A retrospective evaluation of traumatized permanent teeth

Comparing fracture resistance on bovine incisors restored by tooth fragment reattachment versus direct composite restoration techniques

BACKGROUND/AIM

Anterior teeth are prone to traumatic dental injuries (TDIs). Although a number of techniques ranging from original tooth fragment reattachment (TFR) to direct composite restoration (DCR) can be used to restore uncomplicated crown fractures, there is no consensus on which method is best. The purpose of this study was to investigate the fracture resistance of bovine incisors restored by two different techniques (TFR and DCR) in three different fracture models.

MATERIALS AND METHODS

Sixty extracted bovine lower incisors were randomly divided into three groups (n = 20). Angle, oblique, or transverse sections of all the teeth in a group were prepared by using a disk. The cut surfaces were scanned, and the cross-sectional areas (CSA) of the enamel and dentin were measured. Half the teeth in each group were restored by DCR (n = 10) and the other half by TFR (n = 10). The forces required to fracture the restored teeth were then measured using a Universal testing machine, and the fracture modes were analyzed (cohesive, adhesive, or mixed).

RESULTS

No statistically significant differences between the TFR and DCR restorations were detected for total and enamel CSAs in any of the restoration shapes (p > .067). The fracture forces required to break DCR angle and transverse restorations were significantly greater than for the corresponding shapes restored with TFR (p < .033). However, the difference in the forces needed to fracture oblique section restorations by DCR or TFR was not statistically significant (p = .239), despite a similar trend (143.4 ± 51 N and 120.9 ± 25 N, respectively).

CONCLUSION

This study revealed that a greater force is required to fracture teeth restored by the DCR than by the TFR technique, especially for a transverse section. This demonstrates that restoring a fractured tooth provides a superior outcome compared to reattaching the fractured fragment.

Survival analysis of fragment reattachments and direct composite restorations in permanent teeth after dental traumatic injuries

BACKGROUND/AIM

In case of crown fractures after traumatic dental injuries, the affected teeth can be restored either with reattachment of the fractured fragment or with a direct composite restoration. So far, longevity data for reattachments and direct composite restorations with regard to different failure types (pulp necrosis and infection, restoration loss) are scarce. Therefore, the aim of this retrospective study was to evaluate the restorative and biological survival of reattached fragments and composite restorations after crown fractures in permanent teeth.

MATERIAL AND METHODS

Dental records of patients treated between 2000 and 2018 were retrospectively analysed regarding the restoration (reattachment or direct composite restorations) of teeth with crown fractures. Survival (no further intervention) and restorative and/or biological failure of all restored teeth were recorded. Statistical analysis was performed using Kaplan-Meier statistics, and the mean annual failure rates for two and 5 years were calculated. Furthermore, the effect of potential risk factors on survival was assessed. Log-rank tests and univariate Cox regression models (likelihood ratio tests) were used to assess the univariate effect of all variables of interest. Variables with a p-value ≤.10 were included in a multivariate Cox regression model with shared frailty (p < .05).

RESULTS

Overall, 164 patients with 235 teeth (uncomplicated crown fracture: N = 201, complicated crown fracture: N = 34) were included (1.6 ± 2.5 years observation time). Of these, 59 teeth were restored with reattachment of the fragment and 176 with a composite restoration. Overall, composite restorations had a significantly higher survival rate than reattachments (p = .002). The cumulative survival after 2 years was 42.9% and 65.0% for teeth treated with a reattachment (mAFR = 34.5%) and a composite restoration (mAFR = 19.3%), respectively. When differentiating between failure types, restoration failure and pulp necrosis were significantly more frequently detected in reattached crown fractures compared to composite restorations (restorative failure: p = .001; biological failure: p = .036). In the multivariate Cox regression model, the variable jaw and luxation significantly influenced the survival when the tooth was restored with a composite restoration. The survival was not influenced by the fracture type.

CONCLUSIONS

Restorative and biological failures were more frequently detected when the tooth was restored with a reattached fragment compared to a direct composite restoration. Both, restoration failure and pulp necrosis with infection should be considered as frequent complications after restoration of crown-fractured teeth which emphasizes the necessity of regular and short follow-up intervals throughout the first 2 years.

The effect of changing apical foramen diameter on regenerative potential of mature teeth with necrotic pulp and apical periodontitis

OBJECTIVE

The aim of the present study was to evaluate the regenerative potential of permanent necrotic mature teeth with different apical foramen diameters in comparison to conventional endodontic treatment.

METHODS

Pulp necrosis and periapical pathosis were induced in premolars (144 roots) in six mongrel dogs. The infected teeth were divided into six groups; conventional root canal treatment (RCT) group prepared up to apical preparation sizes #F3 ProTaper file, regenerative endodontic therapy (RET) groups; groups RET-F3, RET-F4, and RET-F5 where regenerative endodontic procedures were applied after apical preparation up to sizes #F3, F4, and F5 ProTaper file, respectively, control groups; and positive (P) and negative (N) groups included infected and healthy teeth respectively. Each group (12 teeth with 24 roots each) was further subdivided into two subgroups (6 teeth with 12 roots each) according to the evaluation periods 1 and 3 months; each group was equally randomized in the upper and lower jaws during each evaluation period.

RESULTS

The inflammatory cell counts for the RCT group were statistically significantly higher than that of all RET groups at the first period and only significantly higher than RET-F5 at the second period. The enlargement of the apical foramen to #F5 showed no statistically significant difference with #F4 regarding the inflammatory cell count, tissue in-growth inside the root canal, and percentage of bone resorption. The tissue formed after RET was not true pulp tissue and is considered tissue repair with connective tissue, dilated blood vessels, and cementum-like structures.  CONCLUSION: Increasing the apical size diameter was associated with less inflammatory cell count, less percentage of bone resorption, more tissue ingrowth, and more percentage of new hard tissue formation inside root canal. The minimum apical diameter that should be enlarged for RET is 0.4 mm.

CLINICAL RELEVANCE

RET could be used as an alternative procedure to RCT for the treatment of mature teeth with necrotic pulp and apical periodontitis.

Introduction of an interactive tool (the Dental Trauma Guide) in the undergraduate dental teaching to manage traumatic dental injuries

BACKGROUND/AIMS

Traumatic dental injuries (TDI) are complex problems where lack of proper care may result in serious complications. The need to improve the management of TDI is a frequently addressed concern. Methods of improvement in their diagnosis and management are continuously evolving. The interactive Internet tool, the Dental Trauma Guide (DTG), helps to simplify diagnostic and management dilemmas. However, it is not a freely available tool. The aim of the current study was to assess the knowledge and diagnostic skills of undergraduate dental students with access to the DTG compared with students without such access, in order to validate and promote this tool in dental education.

MATERIALS AND METHODS

Two groups of students were randomly selected where one group of final year dental undergraduate students were exposed to lectures, demonstrations, discussions and tutorials on the management of TDI according to the standard undergraduate curriculum in Sri Lanka. Another test group of 21 students were provided with access to DTG during their training in paediatric dentistry. At the end of the study period, students were assessed on their knowledge of TDI using MCQs (Multiple Choice Questions) and OSCEs (Objective Structured Clinical Examination), based on the DTG.

RESULTS

The students with access to the DTG were more knowledgeable in providing the correct answers to three out of the seven OSCE questions. Evaluation based on the MCQs did not reveal a significant difference (p = .913). However, users of the DTG showed a statistically significant difference with better overall knowledge based on their answers (p = .028). Following this period of evaluation, all of the students were provided with access to the DTG to supplement their learning experience.

CONCLUSION

The Dental Trauma Guide is a useful supplementary tool for undergraduate students to arrive at a correct diagnosis and treatment plan for TDI.

Is there an association between crown discoloration and pulp necrosis in traumatized per in vitro manent teeth? A meta-analysis

The present study aimed to identify the scientific evidence regarding the association between crown discoloration and pulp necrosis in traumatized permanent teeth. A systematic literature search was conducted in the PubMed/Medline, Lilacs/BBO, Scopus, Web of Science, Cochrane Library databases, and grey literature. Quality assessment and bias control were carried out according to the Fowkes and Fulton guidelines. Meta-analysis was performed, and the odds ratio was calculated with a 95% confidence interval. The quality assessment of the evidence was determined for the meta-analysis outcomes using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. From 2,702 studies identified, five articles met the inclusion criteria. One among these showed no methodological soundness and was excluded from the meta-analysis, and the remaining four studies were included in the meta-analysis. The total number of traumatized permanent teeth evaluated in the meta-analysis was 367. The results showed a positive association between crown discoloration and pulp necrosis in permanent teeth. Teeth with crown discoloration showed 23 times more chance to present pulp necrosis than teeth without crown discoloration (OR 23.82 [1.25, 452.87]; p = 0.03), with a very low certainty of evidence. There is a significant association between crown discoloration and pulp necrosis of traumatized permanent teeth. Due to the very low strength of evidence according to GRADE, this result should be viewed with caution.

Prevalence of traumatic crown injuries in German adolescents

OBJECTIVES

Although dental trauma and its unfavorable sequelae are considered major public health problems worldwide, the published data on the prevalence of traumatic crown injuries (TCIs) in Germany are lacking. Therefore, the present study assessed the prevalence of TCIs among adolescents in Bavaria, Germany.

MATERIAL AND METHODS

Ethical approval and parental consents were obtained, and population-based information from 10- (N = 1158), 12- (N = 416), and 15-year-olds (N = 1302) from two different cohort studies performed in Bavaria (GINIplus/LISA and LAGZ) were examined for the presence of TCIs, dental caries, and restorations. Statistical comparisons were made using Mann-Whitney U test and Wilcoxon signed-rank test.

RESULTS

The prevalence of TCIs was 6.3% in the 10- and 12-year-old children and 14.0% in 15-year-old children, and a higher prevalence was observed in boys than in girls. Most (87.5%) of the traumatized teeth were maxillary incisors. The caries prevalence was low in all three populations.

CONCLUSION

The prevalence of TCIs in Bavarian adolescents at a low risk for caries was found to be low.

CLINICAL RELEVANCE

Dental trauma is a prevalent event in children and adolescents, and incisors are the most affected teeth. Therefore, dental practitioners should be able to manage the spectrum of traumatic injuries.

Impact of voxel size and scan time on the accuracy of three-dimensional radiological imaging data from cone-beam computed tomography

PURPOSE

Three-dimensional (3D) radiological imaging plays an important role in surgical planning used in modern dentistry. The aim of this study was to optimize imaging parameters with a special focus on voxel size and scan time.

MATERIAL AND METHODS

A virtual 3D master model of a macerated human skull was generated using an industrial optical noncontact white light scanner. The skull was X-rayed with cone-beam computed tomography that was applied using different settings for voxel size and acquisition time (voxel edge length of 0.3 mm, scan times 4.8 s and 8.9 s; voxel edge length of 0.2 mm, scan times 14.7 s and 26.9 s). The scan was repeated 10 times at each setting. The CBCT scans were converted into 3D virtual models (actual value), which were superimposed with the 3D master model (reference value) to detect absolute differences.

RESULTS

The mean value of deviation increased with increasing voxel size and decreasing scan time. For a voxel edge length of 0.3 mm, the mean values of deviation were 0.33 mm and 0.22 mm with scan times of 4.8 s and 8.9 s, respectively. For a voxel edge length of 0.2 mm, the mean deviations were 0.16 mm and 0.14 mm with scan times of 14.7 s and 26.9 s, respectively.

CONCLUSIONS

When using small voxel sizes, the scan time does not have a significant impact on image accuracy and therefore the scan time can be shortened. However, for larger voxel sizes, shorter scan times can lead to increased inaccuracy.

Treatment and restoration of adult dentoalveolar trauma: A clinical case report

Adult dentoalveolar trauma most often occurs in the context of sports activities and traffic accidents. Coronal fractures are the most common type of lesion, followed by tooth luxation. We present the case of a 25-year-old woman who suffered alveolar bone damage and coronal fractures of the upper incisors, with extrusive luxation of the right central incisor, as the result of a fall. On the first visit, manual reduction of the buccal plate was carried out under local anesthesia, with repositioning of the right central incisor and splinting to the neighboring teeth. Composites were used to restore the coronal fractures. After one month, both upper central incisors and the right lateral incisor were subjected to endodontic treatment. Internal bleaching of the right lateral incisor was also carried out, due to pigmentation secondary to pulp necrosis. At follow-up 5 months later, the alveolar bone fracture was seen to have healed. Definitive anterior restorative treatment with porcelain veneers was therefore carried out. After two years the patient remains asymptomatic and in good dental condition. Key words:Dental trauma, extrusive luxation, dento-alveolar fracture, esthetic restoration.

Development of the Teen Oral Health-Related Quality of Life Instrument

OBJECTIVE

The aim of this study was to develop the Teen Oral Health-Related Quality of Life instrument (TOQOL) and demonstrate its validity and reliability in a diverse sample of 13-18-year-old adolescents.

METHODS

A total of 363 adolescents aged 13-18 years participated in this cross sectional study. Oral screening examinations were conducted to collect oral health status data. Adolescents completed the TOQOL and a generic measure of health-related quality of life, the PedsQL. The psychometric properties of the TOQOL were evaluated in terms of face, content, convergent, concurrent and discriminant validity in addition to internal reliability.

RESULTS

The 16-item TOQOL covers five domains: Physical functioning, Role functioning, Social functioning, Oral problems, and Emotional functioning. The total scale and subscales showed satisfactory reliability with Cronbach alpha ranging from 0.75 to 0.92. TOQOL scores showed significant associations with perceived oral health status and the PedsQL (convergent validity) and discriminated well between adolescents with caries and adolescents who were caries free (discriminate validity).

CONCLUSION

The TOQOL is a valid and reliable oral health-related quality of life measurement that can be recommended for self-report in adolescents aged 13-18 years.

Surgical Retrieval of Tooth Fragment from Lower Lip and Reattachment after 6 Months of Trauma

Dental traumas are one of the most frequent facial traumas especially in children. Maxillary incisors are the most frequently involved teeth. Here we present, a report of a child who sustained a crown fracture with lost portion of tooth embedded in her lower lip for 6 months. The fragment was surgically retrieved and successfully reattached to the fractured 21 using acid-etch resin technique.

How to cite this article: Marwaha M, Bansal K, Srivastava A, Maheshwari N. Surgical Retrieval of Tooth Fragment from Lower Lip and Reattachment after 6 Months of Trauma. Int J Clin Pediatr Dent 2015;8(2):145-148.

Surgical removal of coronal fragment of tooth embedded in lower lip and esthetic management of fractured crown segment

Dental fractures of the permanent maxillary anterior teeth are relatively frequent accidents during childhood. The Efficient diagnosis and treatment of dental injury are important elements in clinical dentistry. This article describes a case of trauma in permanent right central maxillary incisors with tooth fragments embedded in the lower lip. Thorough clinical examination followed by soft tissue radiographs confirmed the presence of a fractured incisal fragment, which was surgically retrieved under local anesthesia. Direct composite restoration was placed. After finishing and polishing, an esthetic and natural-looking restoration was achieved; this completely satisfied the functional and esthetic expectation of the patient and dental team. How to cite this article: Avinash A, Dubey A, Singh RK, Prasad S. Surgical Removal of Coronal Fragment of Tooth Embedded in Lower Lip and Esthetic Management of Fractured Crown Segment. Int J Clin Pediatr Dent 2014;7(1):65-68.

The importance of soft tissue examination in post-traumatic decision-making: a case report

Dental and facial traumas involving teeth and supporting tissues are common sports-related injuries. In this case report treatment of a 23-year-old student who had been elbowed by an opponent player during a basketball game, which caused oblique fractures on both maxillary incisor teeth is presented. The patient presented 17 days following trauma having completed full recovery of soft tissues. A fragment of upper incisor tooth had been embedded in lower lip at the time of trauma, which was covered by healing tissues. At the 1 month control the patient complained of a hard structure in his lower lip. The elusive broken fragment was revealed by a radiograph and then removed surgically. This case report is a good example of the importance of the training of general dentists about sports-related traumatic injuries as well as emphasising the importance of the use of mouthguards during contact sports.

Shear bond strength of restorations applied to un-complicated crown fractures: an in vitro study

BACKGROUND

Study was designed to evaluate shear bond strengths of different restorative techniques of uncomplicated enamel-dentin fractures in permanent incisors.

MATERIAL AND METHODS

Forty human mandibular incisors were divided into four groups. One-third of their anatomical crowns from the incisal edges were cut off in three groups, representing an uncomplicated enamel-dentin fracture. Intact teeth in group 1 were used as control. In group 2, edge fragments were reattached by flowable composite (Filltek Flowable Supreme XT). In group 3, teeth were restored with universal resin composite (Filtek Z 250). In group 4, pre-impregnated glass fiber sheet (everStickNet) was positioned onto fractured surface, and then restorations were completed with resin composite. Three-step etch-and-rinse adhesive system (Adper Scotchbond Multi Purpose) was used in all test groups. Shear bond strengths of all samples were determined in universal testing machine, and data were analyzed with Kruskal-Wallis followed by Mann-Whitney U tests. Failure types were observed by light microscope.

RESULTS

Shear bond strength of sound teeth was significantly higher than those of restored teeth (P < 0.05). Mean shear bond strengths of the reattached teeth were lower than the other two restoration types; however, differences were not statistically significant (P > 0.05).

CONCLUSIONS

Load-bearing capacity of restored teeth was not as high as sound teeth in the uncomplicated crown fracture. However, shear bond strength of different types of restorations seems close to each other.

Longitudinal study on types of injury, complications and treatment in permanent traumatized teeth with single and multiple dental trauma episodes

The purpose of this study was to compare the type of injuries, complications and treatment in permanent traumatized teeth with single and multiple dental trauma episodes (MDTE). One hundred and fifty-five children, aged 6-14 years, sustaining one or more traumatic episodes to permanent teeth were included in this investigation. After the medical and dental history the patients were examined clinically and radiographically and the diagnosis of trauma, the treatment plan and the applied treatment were recorded. Also, information regarding the number of traumatic episodes, the number of injured permanent teeth and the vitality of the pulp was collected. In follow-ups, traumatized teeth were examined clinically and radiographically to evaluate the treatment applied and to detect any complication. The t-statistic was used to test differences in the mean number of teeth per patient with different types of injury, complications and treatment between permanent traumatized teeth with single and multiple trauma episodes. A 95% probability level was used. The results showed that MDTE significantly affected the mean number of teeth per patient with fractured restoration, root fracture, concussion, pulp canal obliteration, root replacement resorption, filling therapy, surgery and prosthetic treatment. It was concluded that MDTE increase the risk of having certain types of injury, complications and treatment.

The role for 'reminders' in dental traumatology: 2. The effectiveness of a reminder stamp compared with the current clinical practice for documenting the diagnostic working length

The aim of this study was to establish if a predesigned prompt in the form of a reminder stamp placed in a patient's dental records is more effective for recording the essential details of a diagnostic working length compared to the current practice without any specific prompts. Following a pilot study of current practice, a stamp was introduced. Twelve months following the introduction of the stamp, 198 patient records were examined, where endodontic treatment had been carried out mainly for traumatic injuries. The following parameters were specifically investigated whether a radiograph had been taken to establish working length and was it available for examination, whether the working length was recorded in the notes and whether a reference point for the measurements was given. The working length was conventionally recorded by 127 notes, whereas 71 used the stamp. A working length radiograph was taken and a working length recorded for 95% of the cases where no stamp had been used, compared to 100% of the stamp group. Where no stamp had been used only 83% of working length radiographs were available compared to 100% of the stamp group. Interestingly, a reference point from where the working length had been measured was only recorded in 5% of the cases where the stamp had not been used compared to 94% using the predesigned stamp. This result was statistically significant using a chi-squared test (P < 0.001). The stamp was generally more effective than the conventional method of recording the working length for endodontics.

Socio-economic burden of permanent incisor replantation on children and parents

This study describes the socio-economic burden and attitudes of children and their parents following replantation of avulsed incisors. Records of 80 patients with 99 avulsion injuries treated in a teaching hospital clinic from 1988 to 1999 were reviewed. Mean age at time of injury was 10.6 years (range = 6.6-17.7 years). Complete records for a minimum of 1 year were obtained for 43 patients with 60 replanted incisors. Mean treatment procedures provided during the first year included 5.5 diagnostic periapical radiographs, 1.9 occlusal radiographs, 1.3 pulpectomies, and 2.7 pulp medicament applications. The mean estimated treatment cost and direct time (dentist) for first-year post-trauma management was 1465 dollars CAD and 7.2 h, respectively. Treatment costs were significantly higher during the first year post-trauma for patients who had their incisors extracted (P = 0.04), but there was no significant difference in direct treatment time between the two groups (P = 0.19). Twenty-one patient-parent pairs were surveyed for a number of qualitative factors. Ninety per cent of patients and 86% of parents reported that school and work time was lost. Even after having gone through the painful experience of replantation, the demands of recall, and in some cases, extraction, the majority of patients (67%) and parents (81%) stated that they would have still made the same (replantation) decision. Patient and parent responses were not statistically different (P = 0.453). Almost half the parents stated they would be willing to pay over 2000 dollars CAD to save an incisor. Patients rated retention of an incisor as significantly more important than infraocclusion. This is the first study to quantify the treatment burden of replantation of avulsion injuries exclusively in the pediatric population. This study describes the socio-economic burden and responsibilities of patient/parent and dentist and their role in informed consent.

Dental injuries in Norwegians aged 7-18 years

- In this prospective study, baseline information regarding trauma to permanent teeth is presented. The aim of the study was twofold: to increase the knowledge of dental injuries in young Norwegians and to examine whether a rise in the number of dental trauma had occurred during the last 10-15 years. Both an urban and a rural area were included, constituting 12% of the 7-18-year-olds living in the country. A total of 1275 children in this age group suffered dental injuries in the capital city of Oslo and in the rural area of Nord-Trøndelag during a 1-year registration period. The children were examined by calibrated dentists in the public dental health service. The service offers regular, free recalls, and 98% of the children attend. The dental injuries were classified according to WHO's classification system. The dental trauma incidence found was 1.8% (2.0% in Oslo and 1.3% in Nord-Trøndelag). Nearly 50% of the children were in the age group 8-10 years. Ninety-seven per cent of the accidents involved the incisors, and the minor trauma dominated. Age and gender were predisposing factors. Boys were nearly twice as often injured as girls and this difference increased with age. No increase in the annual frequency of dental injuries was observed.

Crown fractures in the permanent dentition: pulpal and restorative considerations

Crown fractures account for the highest percentage of all traumatic injuries in the permanent dentition. This review paper will discuss the different types of crown fracture, from the uncomplicated to complicated, including crown-root fractures. It will focus on two different aspects: the pulp, with an attempt to correlate epidemiological, experimental, histopathological and clinical studies, so that the clinician can better understand the underlying processes accounting for success or failure to maintain pulp vitality. Also, we will consider the restoration: knowledge about bonding to dentin and new material is evolving extremely quickly making it difficult for the clinician to keep up with the developments. If handled properly, prognosis of the pulp, after traumatic crown fracture, is good. Prognosis of the restoration has also improved considerably over the last few years, and it appears that this trend will continue in the future.

Use of a removable splint in the treatment of subluxated, luxated and root fractured anterior permanent teeth in children

AIM

The aim of this study was to evaluate the prognosis of subluxated, luxated and root fractured teeth in children treated by removable splints, designed to stabilize mobile anterior teeth and eliminate occlusal trauma due to malocclusion.

MATERIAL AND METHODS

A total of 227 traumatized anterior teeth (91 subluxated, 105 luxated and 31 root fractured teeth) treated with a removable splint were observed for 3 years. The traumatized teeth were from 79 children aged between 6-12 years (mean 8 years 5 months). If a traumatized tooth was extremely mobile, a fixed splint was first made before the impression was taken for the removable splint. Two weeks after completion of the removable splint treatment, an impression was taken again to evaluate the occlusal relationship of pre- versus post-treatment of removable splint.

RESULTS

The treatment period with a removable splint averaged 3 weeks in subluxated teeth, 3-5 weeks in luxated teeth, 4-6 weeks in apical third root fracture injuries, and more than 5 weeks in middle third root fracture injuries. All the subluxated teeth and 74.1% of the luxated teeth maintained their pulp vitality during the 3-year follow-up period. Two of 21 (9.5%) apical third root fracture teeth and three of five (60%) middle third root fracture teeth had pulp necrosis in the coronal fragments. Internal resorption was not found in any of the traumatized teeth. External replacement resorption was not found in subluxated and luxated teeth. All the root fractured teeth displayed transient external resorption around the fracture lines. The surface resorption appeared to be self-limiting and not to threaten the retention of the tooth. Inflammatory resorption was observed in teeth with pulp necrosis, but in all cases this was reversed with endodontic treatment. Eight of 23 (39%) apical third root fractured teeth displayed replacement resorption in their apical fragments, but the resorption was not serious enough to extract the tooth. No obvious alteration in the occlusal relationship was found comparing pre- and post-treatment casts. The removable splints appeared to positively affect healing after traumatic injuries, as evidenced by the low number of complications at the 3-year follow-up period.

Therapeutic and economic implications of traumatic dental injuries in Denmark: an estimate based on 7549 patients treated at a major trauma centre

AIM

To analyse the type and extent of injuries presented by patients seeking treatment for traumatic dental injuries at a major trauma centre. Furthermore, to analyse acute and subsequent treatment demands and treatment costs.

METHODS

A therapeutic and economic analysis was performed of 7549 patients treated for traumatic dental injuries in a major trauma centre located at the University Hospital in Copenhagen, Denmark. Cases were divided into uncomplicated (concussion, subluxation, enamel and enamel-dentine fractures) and complicated cases (crown fractures with exposed pulps and crown-root fractures, luxation injuries with displacement of the tooth and bone fractures).

RESULTS

Primary tooth injuries were found in 2874 patients, involving 5443 teeth, among which 62.8% had complicated injuries. Permanent tooth injuries were found in 4525 patients, involving 10,673 teeth, among which 40.4% had complicated injuries. The cost of treatment (including acute trauma service, follow-up and subsequent restoration) was estimated to be 0.6-1 mill USD a year for the patients treated in this trauma centre. If this figure is transferred to the estimated trauma population in Denmark, a yearly cost of traumatic dental injuries appears to range from 2 to 5 mill USD per 1 mill inhabitants per year according to the treatment scenario.

CONCLUSION

Thus, treatment of traumatic dental injuries comprises an expensive part of the health services in Denmark.

Dental trauma in children presenting for treatment at the Department of Dentistry for Children and Orthodontics, Budapest, 1985-1999

Data on children with dental trauma who presented for treatment at the Department of Dentistry for Children and Orthodontics in Budapest over a period of 15 years were analysed. The WHO guidelines were used to classify the traumatic injuries. A total of 590 children were involved, 810 teeth being affected. Children aged 7-14 years made up 88% of the cohort. The male:female ratio was 58:42. The permanent:primary ratio for the affected teeth was 90:10. The teeth most commonly affected were the maxillary central incisors. In 70% of the cases, only one tooth was traumatised. The incidence of dental trauma peaked at 10 years of age. The most common injury type observed was enamel-dentin crown fracture. The decreasing sequence of frequency of etiological factors was playing, sports, falls, cycling, road accidents and fighting. Of the accidents, 65% occurred at school or at home. Seventy seven per cent of the patients presented for medical care in the first 3 days after the accident.

Long-term prognosis of crown-fractured permanent incisors. The effect of stage of root development and associated luxation injury

OBJECTIVES

The aim of the present study was to investigate pulp healing responses following crown fracture with and without pulp exposure as well as with and without associated luxation injury and in relation to stage of root development. PATIENT MATERIAL AND METHODS: The long-term prognosis was examined for 455 permanent teeth with crown fractures, 352 (246 with associated luxation injury) without pulpal involvement and 103 (69 with associated luxation injury) with pulp exposures. Initial treatment for all patients was provided by on-call oral surgeons at the emergency service, University Hospital (Rigshospitalet), Copenhagen. In fractures without pulpal involvement, dentin was covered by a hard-setting calcium hydroxide cement (Dycal), marginal enamel acid-etched (phosphoric acid gel), then covered with a temporary crown and bridge material. In the case of pulp exposure, pulp capping or partial pulpotomy was performed. Thereafter treatment was identical to the first group. Patients were then referred to their own dentist for resin composite restoration.

RESULTS

Patients were monitored for normal pulp healing or healing complications for up to 17 years after injury (x = 2.3 years, range 0.2-17.0 years, SD + 2.7). Pulp healing was registered and classified into pulp survival with no radiographic change (PS), pulp canal obliteration (PCO) and pulp necrosis (PN). Healing was related to the following clinical factors: stage of root development at the time of injury, associated damage to the periodontium at time of injury (luxation) and time interval from injury until initial treatment. Crown fractures with or without pulp exposure and no concomitant luxation injury showed PS in 99%, PCO in 1% and PN in 0%. Crown fractures with concomitant luxation showed PS in 70%, PCO in 5% and PN in 25%. An associated damage to the periodontal ligament significantly increased the likelihood of pulp necrosis from 0% to 28% (P < 0.001) in teeth with only enamel and dentin exposure and from 0% to 14% (P < 0.001) in teeth with pulp exposure.

CONCLUSIONS

In the case of concomitant luxation injuries, the stage of root development played an important role in the risk of pulp necrosis after crown fracture. However, the primary factor related to pulp healing events after crown fracture appears to be compromised pulp circulation due to concomitant luxation injuries.