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Zhang J, Wang N, Gao X, Qin M. Orthodontic extrusion with fixed appliances for treatment of intrusive luxation injuries: A prospective study of 28 permanent maxillary incisors. Int J Paediatr Dent 2024. [PMID: 39096055 DOI: 10.1111/ipd.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Limited evidence exists on the treatment options of tooth repositioning after intrusive luxation. AIM The study aimed to investigate the outcomes and complications of orthodontic extrusion in treating intruded maxillary permanent incisors. DESIGN A prospective study was conducted involving 28 intruded maxillary permanent incisors treated with orthodontic extrusion, compared with a retrospective control group of 29 teeth that underwent spontaneous re-eruption. The success rate of tooth repositioning, as well as pulp condition, periodontal healing, and root development were assessed and compared. RESULTS The success rate of orthodontic extrusion was 96.4%, excluding one tooth that was ankylosed before treatment. There were no significant differences in pulp condition between the orthodontic extrusion and control groups for teeth with immature root development. Teeth with mature root development in the orthodontic group, however, showed a significantly higher rate of pulp necrosis (100%, p < .05). Periodontal healing outcomes were similar across both groups, regardless of the maturity of root development. The root length continued increasing during orthodontic extrusion treatment. CONCLUSIONS Orthodontic extrusion treatment could effectively reposition moderately to severely intrusive permanent incisors, without increasing the risk of complications compared with spontaneous re-eruption.
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Affiliation(s)
- Jingjing Zhang
- Department of Paediatric Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Nan Wang
- Department of Paediatric Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Department of Stomatology, Peking University Third Hospital, Beijing, China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Man Qin
- Department of Paediatric Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
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Cheng J, Li J, Li C, Zhang X, Zhao X, Song G. Treatment outcomes of permanent teeth with uncomplicated and complicated crown fractures and factors associated with pulp survival: A retrospective study. Dent Traumatol 2024; 40:306-315. [PMID: 37916540 DOI: 10.1111/edt.12907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Crown fracture is the most common injury in permanent teeth. This study aimed to evaluate the treatment outcomes of permanent teeth with uncomplicated and complicated crown fractures and to investigate potential factors. MATERIALS AND METHODS This retrospective study included patients who experienced crown fractures in permanent teeth from 2018 to 2021 with at least 12 months of follow-up. All complicated crown fractured teeth were treated with pulpotomy, while for teeth with uncomplicated crown fractures, three treatments (restoration, indirect pulp capping, or pulpotomy) were employed. The chi-square test was used to compare the prognosis of teeth with uncomplicated and complicated crown fractures. Potential factors associated with pulp survival including gender, interval, root development, enamel infraction, mobility, concomitant luxation injury, treatment, and coronal restoration were identified via Cox regression analysis. RESULTS A total of 307 teeth from 220 children (average age = 9.3 ± 1.4 years; age range, 6-14 years) with a median follow-up of 23 months were included, and 82.1% of all teeth had immature roots. Complicated crown fractured teeth (93.6%, 102/109) had a significantly higher success rate compared with uncomplicated crown fractured teeth (85.4%, 169/198) (p < .05). Pulpotomy (96.9%) had the highest success rate of all treatments for uncomplicated crown fractures, followed by only restoration (85.0%) and indirect pulp capping (76.9%). The success rate of teeth that received pulpotomy was significantly higher than those treated by indirect pulp capping (p < .05). In uncomplicated crown fractures, teeth with Class II mobility were more vulnerable to failure than teeth without abnormal mobility (HR = 34.83; 95% CI, 9.59-126.56; p < .05); teeth that received pulpotomy were less prone to failure than teeth that received indirect pulp capping (HR = 13.53; 95% CI, 1.58-115.72; p < .05). CONCLUSION Crown fractures treated with conservative pulp treatments had a relatively highly favorable prognosis. The prognosis of uncomplicated crown fractured teeth was impacted by the severity of periodontal injury and treatment strategies. Accurate diagnosis and identification of micro-exposures are important. Dentists should take multiple risk factors into account and select optimal treatment strategies.
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Affiliation(s)
- Jing Cheng
- Department of Paediatric Dentistry, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Stomatology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiahui Li
- Department of Paediatric Dentistry, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Chunmei Li
- Department of Paediatric Dentistry, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xiaojin Zhang
- Department of Paediatric Dentistry, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xiaoe Zhao
- Department of Special Diagnosis, School & Hospital of Stomatology, Lanzhou University, Lanzhou, China
| | - Guangtai Song
- Department of Paediatric Dentistry, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
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Amilcar ALL, Vieira WA, Matta ACG, de Almeida Gomes BPF, da Silva MAM, de Almeida JFA, Ferraz CCR, Santos ECA, Neto JV, de Jesus Soares A. Epidemiological profile of luxations injuries with or without dental fractures in permanent teeth: A 10-years retrospective study. Dent Traumatol 2024. [PMID: 38576382 DOI: 10.1111/edt.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND/AIM This study assessed the epidemiology of luxation injuries with or without dental fractures in patients attending the outpatient clinic of a Brazilian dental school over the past decade. MATERIAL AND METHODS We reviewed clinical records from a specialized center for dental trauma care in Brazil, focusing on patients who experienced at least one traumatic dental injury (TDI) in a permanent tooth between 2012 and 2022. The extracted data included sex, age, etiology, time between trauma occurrence and the search for initial care, TDI classification, and the need for endodontic treatment. The statistical analysis involved Pearson's chi-squared and Fisher's exact tests at a 5% significance level. RESULTS The 366 analyzed clinical records included 166 patients (350 teeth) with luxation injuries. Men (n = 102) showed a higher prevalence of luxation injuries than women (n = 64). Extrusive luxation prevailed (n = 99 patients and 208 teeth). Patients with luxation injuries sought care promptly after dental trauma incidents (p = .02) and demonstrated a higher incidence of endodontic treatment (p < .0001) than those without luxation injuries. Lateral luxation was notably associated with traffic accidents (p < .0001). The combination of luxation injuries and tooth fractures did not correlate with a higher need for endodontic treatment (p > .05). CONCLUSIONS Age and trauma etiology seemed to have influenced the epidemiological profile of luxation injuries. Additionally, these injuries affected the time to seek initial care and the need for endodontic treatment.
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Affiliation(s)
- Ana Laura Lopes Amilcar
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School-State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Walbert A Vieira
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School-State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Aline Cristine Gomes Matta
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School-State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | | | - Marina Angélica Marciano da Silva
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School-State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - José Flávio Affonso de Almeida
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School-State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Caio Cézar Randi Ferraz
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School-State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Eduardo César Almada Santos
- Piracicaba Dental School, Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School-State University of Campinas (FOP-UNICAMP), Piracicaba, Brazil
| | - Julio Vargas Neto
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School-State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Adriana de Jesus Soares
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School-State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
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Zhang N, Kang Q, Cheng Y. Pulpotomy for teeth with irreversible pulpitis in immature permanent teeth: a retrospective case series study. Sci Rep 2024; 14:6395. [PMID: 38493190 PMCID: PMC10944512 DOI: 10.1038/s41598-024-56975-6] [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: 06/03/2023] [Accepted: 03/13/2024] [Indexed: 03/18/2024] Open
Abstract
To evaluate the success of pulpotomy in treating immature permanent teeth with irreversible pulpitis. This case series included patients with irreversible pulpitis admitted to the Department of Oral Medicine at the author's Hospital between 2015 and 2020. The pulpotomies were carried out by clinicians with > 5 years of working experience. The follow-up findings and radiographic images were reviewed by two attending dentists. This study included 49 teeth from 48 children (25 boys and 23 girls). The follow-up was 23.3 ± 6.8 months (from 12 to 40 months). The success rate of pulpotomy was 85.7% (42/49). Pulpotomy failed in seven teeth (14.3%). The treatment success rate for traumatic crown fracture was lower than for dental caries and dens evaginatus (P < 0.001). There were no significant differences in the success rate of the pulp-capping agent, tooth root developmental phase, and pulpotomy method (all P > 0.05). Pulpotomy might be successfully used to treat immature permanent teeth with irreversible pulpitis in young patients mainly caused by caries and a fractured tubercle of dens evaginatus.
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Affiliation(s)
- Na Zhang
- Department of Oral Medicine, Shanxi Provincial People's Hospital, Taiyuan, 030012, China.
| | - Qian Kang
- Department of Oral Medicine, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Yuzhao Cheng
- Department of Oral Medicine, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
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Yang Y, Liu Y, Wang Z, Li Q, Wang J, Zhang M. The impact of COVID-19 pandemic on the epidemiological characteristics of permanent dental injury in Xi'an of China: A retrospective study. Medicine (Baltimore) 2023; 102:e35358. [PMID: 37773846 PMCID: PMC10545125 DOI: 10.1097/md.0000000000035358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) has become a major global concern, seriously affecting the lives and health of the population. This retrospective study aimed to investigate changes in permanent tooth injury in the Xi'an area of China influenced by the COVID-19 pandemic. The medical records of 466 dental emergency patients in 2019 and 2020 were retrospectively analyzed. The number of injured teeth in a single patient, the number of injury types, the time from injury to hospital visit and follow-up visits within 1 year before and after the pandemic were analyzed using the chi-squared test and the paired t-test. There was significant difference in the number of emergency patients and trauma types before and during COVID-19 pandemic (P < .05). The time from injury to hospital visit and the interval between the trauma event and visit showed longer during the COVID-19 pandemic (P < .05). The rate of on-time follow-up in the following year was significantly decreased, and the rates of delayed visits and patients lost to follow-up were significantly increased (P < .05). The outbreak of the COVID-19 pandemic brought a certain change in the epidemiological characteristics of dental injury in the Xi'an area of China. Dental emergency departments should provide even more timely and effective treatments. It is also necessary to strengthen public education, with emphasis on the importance of timely medical treatment and regular follow-up for dental trauma.
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Affiliation(s)
- Yang Yang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Department of General Dentistry & Emergency, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Yanli Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Department of General Dentistry & Emergency, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Ziheng Wang
- School of Computer Science and Engineering, Beihang University, Beijing, China
| | - Qiang Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Department of General Dentistry & Emergency, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Jiang Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Department of General Dentistry & Emergency, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Min Zhang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Department of General Dentistry & Emergency, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi, China
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Vieira WA, Pereira AC, Lazzari J, Pecorari VG, Gomes BP, de Almeida JFA, Ferraz CCR, Santos ECA, Vargas-Neto J, de-Jesus-Soares A. Epidemiology and severity of traumatic dental injuries in permanent teeth: A 20-year retrospective study. Braz Dent J 2023; 34:1-8. [PMID: 37466516 PMCID: PMC10355269 DOI: 10.1590/0103-6440202305257] [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: 10/15/2022] [Accepted: 03/20/2023] [Indexed: 07/20/2023] Open
Abstract
This study aimed to assess the traumatic dental injuries (TDIs) in permanent dentition among patients who attended at the outpatient clinic of a Brazilian dental school, during the last 20 years, and to investigate factors associated with the severity of these injuries. Clinical records of patients who attended a specialized center for dental trauma care in Brazil presenting at least one TDI in a permanent tooth, between the years 2000 and 2019, were reviewed. The data recorded were sex, age, affected arch, etiology, number, and type of the teeth affected, and classification and severity of the TDIs. The diagnosis and classification of the TDIs were based on the guidelines of the International Association of Dental Traumatology (IADT). The severity of each patient's injuries was defined as mild, moderate, or severe. Descriptive statistics, chi-square and multinomial regression analyses were used to evaluate the results. The significance level was set at 5%. A total of 837 clinical records were included, totaling 2357 teeth. Males were more prevalent than females. The patients' age ranged from 5 to 71 years. The most common traumas were avulsion (n=512) and uncomplicated enamel-dentin fracture (n=488). Univariate analyses showed that there was a statistically significant association between age group (p=0.004), etiology (p=0.000) and number of teeth affected (p=0.000) with severity of dental trauma. In conclusion, TDIs that occurred in Piracicaba and region are epidemiologically similar to those found worldwide, and that more severe injuries are related to age range, etiology and number of teeth affected.
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Affiliation(s)
- Walbert A. Vieira
- Department of Restorative Dentistry, Endodontics Division, School of
Dentistry of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - Andrea C. Pereira
- Department of Restorative Dentistry, Endodontics Division, School of
Dentistry of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - Jaqueline Lazzari
- Department of Restorative Dentistry, Endodontics Division, School of
Dentistry of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | | | - Brenda P.F.A. Gomes
- Department of Restorative Dentistry, Endodontics Division, School of
Dentistry of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - José Flávio A. de Almeida
- Department of Restorative Dentistry, Endodontics Division, School of
Dentistry of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - Caio C. R. Ferraz
- Department of Restorative Dentistry, Endodontics Division, School of
Dentistry of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - Eduardo C. A. Santos
- Department of Paediatric Dentistry, Orthodontics Division, School
of Dentistry of Piracicaba, State University of Campinas- UNICAMP, Piracicaba,
Brazil
| | - Júlio Vargas-Neto
- Department of Restorative Dentistry, Endodontics Division, School of
Dentistry of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - Adriana de-Jesus-Soares
- Department of Restorative Dentistry, Endodontics Division, School of
Dentistry of Piracicaba, State University of Campinas, Piracicaba, Brazil
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Lu H, Lu J, Guo J, Zeng B, Zeng Q, Zhao W, Lin J. Radiographic outcomes and prognostic factors in nonvital immature permanent teeth after apexification with modified calcium hydroxide paste: a retrospective study. Clin Oral Investig 2022; 26:5079-5088. [DOI: 10.1007/s00784-022-04481-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
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Dentoalveolar Trauma of Children and Adolescents. Pediatr Dent 2022. [DOI: 10.1007/978-3-030-78003-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shahmohammadi R, Sheikhnezami M, Moradi S, Jafarzadeh H, Azarpazhooh A. Treatment Outcomes of Permanent Immature Teeth with Crown Fracture: A Retrospective Cohort Study. J Endod 2021; 47:1715-1723. [PMID: 34478786 DOI: 10.1016/j.joen.2021.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/18/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Crown fractures are a common type of traumatic dental injury. Various factors may affect the outcome of crown fractures. This study aimed to evaluate the treatment outcomes of immature teeth with a crown fracture. METHODS This retrospective cohort study included patients who presented to a dental trauma center from 2008-2018 with a history of a crown fracture of immature teeth and at least 6 months of follow-up. Outcomes of primary endodontic or restorative interventions as well as reinterventions were evaluated. Kaplan-Meier curves were used to compare the unadjusted differences in survival time. Logistic and Cox regression analyses were performed to identify potential predictors for complication and survival time, respectively. RESULTS The success rates of the primary interventions for 99 teeth (72 patients) after a median follow-up of 22 months were as follows: cervical pulpotomy (90.4%), partial pulpotomy (85.2%), mineral trioxide aggregate apical barrier (80.0%), root canal treatment (66.6%), and only restoration (47.2%). Teeth that received vital pulp therapy were less prone to complications (adjusted hazard ratio = 0.21; 95% confidence interval, 0.09-0.53; P < .05), whereas those with concomitant luxation injuries were more susceptible to complications (adjusted odds ratio = 2.90; 95% confidence interval, 1.01-8.29; P < .05). CONCLUSIONS Crown fractures had a relatively high favorable prognosis. Vital pulp therapy (partial or cervical pulpotomy) had the highest success rate, whereas cases that received only restoration had the lowest success rate. Teeth with concomitant luxation injuries had more odds and hazards of complications.
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Affiliation(s)
- Reza Shahmohammadi
- Department of Endodontics, Faculty of Dentistry, Birjand University of Medical Sciences, Birjand, Iran
| | - Mahshid Sheikhnezami
- Dental Trauma Center, Iranian Academic Center for Education, Culture, and Research, Mashhad, Iran
| | - Saeed Moradi
- Department of Endodontics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Jafarzadeh
- Dental Trauma Center, Iranian Academic Center for Education, Culture, and Research, Mashhad, Iran; Department of Endodontics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Department of Dentistry, Centre for Advanced Dental Research and Care, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Evaluation of Clinical and Radiographic Findings among Patients with Traumatic Dental Injuries Seeking Delayed Treatment. Int J Dent 2021; 2021:9549508. [PMID: 34471410 PMCID: PMC8405333 DOI: 10.1155/2021/9549508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/09/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Time elapsed between trauma and treatment greatly influences the prognosis of traumatic dental injuries (TDIs). The aim of this study was to analyze clinical and radiographic findings related to complications of TDIs among patients seeking delayed treatment of such injuries. Materials and Methods 123 permanent teeth with a history of previous TDIs were included in the study. Clinical findings analyzed were the type of fracture, type and number of injured teeth, crown discoloration, and pulpal status of the injured tooth (pulpal diagnosis). The radiographic findings analyzed included pulp canal obliteration (PCO), root resorption (RR), and periapical radiolucency (PR). Statistical analysis included descriptive analysis. Results Tooth discoloration was the most common presenting complaint (53.65%), while fall (48.78%) was the most frequent cause of trauma. The range of time duration between trauma and presentation for treatment was 5 months to 30 years (average time 12.82 years). Pulp necrosis (PN) was the most common complication (90.24%). Almost half of the teeth with PN had fracture injury and discoloration along with a high frequency of PR (78.37%). Even teeth with a normal appearance were found to have a high incidence of PN (76.92%) and PR (53.84%). The crown discoloration was the second most frequent finding (48.78%). Many teeth (41.66%) with vital pulp were also discolored. Most of the teeth (79.31%) with yellowish discoloration and all teeth with brownish discoloration were nonvital. A high frequency of PN (90%) and PR (78.33%) was found in teeth with discoloration. PR was the most common radiographic finding (69.10%), while PCO and RR were observed in 17.88% and 21.13% of teeth, respectively. Conclusion The findings of this study support the fact that delayed treatment of TDIs leads to increased complications. PN was the most common complication followed by tooth discoloration, RR, and PCO among patients seeking delayed treatment after TDIs.
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Wimalarathna AAAK, Herath EMUCK, Senarath NH, Fonseka MCN, Manathunga MMKM, Nawarathna LS, Andersson L. Introduction of an interactive tool (the Dental Trauma Guide) in the undergraduate dental teaching to manage traumatic dental injuries. Dent Traumatol 2021; 37:717-724. [PMID: 34120401 DOI: 10.1111/edt.12687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- A A A K Wimalarathna
- Department of Prosthetic Dentistry, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - E M U C K Herath
- Division of Paedodontics, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - N H Senarath
- Division of Paedodontics, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - M C N Fonseka
- Department of Restorative Dentistry, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - M M K M Manathunga
- Technical Officer, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - L S Nawarathna
- Department of Statistics & Computer Science, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - L Andersson
- Oral & Maxillofacial Surgery, Faculty of Odontology, Malmö University, Malmo, Sweden
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12
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Apponi R, Murri dello Diago A, Colombini V, Melis G. Direct versus Indirect Techniques to Menage Uncomplicated Crown Fractures of Anterior Teeth Following Dentoalveolar Trauma. Dent J (Basel) 2021; 9:dj9020013. [PMID: 33498541 PMCID: PMC7909509 DOI: 10.3390/dj9020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 11/30/2022] Open
Abstract
Dental trauma are the most common reasons for dental fractures in the anterior area, they have an incidence of 5% in the population, and in permanent teeth, they are mainly caused by sports. The most involved teeth are the maxillary anterior teeth. Direct composite restorations and indirect ceramic restorations are the therapy of choice for restoring anterior teeth after fracture when is not possible to reattach the tooth fragment. The treatment options in uncomplicated coronal fractures depend on various factors such as the amount of residual dentinal enamel tissue, the relationship with the gingival profiles, and the age of the patient. The purpose of this article is to discuss the option of using direct or indirect restorative techniques in the treatment of traumatically fractured anterior teeth and to analyze the advantages and disadvantages of the two methods.
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Affiliation(s)
- Roberto Apponi
- Department of Dentistry and Oral Maxillofacial Surgery, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.M.d.D.); (V.C.)
- Correspondence: ; Tel.: +39-339-681-7954
| | - Alberto Murri dello Diago
- Department of Dentistry and Oral Maxillofacial Surgery, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.M.d.D.); (V.C.)
| | - Vittorio Colombini
- Department of Dentistry and Oral Maxillofacial Surgery, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.M.d.D.); (V.C.)
| | - Giorgia Melis
- Department of Surgical Sciences, Dental Prosthetic Division, University of Cagliari, 09121 Cagliari, Italy;
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Bissinger R, Müller DD, Reymus M, Khazaei Y, Hickel R, Bücher K, Kühnisch J. Treatment outcomes after uncomplicated and complicated crown fractures in permanent teeth. Clin Oral Investig 2021; 25:133-143. [PMID: 32705398 PMCID: PMC7785561 DOI: 10.1007/s00784-020-03344-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of this retrospective clinical study were to describe characteristics of crown fractures in permanent teeth and to investigate the survival of pulp vitality and restorations in uncomplicated and complicated crown fractures. MATERIALS AND METHODS This retrospective study collected information from patients suffering from dental trauma who were treated between January 2004 and June 2017. The study population consisted of 434 patients (253 males/181 females; mean age 20.7 years) with 489 uncomplicated and 127 complicated crown fractures. The Kaplan-Meier survival curves and Cox proportional hazard regression analyses were performed to explore the data statistically. RESULTS The mean observation time was 522 days. Uncomplicated crown fractures without luxation showed a higher success rate of 82.3% (345/419) than complicated crown fractures without luxation (72.3%, 73/101). An additional luxation in uncomplicated crown fractures resulted in significantly reduced success rates in terms of survival of the pulp and restoration. Direct restorations survived significantly better independent of the fracture mode than did adhesively reattached crown fragments. No superiority of mineral trioxide aggregate or calcium hydroxide as pulp capping agent in complicated crown fractures was documented. Approximately 85.5% of all complications occurred within 2 years after the accident. CONCLUSION The treatment of crown fractures resulted mostly in successful outcomes and only a moderate number of complications were observed. CLINICAL RELEVANCE Primary dental management of crown fractures should follow recently published clinical guidelines, and close monitoring over at least 2 years seems to be justified.
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Affiliation(s)
- Ricarda Bissinger
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Daniel David Müller
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Marcel Reymus
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Yegane Khazaei
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Katharina Bücher
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany.
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Demir P, Kizilci E, Botsali MS. Occurrence and Timing of Complications of Crown-Fractures in Permanent Incisors: A Randomized Clinical Trial. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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15
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Bratteberg M, Thelen DS, Klock KS, Bårdsen A. Traumatic dental injuries and pulp sequelae in an adolescent population. Dent Traumatol 2020; 37:294-301. [PMID: 33220150 DOI: 10.1111/edt.12635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIMS Traumatic dental injuries (TDI) occur frequently and may result in pulp sequelae. This includes pulp necrosis with infection, pulp canal obliteration and root resorption. The aim of this study was to assess the prevalence and risk factors of pulp sequelae after TDI among Norwegian adolescents. MATERIAL AND METHODS A retrospective longitudinal study, including historical clinical data, was conducted with 16-year-old pupils in western Norway. All first-grade pupils, born in 1997 (n = 5184), attending public high schools, were invited to participate and to respond to an electronically administered closed-ended questionnaire (response rate 39.6%, n = 2055). Consent was given to access the dental records in the Public Dental Health Service in Hordaland, where information regarding TDI (diagnosis and treatment) and radiographs were interpreted. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible). Outcome variables of TDI were registered and analysed using logistic regression, Kaplan-Meier survival estimates and log-rank test. RESULTS The prevalence of TDI in the sample population was 16.4% (338 pupils), with a total of 637 teeth involved. The number of included teeth for analysis was 571 (90.5%). The prevalence of pulp necrosis with infection was 7.5%. Moderate and severe TDI was associated with a higher frequency of pulp necrosis with infection. Pulp canal obliteration and root resorption were found in 2.8% and 2.3% of teeth with TDI, respectively. Dental hard tissue injuries were more prone to the development of pulp necrosis than luxation injuries and combination injuries. The relationship between root development stage and development of pulp necrosis with infection was not statistically significant. CONCLUSIONS Occurrence of different pulp sequelae among teeth affected with TDI was low. Moderate and severe TDI were more at risk of developing pulpal complications and hard tissue injuries were at higher risk of developing pulp necrosis with infection.
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Affiliation(s)
- Magnus Bratteberg
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | - Kristin S Klock
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Asgeir Bårdsen
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
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16
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Bissinger R, Müller DD, Hickel R, Kühnisch J. Survival analysis of adhesive reattachments in permanent teeth with crown fractures after dental trauma. Dent Traumatol 2020; 37:208-214. [PMID: 33180986 DOI: 10.1111/edt.12613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM When patients have saved tooth fragments in case of crown fractures, reattachment is considered as the treatment of choice. With respect to the need to provide clinical outcome data regarding adhesively reattached fragments, the aim of this practice-based clinical study was to evaluate the survival of reattached fragments after crown fractures in permanent teeth. MATERIALS AND METHODS Records from patients treated at Ludwig-Maximilians-University between 2004 and 2017 were analyzed to collect clinical and radiographic data regarding the management of fractured teeth that were treated with an adhesive reattachment. The study population consisted of 109 patients comprising 135 reattached fragments divided into uncomplicated (N = 84/135) and complicated (N = 51/135) crown fractures. The Kaplan-Meier Survival estimator was used to estimate the survival probability of primary reattachments after uncomplicated and complicated crown fractures. RESULTS Overall, 77.4% (N = 65/84) and 66.6% (N = 34/51) of the primarily applied reattachments in uncomplicated fractured teeth and complicated fractured teeth, respectively, survived over the period of observation. The survival rate for adhesive reattachment in all teeth was 84.4% (N = 114/135) after 608.2 days (±983.1 days). The data further suggest that in the case of a detachment, repeated reattachment might be a valuable restoration strategy. CONCLUSIONS Adhesive reattachment is a good first-choice treatment option in cases of crown fractures when the fractured fragment has been saved.
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Affiliation(s)
- Ricarda Bissinger
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Daniel David Müller
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
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Goodman AE, Niemiec BA, Carmichael DT, Thilenius S, Lamb KE, Tozer E. The Incidence of Radiographic Lesions of Endodontic Origin Associated With Uncomplicated Crown Fractures of the Maxillary Fourth Premolar in Canine Patients. J Vet Dent 2020; 37:71-76. [PMID: 33063625 DOI: 10.1177/0898756420946500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fractured maxillary fourth premolar teeth are commonly diagnosed in canine patients. These fractures are subdivided into uncomplicated and complicated, depending on absence or presence of pulp exposure, respectively. Pulp injury associated with fractures can lead to pulpitis, pulp necrosis, and "lesions of endodontic origin" (LEO) on intraoral radiographs. The incidence of LEO associated with uncomplicated crown fractures (UCFs) of the maxillary fourth premolar in canine patients is currently unknown. We hypothesized that a significant number of UCFs of the maxillary fourth premolar would have LEO evident on intraoral radiographs. The purpose of this article was to identify this incidence and to illustrate the importance of radiographing these teeth. This was a retrospective study of 111 UCFs and 500 nonfractured (control) maxillary fourth premolars in domestic canine patients. The frequency of LEO was 24.3% (27/111) in the UCF population and 0% (0/500) in the control population (P < .0001). These findings are important because UCFs are sometimes ignored or considered insignificant, when in fact a large proportion of them have LEO, indicating periapical pathology. These results suggest that all UCFs be radiographed, even if there are no other abnormalities noted on clinical oral examination.
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Affiliation(s)
- Alice E Goodman
- Veterinary Medical Center of Long Island, West Islip, NY, USA
| | - Brook A Niemiec
- Veterinary Dental Specialties & Oral Surgery, San Diego, CA, USA
| | | | | | | | - Erik Tozer
- Lamb Consulting LLC, West St. Paul, MN, USA
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18
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Rao Q, Kuang J, Mao C, Dai J, Hu L, Lei Z, Song G, Yuan G. Comparison of iRoot BP Plus and Calcium Hydroxide as Pulpotomy Materials in Permanent Incisors with Complicated Crown Fractures: A Retrospective Study. J Endod 2020; 46:352-357. [PMID: 32035640 DOI: 10.1016/j.joen.2019.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 12/11/2019] [Accepted: 12/21/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Calcium hydroxide has been used as a traditional pulpotomy agent for a long time but has some disadvantages. iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, Canada) is a newly developed, ready-to-use calcium silicate-based bioactive ceramic with excellent bioactivity and sealing ability. However, whether iRoot BP Plus shows superiority over calcium hydroxide as a pulpotomy material on permanent incisors with complicated crown fractures remains unknown. METHODS This research included 205 permanent incisors with complicated crown fractures. These teeth were treated with pulpotomy and divided into 2 groups according to the pulpotomy material (105 treated with iRoot BP Plus and 100 with calcium hydroxide). Clinical and radiographic information was collected during the 12- to 24-month follow-up period. The formation of reparative dentin bridges and pulp canal obliteration were analyzed using radiographs in both groups. RESULTS The success rates for recall in the average follow-up period of 17.5 ± 4.4 months (12-24 months) after pulpotomy treatment were significantly different between the 2 groups, with 99% for the iRoot BP Plus group and 93% for the calcium hydroxide group. Reparative dentin bridges were observed in 92.4% of the iRoot BP Plus group and 90% of the calcium hydroxide group, but the difference was not significant. Pulp canal obliteration was observed in 2 teeth (2%) in each group. CONCLUSIONS The success rates obtained in our study indicate that iRoot BP Plus as a pulpotomy agent can be a suitable alternative to calcium hydroxide to manage complicated crown fractures.
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Affiliation(s)
- Qian Rao
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory for Oral Biomedicine of Ministry of Education, Department of Pediatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jin Kuang
- Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuanxia Mao
- Tengzhou Central People's Hospital, Shandong, China
| | - Jing Dai
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory for Oral Biomedicine of Ministry of Education, Department of Pediatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Linying Hu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory for Oral Biomedicine of Ministry of Education, Department of Pediatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhiyun Lei
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangtai Song
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory for Oral Biomedicine of Ministry of Education, Department of Pediatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
| | - Guohua Yuan
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory for Oral Biomedicine of Ministry of Education, Department of Pediatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
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19
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Wang G, Wang C, Qin M. A retrospective study of survival of 196 replanted permanent teeth in children. Dent Traumatol 2019; 35:251-258. [PMID: 30980776 DOI: 10.1111/edt.12475] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/06/2019] [Accepted: 04/09/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Guiyan Wang
- Department of Pediatric Dentistry Peking University School and Hospital of Stomatology Beijing China
| | - Chao Wang
- Department of Pediatric Dentistry Peking University School and Hospital of Stomatology Beijing China
| | - Man Qin
- Department of Pediatric Dentistry Peking University School and Hospital of Stomatology Beijing China
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20
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Abstract
The aim of the study was to review literature data on incidence and outcomes of traumatic dental injuries (TDI) in pediatric population. A systematic search was conducted using Elibray, Pubmed/Medline, Scopus databases in October 2018. Reference lists were also hand-searched to identify additional literature. The most prevalent complication of TDI is pulp necrosis (PN) which triggers inflammatory root resorption (IRR). PN and IRR are however much more specific for mature permanent teeth. In immature teeth pulp revascularization may occur even after avulsion. Pulpectomy timing is well defined for mature teeth only. It is accepted that pulp extirpation should be performed in the first 10 days after trauma. In immature teeth no criteria exist with pulp electrosensitivity having very low negative prognostic value as drop of pulp sensitivity because of trauma not necessary indicate PN. Follow-up protocol for immature teeth with various TDI would be useful for proper timing of pulpectomy and prevention of IRR.
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Affiliation(s)
- M V Korolenkova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - M S Rakhmanova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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21
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Scholtes E, Suttorp CM, Loomans BA, Van Elsas P, Schols JG. Combined orthodontic, surgical, and restorative approach to treat a complicated crown-root fracture in a maxillary central incisor. Am J Orthod Dentofacial Orthop 2018; 154:570-582. [PMID: 30268267 DOI: 10.1016/j.ajodo.2017.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 11/29/2022]
Abstract
This case report shows the treatment of a severe traumatic tooth injury. For the maxillary right central incisor, the trauma was considered a complicated crown-root fracture. The level of the fracture line, the length of the remaining root segment, and the presence and condition of the tooth fragment determined the type of therapy. Traumatized teeth with fractures below the alveolar crest are often considered hopeless. As this report shows, the treatment of a complicated crown-root fracture in the esthetic region can be challenging. Orthodontic extrusion and crown-length surgery were performed to bring the fracture line above the alveolar bone crest. A multidisciplinary approach was required for complete rehabilitation of the traumatized maxillary incisor. Suggestions are made to improve treatment planning of complicated crown-root fractures.
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Affiliation(s)
- Eva Scholtes
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christiaan M Suttorp
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas A Loomans
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pieter Van Elsas
- Private practice, Bloemendaal, The Netherlands; Department of Oral Implantology and Prosthetic Dentistry, Academic Center for Dentistry, Amsterdam, The Netherlands
| | - Jan G Schols
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands.
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22
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Tzanetakis GN. Management of Intruded Immature Maxillary Central Incisor with Pulp Necrosis and Severe External Resorption by Regenerative Approach. J Endod 2018; 44:245-249. [DOI: 10.1016/j.joen.2017.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 12/14/2022]
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23
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Wang G, Wang C, Qin M. Pulp prognosis following conservative pulp treatment in teeth with complicated crown fractures-A retrospective study. Dent Traumatol 2017; 33:255-260. [PMID: 28235162 DOI: 10.1111/edt.12332] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIM Complicated crown fractures are relatively common in children where the maintenance of the pulp is especially important in young permanent teeth. The aim of this study was to analyze the pulp prognosis of permanent teeth with complicated crown fractures treated with conservative pulp treatment in adolescents. MATERIAL AND METHODS Complete dental records of teeth with complicated crown fractures treated with conservative pulp treatment were obtained. The risk of pulp necrosis and infection was evaluated by the Kaplan-Meier method and Cox regression (P<.05). Risk factors included gender, age, time interval between dental injury and treatment, stage of root development, type of pulp treatment, and coronal restoration. RESULTS The study involved 375 teeth treated with direct pulp capping, partial or coronal pulpotomy, and direct pulp capping retreated by pulpotomy (partial or coronal). The frequency of pulp necrosis and infection was 10.1% (11/109) for partial pulpotomy and 9.8% (22/205) for coronal pulpotomy. There was no difference between partial and coronal pulpotomy (P=.673). The risk of pulp necrosis and infection was not significantly different between pulpotomy (partial and coronal; 33/314, 10.5%) and retreatment by pulpotomy (partial or coronal) after direct pulp capping (2/33, 6.1%; P=.436). However, the frequency of pulp necrosis and infection after direct pulp capping (16/28, 57.1%) was significantly higher than that with pulpotomy (partial or coronal; odds ratio=8.216, P<.001). The time interval between dental injury and treatment did not significantly influence pulp survival after pulpotomy (partial or coronal; P=.312), but the stage of root development had a significant impact (P<.001). CONCLUSIONS Partial or coronal pulpotomy, employed either as a primary pulp treatment or secondary to emergency pulp capping, had similarly satisfactory pulp survival rates.
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Affiliation(s)
- Guiyan Wang
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chao Wang
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Man Qin
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
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Serra-Pastor B, Penarrocha-Diago M, Penarrocha-Diago M, Agustín-Panadero R. Treatment and restoration of adult dentoalveolar trauma: A clinical case report. J Clin Exp Dent 2016; 8:e634-e637. [PMID: 27957283 PMCID: PMC5149104 DOI: 10.4317/jced.52990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/27/2016] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Blanca Serra-Pastor
- Postgraduate student in Prosthodontics. Department of Buccofacial Prostheses. University Complutense of Madrid. Spain
| | - Miguel Penarrocha-Diago
- Chairman of Oral Surgery, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - María Penarrocha-Diago
- Full Professor of Oral Surgery, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Rubén Agustín-Panadero
- Associate Professor of the Department of Stomatology. Faculty of Medicine and Dentistry, Valencia University, Spain
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25
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Lin S, Pilosof N, Karawani M, Wigler R, Kaufman AY, Teich ST. Occurrence and timing of complications following traumatic dental injuries: A retrospective study in a dental trauma department. J Clin Exp Dent 2016; 8:e429-e436. [PMID: 27703612 PMCID: PMC5045691 DOI: 10.4317/jced.53022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/17/2016] [Indexed: 11/20/2022] Open
Abstract
Background This study explores the pattern of complications occurrence resulting from traumatic dental injuries, the relation of this pattern to the number of years from the time of the injury to its first diagnosis, and other contributing characteristics such as root development and trauma characteristic. Material and Methods Patients’ data treated following dental trauma from 2002 to 2014 were classified and grouped according to age, gender, tooth type, injury type, diagnosis and the time that elapsed between the traumatic event and the diagnosis of complications (TIC). The distribution function of the quantitative parameters was determined with the Kolmogorov-Smirnov test. Fisher exact test was used to test differences between categorical parameters. Results The review identified 166 patients (114 male and 52 female), with a total of 287 traumatized teeth, and a mean of 1.8 injured teeth per incident. Maxillary teeth were involved significantly more often in traumatic dental injuries. The follow-up period range (TIC) had a mean of 2.99 years. The most frequent complication was pulp necrosis (34.2%).
The most frequent complication related to avulsion was ankylotic root resorption (50%) diagnosed after a median TIC of 1.18 years. Open apices at the occurrence of trauma were observed in 52 teeth. Of these, 54.9% experienced pulp necrosis and 9.8% inflammatory root resorption with a median TIC of 1.63 years.
Teeth that experienced multiple traumatic events showed significantly more late pulp necrosis compared to teeth that experienced a single traumatic injury (61.9% vs. 25.3%, respectively, p<0.0001). Conclusions Follow-up periods should be based on the type of traumatic dental injury and the severity of the potential complications for the tooth. Current recommendations for follow-up after traumatic dental injury should be revised to reflect the need for more frequent and overall prolonged follow-up. Key words:Dental trauma, avulsion, open apex, pulp necrosis, root resorption, follow-up, complications.
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Affiliation(s)
- Shaul Lin
- DMD, Endodontics and Dental Trauma Department, School of Graduate Dentistry, Rambam Medical Center, Haifa, Israel; DMD, Faculty of Medicine at the Technion Institute of Technology, Haifa, Israel
| | - Nir Pilosof
- DMD, Endodontics and Dental Trauma Department, School of Graduate Dentistry, Rambam Medical Center, Haifa, Israel
| | - Munir Karawani
- DMD, Endodontics and Dental Trauma Department, School of Graduate Dentistry, Rambam Medical Center, Haifa, Israel
| | - Ronald Wigler
- DMD, Endodontics and Dental Trauma Department, School of Graduate Dentistry, Rambam Medical Center, Haifa, Israel
| | - Arieh Y Kaufman
- DMD, Endodontics and Dental Trauma Department, School of Graduate Dentistry, Rambam Medical Center, Haifa, Israel
| | - Sorin T Teich
- DMD, MBA, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
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26
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Lam R. Epidemiology and outcomes of traumatic dental injuries: a review of the literature. Aust Dent J 2016; 61 Suppl 1:4-20. [DOI: 10.1111/adj.12395] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R Lam
- International Research Collaborative - Oral Health and Equity, School of Anatomy, Physiology and Human Biology; The University of Western Australia; Western Australia Australia
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27
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Moule A, Cohenca N. Emergency assessment and treatment planning for traumatic dental injuries. Aust Dent J 2016; 61 Suppl 1:21-38. [DOI: 10.1111/adj.12396] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- A Moule
- Department of Endodontics; Kuwait University; Kuwait
- School of Dentistry; The University of Queensland; Queensland Australia
| | - N Cohenca
- Department of Pediatric Dentistry and Seattle Children's Hospital; University of Washington; USA
- Private Practice; Lakeside Endodontics; Everett Washington USA
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28
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Martins JN, Freitas F, Andre S, Moreira A, Carames J. Very Large Inflammatory Odontogenic Cyst with Origin on a Single Long Time Traumatized Lower Incisor. J Clin Diagn Res 2015; 9:ZD07-10. [PMID: 26393219 PMCID: PMC4573052 DOI: 10.7860/jcdr/2015/14571.6173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 05/19/2015] [Indexed: 11/24/2022]
Abstract
One of the consequences of traumatic injuries is the chance of aseptic pulp necrosis to occur which in time may became infected and give origin to periapical pathosis. Although the apical granulomas and cysts are a common condition, there appearance as an extremely large radiolucent image is a rare finding. Differential diagnosis with other radiographic-like pathologies, such as keratocystic odontogenic tumour or unicystic ameloblastoma, is mandatory. The purpose of this paper is to report a very large radicular cyst caused by a single mandibular incisor traumatized long back, in a 60-year-old male. Medical and clinical histories were obtained, radiographic and cone beam CT examinations performed and an initial incisional biopsy was done. The final decision was to perform a surgical enucleation of a lesion, 51.4 mm in length. The enucleated tissue biopsy analysis was able to render the diagnosis as an inflammatory odontogenic cyst. A 2 year follow-up showed complete bone recovery.
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Affiliation(s)
- Jorge N.R. Martins
- Doctor of Dental Surgery, Lisbon University School of Dentistry, Inter PG Endodontics, New York University College of Dentistry Private Practice, Implantology Institute, Lisbon, Portugal
| | - Filipe Freitas
- Doctor of Dental Surgery, Department of Oral Medicine, Pathology and Surgery,Lisbon University School of Dentistry, Lisbon University School of Dentistry Private Practice, Implantology Institute, Lisbon, Portugal
| | - Saudade Andre
- Anatomopathologist Physician, Department of Anatomopathology, Francisco Gentil Portuguese Institute of Oncology, Lisbon Private Practice, Histological and Cytologic Diagnosis Unit, Lisbon, Portugal
| | - Andre Moreira
- Doctor of Dental Surgery, Lisbon University School of Dentistry, PG Implant Dentistry,Lisbon University School of Dentistry Private Practice, Implantology Institute, Lisbon, Portugal
| | - Joao Carames
- Professor and Chairman, Department of Implant, Lisbon University School of Dentistry Director of the Implantology Institute, Lisbon President of the General Assembly of the Portuguese Dental Association
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Andreasen FM, Kahler B. Pulpal Response after Acute Dental Injury in the Permanent Dentition: Clinical Implications—A Review. J Endod 2015; 41:299-308. [DOI: 10.1016/j.joen.2014.11.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/09/2014] [Accepted: 11/27/2014] [Indexed: 12/28/2022]
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30
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Pini NIP, Nagata JY, Sundfeld-Neto D, Correr-Sobrinho L, Soares A, Aguiar FHB, Lima DANL. Reestablishing Biology, Function, and Esthetics for Fractured, Immature Incisors. Oper Dent 2015; 40:341-9. [PMID: 25575198 DOI: 10.2341/14-167-t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A seven-year-old boy with enamel-dentin fractures on both maxillary central incisors presented to the Piracicaba Dental School-UNICAMP seven days after the trauma. At the clinical evaluation, there were no clinical signs of pulp exposure, neither tooth was mobile, and both affected teeth presented a positive response to sensitivity tests and a negative response for percussion and palpation. The radiographic examination showed an undeveloped root and opened apex for both teeth. Indirect pulp capping was performed on the left maxillary central incisor, followed by a direct restoration. After one month, the patient complained of pain in the left central incisor, which responded negatively to sensitivity testing. Pulp revascularization was performed only on this tooth and was followed for 18 months. During this period, the left maxillary central incisor did not recover sensitivity, although radiographic examination showed apical closure, a slight increase in root length, and the formation of a mineralized barrier between the root canal and sealing material. The technique achieved its goal of restoring biological aspects, function, and esthetics of traumatized teeth when using this multidisciplinary approach.
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