1
|
Alani A, Tewari N, Calvert G. Contemporary issues in the management of dental trauma. Br Dent J 2023; 235:946-956. [PMID: 38102262 DOI: 10.1038/s41415-023-6564-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 12/17/2023]
Abstract
Contemporary diagnosis and management of traumatic dental injuries requires a multifaceted understanding of the pathological and psychological impact over a patient's lifetime. The legacy of dental trauma injuries can have repercussions for the dentition and supporting tissues, requiring complicated multidisciplinary clinical input. Foresight is required to ensure optimal aesthetic and functional outcomes. Mitigating risks and maximising benefits in patients presenting with polytrauma can be challenging, but if optimally managed at the acute presentation, the long-term burden to the patient and the clinician is reduced. This paper aims to discuss the contemporary clinical dilemmas, challenges and controversies related to the management of dental trauma.
Collapse
Affiliation(s)
- Aws Alani
- King´s College Hospital, London, United Kingdom.
| | - Nitesh Tewari
- All India Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
2
|
Duong C, Zhu Q, Aseltine RH, Kuo CL, da Cunha Godoy L, Kaufman B. A Survey on Cone-beam Computed Tomography Usage Among Endodontists in the United States. J Endod 2023; 49:1559-1564. [PMID: 37657729 DOI: 10.1016/j.joen.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023]
Abstract
INTRODUCTION The aim of the study was to investigate the accessibility and frequency of cone-beam computed tomography (CBCT) usage and to assess the economic and logistical factors involved with its usage among active American Association of Endodontists (AAE) members, utilizing a web-based survey. METHODS A survey of 19 questions was sent to 3,071 AAE members addressing participant access to, along with financial and logistical aspects of CBCT imaging. Descriptive analysis was performed and Fisher exact test utilized to test associations between groups (P < .05). RESULTS The overall response rate was 14.7% (n = 544). Ninety-five percent of respondents (n = 486) had an in-office CBCT unit, with those graduating after the year 2000 statistically more likely to have one (P < .05). Utilization of CBCT imaging for every case was reported by 40% of providers. Eighty-nine percent reported taking the scan at the consultation visit and 20% included this charge with the consultation fee. For those who charged for the scan separately, 85% charged more than $100. Providers who paid off their unit did so within 1-2 years (41%), 3-4 years (36%), 4-5 years (12%), and 5+ years (11%). Limited field of view was utilized by 95% of respondents. Fifty-eight percent reported interpreting the scans themselves, 38% send only if pathology is expected, and 3% always send their scans to a radiologist. CONCLUSIONS In conclusion, accessibility and utilization of CBCT imaging among United States endodontists has increased and acquisition of this equipment has not made a long lasting financial burden on providers.
Collapse
Affiliation(s)
- Christie Duong
- Division of Endodontology, University of Connecticut School of Dental Medicine, Farmington, Connecticut.
| | - Qiang Zhu
- Division of Endodontology, University of Connecticut School of Dental Medicine, Farmington, Connecticut
| | - Robert H Aseltine
- Center for Population Health, Division of Behavioral Sciences and Community Health, UConn Health, Farmington, Connecticut
| | - Chia-Ling Kuo
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Connecticut
| | - Lucas da Cunha Godoy
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Connecticut
| | - Blythe Kaufman
- Division of Endodontology, University of Connecticut School of Dental Medicine, Farmington, Connecticut
| |
Collapse
|
3
|
Abstract
Cone-beam computed tomography (CBCT) is a three-dimensional imaging modality which can aid endodontic diagnosis and treatment planning. While there are guidelines available describing the indications, there are divergent philosophies on when this technology should be applied in clinical practice. This paper reviews the applications of CBCT including the clinical relevance of parameters which can be assessed, highlights the limitations of this technology, and provides guidance on how to maximise its clinical utility.
Collapse
Affiliation(s)
- F Chan
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| | - L F Brown
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| | - P Parashos
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Van Gorp G, Maes A, Lambrechts M, Jacobs R, Declerck D. Is use of CBCT without proper training justified in paediatric dental traumatology? An exploratory study. BMC Oral Health 2023; 23:270. [PMID: 37165416 PMCID: PMC10170728 DOI: 10.1186/s12903-023-03013-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/03/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Proper skills in radiographic diagnosis are essential for optimal management of dental trauma. AIM To assess diagnostic accuracy obtained by paediatric dentists using Cone Beam Computed Tomography (CBCT) without specific training and to compare this with their performance using intraoral radiographs. METHODS Intraoral and CBCT images of 89 teeth, spread over twenty dental trauma cases were presented in random order to nine paediatric dentists. Diagnostic findings were compared with those of a benchmark reference. Sensitivity and specificity were calculated and compared using paired t-tests. RESULTS Overall, observers' diagnostic performance was rather poor with significantly higher sensitivity when using 2D images (P = 0.017). Performance differed considerably according to the type of pathology. Using either imaging modality, sensitivity for diagnosing apical pathology and root fractures was high while the opposite was seen for inflammatory root resorption, root cracks and subluxations. Statistically significant differences between imaging modalities were seen for root fractures (P = 0.013) and apical pathology (P = 0.001), in favor of 3D, and for crown fractures (P = 0.009) in favor of 2D. CONCLUSION Overall poor performance of paediatric dentists indicates that additional training in radiographic diagnosis is required. In order to justify the use of CBCT to increase diagnostic performance, proper training of the paediatric dentist is mandatory.
Collapse
Affiliation(s)
- Gertrude Van Gorp
- KU Leuven Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 7, Leuven, PO box 7001, B-3000, Belgium.
| | - Arno Maes
- KU Leuven Department of Oral Health Sciences, Master in Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Marjan Lambrechts
- KU Leuven Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 7, Leuven, PO box 7001, B-3000, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dominique Declerck
- KU Leuven Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 7, Leuven, PO box 7001, B-3000, Belgium
| |
Collapse
|
5
|
Determinants of Clinical Decision Making under Uncertainty in Dentistry: A Scoping Review. Diagnostics (Basel) 2023; 13:diagnostics13061076. [PMID: 36980383 PMCID: PMC10047498 DOI: 10.3390/diagnostics13061076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
Clinical decision-making for diagnosing and treating oral and dental diseases consolidates multiple sources of complex information, yet individual clinical judgements are often made intuitively on limited heuristics to simplify decision making, which may lead to errors harmful to patients. This study aimed at systematically evaluating dental practitioners’ clinical decision-making processes during diagnosis and treatment planning under uncertainty. A scoping review was chosen as the optimal study design due to the heterogeneity and complexity of the topic. Key terms and a search strategy were defined, and the articles published in the repository of the National Library of Medicine (MEDLINE/PubMed) were searched, selected, and analysed in accordance with PRISMA-ScR guidelines. Of the 478 studies returned, 64 relevant articles were included in the qualitative synthesis. Studies that were included were based in 27 countries, with the majority from the UK and USA. Articles were dated from 1991 to 2022, with all being observational studies except four, which were experimental studies. Six major recurring themes were identified: clinical factors, clinical experience, patient preferences and perceptions, heuristics and biases, artificial intelligence and informatics, and existing guidelines. These results suggest that inconsistency in treatment recommendations is a real possibility and despite great advancements in dental science, evidence-based practice is but one of a multitude of complex determinants driving clinical decision making in dentistry. In conclusion, clinical decisions, particularly those made individually by a dental practitioner, are potentially prone to sub-optimal treatment and poorer patient outcomes.
Collapse
|
6
|
Chen C, Zhu T, Wu H, Zhao X, Leng D, Wang J, Yang L, Wu D. Prevalence and correlation of C-shaped root canals of mandibular premolars and molars in Eastern Chinese individuals. Sci Rep 2022; 12:19779. [PMID: 36396689 PMCID: PMC9671964 DOI: 10.1038/s41598-022-24381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate the prevalence, correlation, and differences of C-shaped root canals (CSRCs) morphology in permanent mandibular premolars and molars in Eastern Chinese individuals using cone-beam computed tomography (CBCT). A total of 8000 mandibular first premolars (MFPs), mandibular second premolars (MSPs), mandibular first molars (MFMs), and mandibular second molars (MSMs) CBCT images from 1000 patients (692 females and 308 males) were collected. The prevalence, correlation, bilateral/unilateral presence, the morphology of CSRCs, level of canal bifurcation, gender differences, and location of radicular grooves (RGs) were evaluated. The prevalence of CSRCs in MFPs, MSPs, MFMs and MSMs were 10.25%, 0.25%, 0.55% and 47.05%, respectively. The prevalence of CSRCs in MFPs of males was higher than that in females, while the prevalence of CSRCs in MSMs of females was higher than that in males (P < 0.05). The bilateral symmetry presence of CSRCs in MSMs was significant but not in MFPs, MSPs, and MFMs. RGs were predominantly found on the mesiolingual (ML) surface of premolars and the lingual surface of molars. There was a high prevalence of CSRCs in MFPs and MSMs in the Eastern Chinese population, but there was no correlation. The prevalence of CSRCs in MFPs and MSMs differ significantly by gender (P < 0.05).
Collapse
Affiliation(s)
- Cheng Chen
- grid.89957.3a0000 0000 9255 8984Department of Endodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,grid.89957.3a0000 0000 9255 8984Present Address: Department of Oral & Maxillofacial Imaging, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Tingting Zhu
- grid.89957.3a0000 0000 9255 8984Department of Endodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,grid.89957.3a0000 0000 9255 8984Present Address: Department of Oral & Maxillofacial Imaging, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Huili Wu
- grid.89957.3a0000 0000 9255 8984Department of Endodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,grid.89957.3a0000 0000 9255 8984Present Address: Department of Oral & Maxillofacial Imaging, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Xiao Zhao
- grid.89957.3a0000 0000 9255 8984Department of Endodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,grid.89957.3a0000 0000 9255 8984Present Address: Department of Oral & Maxillofacial Imaging, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Diya Leng
- grid.89957.3a0000 0000 9255 8984Department of Endodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,grid.89957.3a0000 0000 9255 8984Present Address: Department of Oral & Maxillofacial Imaging, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Jingyan Wang
- grid.89957.3a0000 0000 9255 8984Present Address: Department of Oral & Maxillofacial Imaging, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Lianfeng Yang
- grid.89957.3a0000 0000 9255 8984Present Address: Department of Oral & Maxillofacial Imaging, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Daming Wu
- grid.89957.3a0000 0000 9255 8984Department of Endodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,grid.89957.3a0000 0000 9255 8984Present Address: Department of Oral & Maxillofacial Imaging, The Affiliated Stomatological Hospital of Nanjing Medical University, 1 Shanghai Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| |
Collapse
|