolar trauma were male and in the 21-30 years. The prevalence of mandibular and maxillary alveolar fractures was 17.61 and 17.01%, respectively, with the most anterior area of injury.

CONCLUSION

Alveolar trauma is one of the most common injuries among trauma patients. Early diagnosis and treatment plans are necessary to reduce the complications of facial trauma. Early training for a young adult is essential to prevent the severity of trauma.

What Are Possible Contributors to Associated Dental Injury in Mandibular Fractures?

PURPOSE

Among previous reports on dental injuries associated with mandibular fractures, there are few investigating the conditions under which dental injuries commonly occur. The aim of this study was to determine specific characteristics of mandibular fractures accompanied by dental injuries.

METHODS

This retrospective cohort study included dentate patients with mandibular fractures treated at a tertiary trauma center between 2011 and 2019. The data were analyzed according to 2 outcome variables: patients with additional dental injuries and patients without. The predictor variables were patient age, sex, accident mechanism, number and location of mandibular fractures, and presence of submental lacerations. Odds ratios for the risk factors for dental injury were calculated in conjunction with descriptive statistics. Binary logistic regression analysis was also performed to identify the factors associated with dental injuries as dependent variables.

RESULTS

Of 252 patients who had only mandibular fractures, 95 (37.7%) had associated dental injuries. In the group with dental injuries, 55.8% of mandibular fractures were caused by a fall (P = .003). Condyle fractures (77.9%) with dislocation (67.6%) and bilateral involvement (41.9%) were more common than in the group without dental injuries (P < .001). In patients with dental injuries, the incidence of 3 or more fractures (29.5%) was significantly higher than in the group without dental injuries. Dental injuries were more likely to occur in patients with concomitant submental lacerations (confidence interval (CI) 1.135-4.983, P = .02), and the risk of dental injury was significantly lower in the presence of angle fractures (CI 0.113-0.999, P = .045).

CONCLUSIONS

A frontal impact involving the anterior part of the mandible is often associated with condyle and multiple mandibular fractures. This seems to be the typical mechanism for concomitant dental injuries. Submental laceration can be considered a prime sign of associated dental injuries.

Dental injuries in paediatric mandibular fracture patients

Purpose

Dental injuries (DIs) are associated with facial fractures, particularly mandibular fractures. As paediatric mandibular fractures have special features, we sought to clarify the occurrence and types of DIs among this patient group. We assessed how age, injury type, and fracture location affects the occurrence of DIs and thereby defined which patients are most susceptible.

Methods

This retrospective study included patients < 18 years with a recent mandibular fracture. Predictor variables were gender, age group, mechanism of injury, type of mandibular fracture, and other associated facial fracture(s). Types and locations of DIs and tooth loss due to injury were also reported.

Results

DIs were detected in 34.7% (n = 41) out of 118 patients. Patients with tooth injury had on average 3.5 injured teeth. A total of 16.2% of injured teeth were lost, typically at the time of the injury. Loss of at least one tooth was seen in approximately 10% of patients. Avulsion was the most common cause of tooth loss (52.2%). Non-complicated crown fracture (50.7%) was the most common DI type. Statistically significant associations between studied variables and DIs were not detected.

Conclusion

DIs are common and often multiple in paediatric mandibular fracture patients regardless of background factors. DIs often lead to tooth loss. Prompt replantation of an avulsed tooth, early detection of DIs, and prevention of tooth loss whenever possible are important to avoid permanent tooth defects.

Dental Trauma on whole Body Trauma CT-An underreported finding

Background

The prevalence of dental injuries (DI) in polytrauma patients is unknown. The purpose of our study was to identify the frequency of dental injuries on whole body CTs acquired in a trauma setting and to estimate how often they are correctly reported by the radiologist.

Methods

In the time period between 2006 and 2018 the radiological database of one university hospital was screened for whole-body trauma CTs. A total of 994 CTs were identified and re-evaluated.

Results

Dental injuries were identified in 127 patients (12.8% of patients). There were 27 women (21.3%) and 100 men (78.7%) with a mean age of 51.0 ± 18.9 years (range 10–96 years). Regarding localization, most findings involved the molars (n = 107, 37.4%), followed by the incisors (n = 81, 28.3%), premolars (n = 59, 20.6%) and canines (n = 39, 13.7%). Most common findings were as follows: luxations (n = 49, 45.8%), followed by crown fractures (n = 46, 43%), root fractures (n = 10, 9.3%), extrusions (n = 1, 0.9%), and intrusions (n = 1, 0.9%). Only 15 findings (11.8% of all patients with dental injuries) were described in the original radiological reports.

Conclusion

DI had a high occurrence in polytrauma patients. A high frequency of underreported dental trauma findings was identified. Radiologists reporting whole-body trauma CT should be aware of possible dental trauma to report the findings adequately.

Injury Prevention, Safety Education and Violence in Relation to the Risk of Tooth Fracture among Korean Adolescents

This study aimed to determine the injury prevention-, safety education-, and violence-related factors pertaining to tooth fracture experience (TFE) in Korean adolescents. We used data from the 14th Korea Youth Risk Behavior Survey (KYRBS) in 2018. The 60,040 participants were selected using a complex sampling design from middle and high schools. The participants completed a self-administered questionnaire. The explanatory variables, including school safety education and violence, were assessed in relation to prevention of traumatic injuries. Complex-samples multivariable logistic regression models were applied to explain the factors related to TFE over the past 12 months. The overall prevalence of TFE was 11.4%. Risk factors related to tooth fractures were not wearing a seatbelt on an express bus, not wearing helmets while riding motorcycles and bicycles, clinical treatment due to injuries at school, injuries associated with earphone/smartphones use, and lack of school safety education such as danger evacuation training. The top risk factor was injuries associated with earphone/smartphone usage, followed by lack of familiarity with school safety education. Thus, to prevent tooth fractures among adolescents, schools should strengthen their safety education, including education regarding mobile device usage, and wearing a seatbelt and wearing a helmet. Care should be taken to manage facilities around the school and to prevent injury related to tooth fracture. Further studies on various risk factors related to tooth fractures are warranted.

Dentoalveolar Fractures: New Orthodontic Protocol Proposal and Pilot Study

The goal of fracture treatment that includes the dentoalveolar process is to obtain the anatomic bone healing and the pre-injury occlusion restoration with functional and aesthetic recovery, avoiding dental or periodontal lesions. Fractures activates, in the damaged tissue, the Regional Acceleratory Phenomenon, a physiological healing process that can also be activated during orthodontic overloads. Orthodontic treatment in the traumatized area could exploit this phenomenon in order to sustain the cellular activity.The aim of this study is to propose a treatment protocol for dentoalveolar fractures based on the use of orthodontics in order to sustain the physiological healing process known as Regional Acceleratory Phenomenon.The authors present 2 cases of an 18 year old woman and 23 year old man affected by dentoalveolar fracture. The operative protocol the authors applied foresaw three steps of treatment: orthodontic brackets application, surgery, orthodontic treatment.The patients showed complete healing at the 3 months follow-up and were treated up to 18 months for further orthodontic treatment.The operative protocol proposed by the Authors appears to be a rational choice since it allows a single orthodontic device to be an "active splinting system", with fast application time, good acceptance by the patient, low complications rate; moreover, it produces any planned dental movements for further orthodontic treatments.

Dental injuries in patients associated with fracture of facial bones

PURPOSE

To assess different types of dental injuries associated with facial bone fractures.

METHOD

One hundred dentate patients were selected randomly of all age and gender who had maxillofacial trauma only and having dental injury in association with facial bones fractures were included. They were thoroughly examined for injury/fracture to facial region as well as for dental injuries (teeth). Tooth injuries were noted according to Ellis classification. The data was collected, compiled, and put to statistical analysis.

RESULTS

Dental injuries were more in females than males found to be statistically significant with (p < 0.05).Crown fracture of maxillary teeth was more as compared to mandibular except molars found to be statistically significant (p < 0.05). Root fracture was more in maxillary incisors followed by canine as compared to mandibular incisors and canines found to be insignificant. Avulsion, extrusion and luxation were more in maxilla as compared to mandible found to be significant.

CONCLUSION

Different types of tooth injuries associated with facial bone fracture found more in females and maxillary teeth.

Mandibular trauma: a two-centre study

The aims of this study were to assess and compare epidemiological data on mandibular fractures from two European centres and to perform a review of the literature. Between 2001 and 2010, a total of 752 patients with a total of 1167 mandibular fractures were admitted to a hospital in Turin, and 245 patients with a total of 434 mandibular fractures were admitted to a hospital in Amsterdam. The mean age in Turin was 34.8 years and in Amsterdam was 32 years. The age group 20-29 years showed the highest incidence of mandibular fractures in both centres. The fractures were mainly the result of assaults, in agreement with several articles in the recent literature, followed by falls. The continuous long-term and multicentre collection of data on the epidemiology of maxillofacial trauma is important because it provides the information necessary for the development of preventative measures aimed at reducing the incidence of facial injuries.

Mandibular trauma treatment: a comparison of two protocols

Objectives: The aim of this study was to evaluate the treatment of mandibular fractures treated in two European centre in 10 years. Study Design: This study is based on 2 systematic computer-assisted databases that have continuously recorded patients hospitalized with maxillofacial fractures in two centers in Turin, Italy and in Amsterdam, the Netherlands for ten years. Only patients who were admitted for mandibular fractures were considered for this study. Results: Between 2001 and 2010, a total of 752 patients were admitted at Turin hospital with a total of 1167 mandibular fractures not associated with further maxillofacial fractures, whereas 245 patients were admitted at Amsterdam hospital with a total of 434 mandibular fractures. At Amsterdam center, a total of 457 plates (1.5 - 2.7 mm) were used for the 434 mandibular fracture lines, whereas at Turin center 1232 plates (1.5 – 2.5 mm) were used for the management of the 1167 mandibular fracture lines. At Turin center, 190 patients were treated primarily with IMF, whereas 35 patients were treated with such treatment option at Amsterdam center. Conclusions: Current protocols for the management of mandibular fractures are quite efficient. It is difficult to obtain a uniform protocol, because of the difference of course of each occurring fracture and because of surgeons’ experiences and preferences. Several techniques can still be used for each peculiar fracture of the mandible.

Key words:Mandibular fracture, facial trauma, maxillofacial, treatment, multicentre, database.

Maxillofacial Fractures due to Falls: does Fall Modality Determine the Pattern of Injury?

Objectives

In several epidemiological studies of maxillofacial trauma, falls were one of the most frequent causes of facial injury. The aim of this study is to analyse the patterns of fall-related maxillofacial injuries based on the height of the fall.

Material and Methods

Using a systematic computer-assisted database of patients hospitalised with maxillofacial fractures, only those with fall-related injuries were considered. The falls were divided into four groups: falls from slipping, tripping or stumbling (STSF), loss of consciousness (LOCF), stairs (SAF), and height (HF). Data on the age, gender, fracture site, Facial Injury Severity Scale (FISS), facial lacerations, associated lesions, type of treatment, and length of hospital stay were also analysed.

Results

This study included 557 patients (338 males, 219 females; average age 51.5 years [range 4 - 99 years]). In the over 60 age group, females were more prevalent in STSF than males. According to aetiology, STSF was the most frequent cause of maxillofacial fractures (315 patients; 56.5%) followed by LOCF (157; 28.2%), HF (55; 9.9%), and SAF (30; 5.4%). The middle third of the face was affected most frequently. After LOCF, however, the inferior third was prevalently involved. The majority of associated fractures, as well as the most severe injuries and greatest rate of facial lacerations, occurred secondary to HF.

Conclusions

This study showed that fracture severity and site are influenced not only by patient age, but also by the nature of the fall.