Prognosis and complications of mature teeth after lateral luxation: A systematic review

Risk of pulp necrosis and related complications in the permanent anterior teeth with lateral luxation: A systematic review and meta-analysis

This systematic review aimed to evaluate the evidence related to the occurrence of pulp necrosis and related complications in permanent anterior teeth with lateral luxation. It was envisaged to address the ambiguity related to the recommendation for pulp extirpation in teeth with mature root apex. An a priori protocol was formulated as per the best practices of evidence-based medicine and registered in PROSPERO. A comprehensive search was performed electronically in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane on July 10,2023 without any restriction of language or year of publication. The screening of titles and abstracts and later the full-text articles were performed. Later, the data extraction was performed by using a self-designed sheet, risk of bias (ROB) assessment was done, meta-analysis was performed, and the GRADE approach was used to assess the quality of evidence. The qualitative synthesis was performed on 13 studies done from 1985 to 2020 in hospital settings. There was variability in the minimum and total observation periods, sample sizes, and characteristics of the sample population. The overall pooled prevalence of pulp necrosis was found to be 57% (95% CI: 42, 72%). It was 12% (95% CI: 8%, 18%, I2 = 0%) in immature teeth, and 58% (95% CI: 42, 73%, I2 = 86%) in mature teeth. The pooled prevalence of EIRR was found to be 11% (95% CI: 4, 27%, I2 = 95%) with greater risk in teeth with mature root apex (RR: 1.26, 95% CI: 1.12, 1.42, I2 = 0%). The ROB was moderate or high in nine studies and the GRADE of evidence was very low in 14 of 15 outcomes. There are greater chances of pulp necrosis in teeth with lateral luxation, especially with mature apex. However, it can still be less than 60% in most cases with the prevalence of EIRR less than 20%. Hence, an absolute recommendation for endodontic intervention in mature teeth with lateral luxation must be interpreted with slight caution.

A retrospective cohort study of pulp prognosis in luxated permanent teeth: a competing risk analysis

AIM

The present retrospective cohort study aimed to evaluate luxated permanent teeth for pulp prognosis and risk factors.

METHODOLOGY

Case records and radiographs of 224 patients, involving 427 luxated permanent teeth, referred for treatment at the Dental Trauma Center-School of Dentistry, Universidade Federal de Minas Gerais, (DTC-SD-UFMG) from 2014 to 2022, were assessed for pulp prognosis classified as vitality, necrosis and pulp canal obliteration (PCO). A competing risk survival analysis estimated the hazards of the three outcomes, and the effect of demographic, clinical and treatment variables was tested using a cause specific Cox regression model.

RESULTS

Pulp vitality was found in163 teeth (38.2%), pulp necrosis in 120 teeth (28.1%) and 55 teeth (12.9%) developed PCO. Pulp vitality decreased in the presence of concomitant crown fractures (HR 0.38 95% CI [0.2-0.8] p = 0.006). The risk of pulp necrosis (HR 0.62 95% CI [0.4-0.96] p = 0.03) was lower in cases with open apices but increased with concomitant crown fractures (HR 4.0 95% CI [2.6-6.1] p = 0.001) and intrusions (HR 2.3 95% CI [1.2-4.1] p = 0.007). Lateral or extrusive luxations (HR 3.0 95% CI [1.3-6.9] p = 0.001) and open apices (HR 2.4 95% CI [1.2-4.7] p = 0.01) showed higher rates of PCO.

CONCLUSION

Type of luxation, the diameter of the apical foramen, and the presence of concomitant crown fractures were main determinants of pulp prognosis after luxation injuries in permanent teeth.

CLINICAL RELEVANCE

Pulp prognosis after tooth luxation is dependent on the presence and direction of tooth displacement together with infection control.

CLINICAL TRIAL REGISTRATION

Not applicable.

Physiological and histological studies of dental response of Luxate tooth with application of VEGF

Background During luxate injury many dental tissue will be involved including pulp, periodontal ligament ,mucosa, hard dental tissue and alveolar bone with affecting the nerve and dental blood supplement. Growth factors may involved in healing process after replantation of tooth in its socket and the  Vascular endothelial factor (VEGF )  is a potent one that increase angiogenesis and accelerate repairing  and healing of dental pulp and the supporting tissues. The study was designed to illustrate the effect of application of growth factor on healing process of luxate molar tooth of rat. Materials & Methods Twenty male Wistar rats with luxate lower right first molar teeth were included in this study. The control were injected  with normal saline (0.5μl ) around the apex of mesial root .Experimental  group injected with  VEGF (0.5μl ). Histological assessment of  physiological responses of (dental pulp, cementum, periodontal ligament (PDL) and alveolar bone in both control and experimental groups with Receptor activator of nuclear factor kappa-Β ligand (RANKL) expression  evaluation were recorded during the healing period in the examined tissue.

Guided endodontic treatment in a region of limited mouth opening: a case report of mandibular molar mesial root canals with dystrophic calcification

BACKGROUND

The endodontic treatment of calcified root canals in molars is a challenging and time-consuming procedure. Even with the aid of a surgical microscope, the risk of root perforation is high, especially in the furcation area. The purpose of this study is to report the Computer-Aided-Design and Manufacturing (CAD-CAM) workflow, the innovative strategies for the template ideation, and the guided endodontic treatment of a mandibular molar with dystrophic calcification in the mesial root canals.

CASE PRESENTATION

A 58-year-old female patient, ASA I, was referred to endodontic treatment in the right first mandibular molar for prosthetic reasons. The mesiobuccal and mesiolingual canals appeared obliterated in the radiographic images. The absence of dental crown, tooth inclination, and the limited mouth opening of the region contributed to a poor visual reference of the tooth in the dental arch and the direction of the remaining lumens of the canals. Despite using surgical microscopy, the conventional technique led to the deviation of the mesiobuccal canal towards the furcation area. The obliteration of both mesial root canals was confirmed using the Cone Beam Computer Tomography. The clinical history associated with the tomography diagnosis was compatible with dystrophic calcifications in the pulp canals. The patient was submitted to an intra-oral scanning as well. The Digital Imaging and Communications in Medicine data (DICOM) were segmented. The Standard Tessellation Language (STL) files were processed following the CAD-CAM workflow, aiming to create two different endodontic templates with a new open design concept. The templates with open design allowed direct visualization of the operative field, irrigation, and dentin debris removal. The strategy of the guidance sleeves niche as half-cylinders allowed the drill insertion in a limited mouth opening region.

CONCLUSIONS

The digital planning and guided access permitted to overcome the case limitations and then re-establish the glide path following the original anatomy of the root canals. The guided endodontic represents a personalized technique that provides security, reduced risks of root perforation, and a significant decrease of the working time to access obliterated root canals even in the mesial root canal of mandibular molars, a region of limited mouth opening.

Endodontic management of traumatized permanent teeth: a comprehensive review

The pulp plays a key role in the treatment of traumatic dental injuries (TDIs) and is strongly associated with the outcome, particularly in severe cases. A correct pulp diagnosis is essential as it forms the basis for developing the appropriate management strategy. However, many TDIs are complex, and their treatment requires a profound knowledge of the physiological and pathological responses of the affected tissues. This comprehensive review will look at the dentine-pulp complex and its interaction with the surrounding tissues following TDIs. The literature up to 2020 was reviewed based on several searches on PubMed and the Cochrane Library using relevant terms. In addition to the recently revised guidelines of the International Association of Dental Traumatology, this article aims to provide background information with a focus on endodontic aspects and to gather evidence on which a clinician can make decisions on the choice of the appropriate endodontic approach for traumatized permanent teeth.

Photographic assessment of simulated dental luxation injuries

BACKGROUND/AIM

Dental photographs are a valid means for documentation of dental luxation injuries. The aim of the study was to evaluate the utility of two photographs from different perspectives in the assessment of dental luxation injuries compared to one perspective only.

MATERIALS AND METHODS

Photographs of simulated dental luxation injuries were shown to experts in dental traumatology and other dentists who had to estimate the displacement in the vertical and horizontal dimensions. The overall error of estimation as a result of both vertical displacement and horizontal displacement was calculated and statistically analyzed.

RESULTS

The mean overall error of estimation was 0.43 mm and 0.75 mm for experts and dentists, respectively. If two (frontal and occlusal) perspectives were available, the overall error was lower than when only one perspective was available (p < .001). Experts had a lower overall error compared to dentists (p < .015).

CONCLUSION

Two photographs from two perspectives allowed better interpretation of dental luxation injuries.

Fractured alveolar process displacement evaluation-Effect of the rigidity of wire-composite splints

BACKGROUNDS/AIMS

Traumatic dental injuries with bone fractures require rigid splinting. The degree of rigidity of the wire-composite splints can be challenging. The aim of this study was to evaluate the effect of the rigidity of different wire-composite splints on alveolar process displacement.

MATERIAL AND METHODS

A model was created using polystyrene resin to simulate the anterior maxilla, bovine incisors to simulate maxillary incisors, and polyether impression material to simulate the periodontal ligament. An alveolar process fracture was created, while maintaining the labial bone connection with the PDL. Four wire-composite splints (0.3, 0.6, 0.9, and 1.2 mm in diameter) were compared with models without splints and with no fracture (n = 5). The alveolar process displacement was measured (3 times per model/per splint type) at the fractured and adjacent central incisor regions using a deflectometer (Instron) under functional cycling and static loading (100 N). Data (μm) were analyzed using RM ANOVA, followed by Tukey's HSD test (α = 0.05).

RESULTS

The displacement at the region of the adjacent incisor was not influenced by the splint during static and cycling load (P > .05). The Tukey test demonstrated that the model without splints had significantly higher alveolar process displacement at the traumatized teeth than that of all other splint models (P < .001). Increasing the wire diameter from 0.3 mm to 0.9 mm significantly reduced the alveolar process displacement (P < .001). No difference was observed between the 0.9 mm (P = .123) and 1.2 mm (P = .219) wire-composite splints irrespective of the measured tooth regions.

CONCLUSIONS

The rigidity of the wire-composite splint significantly influenced the mobility of the fractured alveolar process. The use of at least 0.9 mm wire was effective in reducing the fractured alveolar process displacement to a level that was similar to the adjacent teeth.

Evidence mapping and quality assessment of systematic reviews in dental traumatology

BACKGROUND/AIMS

Evidence mapping of systematic reviews (SRs) systematically and comprehensively identifies, organizes, and summarizes the distribution of scientific evidence in a field. The aims of this study were to delineate domains in dental traumatology (DT), evaluate the existing SRs within the domains, and identify the paucity of evidence for future research.

METHODS

Domains and sub-domains of DT were established according to the methods of qualitative research. The protocol for evidence mapping was prepared as per the guidelines of GEM and PRISMA. The search strategy was formulated using words and MeSH terms in eight databases without restriction of languages and year of publication. Gray literature, protocol registries, and references of selected articles were also searched. Duplicates were removed, and the final selection of SRs was completed. Data extraction and quality analysis using the ROBIS tool and the PRISMA checklist were performed.

RESULTS

The overall search resulted in 64 SRs from 1999 to 2020 with 44 published in last six years. The highest number of SRs had been performed in the Prognostic domain (n = 19) followed by the domains of Epidemiology (n = 15), Therapeutics (n = 10), Oral Biology (n = 7), Diagnostics (n = 6), Preventive (n = 5), and Research Methods (n = 2). Within each domain, there were variabilities in the number of reviewers, a priori protocols, search limitations, risk of bias methods, and meta-analysis. Of the SRs, including 4 Cochrane reviews, 28.4% were inconclusive. A low risk of bias was found in 48.4% of the SRs. Among the registered and ongoing SRs, six were from the domain of epidemiology, two in the domain of therapeutics, five from prognostics, and one each in the domains of prevention and research methods.

CONCLUSION

The SRs in DT could be mapped in seven domains with variabilities in the methods. The majority had an a priori registered protocol and a low risk of reporting errors. Within the Epidemiology and Preventive domains, SRs were present in all the sub-domains with the majority demonstrating low-risk of bias (ROB). The domain of prognosis had SRs in most sub-domains but with a high ROB. Insufficient numbers of SRs were present in most sub-domains of the Diagnostics, Therapeutics, Research Methods and Oral Biology domains.