Alveolar process fractures in the permanent dentition. Part 1. Etiology and clinical characteristics. A retrospective analysis of 299 cases involving 815 teeth

Dental Trauma and Alveolar Fractures

A dentoalveolar fracture requires thorough clinical and radiographic examination for an accurate diagnosis to guide appropriate treatment. Dentoalveolar fractures can be classified into the following 4 groups: (1) crown/root fractures, (2) luxation/displacement of teeth, (3) avulsion, and (4) alveolar fractures. Treatment can be divided into nonrigid fixation (splinting with wires and composite) and/or rigid fixation (Erich arch bars, Risdon cable wires) depending on the extent of dentoalveolar fractures. Special considerations must be made for primary teeth and mixed dentition to avoid injuring tooth buds and arising permanent dentition.

Diagnosis and Management of Traumatic Dental Injuries Using Intraoral Radiography and Cone-beam Computed Tomography: An In Vivo Investigation

INTRODUCTION

The aim of this study was to compare periapical radiographs (PRs) and upper standard occlusal (USO) radiographs with cone-beam computed tomographic (CBCT) imaging on clinicians' confidence in the diagnosis and management of traumatic dental injuries (TDIs).

METHODS

This study included 35 maxillary anterior teeth from 25 patients with at least 1 PR (parallax view) and a CBCT scan. Fourteen patients also had a USO radiograph. Ten examiners selected a diagnosis and treatment plan, which were compared with a reference standard. Sensitivity, specificity, positive and negative predictor values, and receiver operating characteristic analysis were used to determine the diagnostic accuracy.

RESULTS

CBCT imaging exhibited significantly higher sensitivity than both conventional radiographic techniques combined (PRs and PRs + USO radiographs) for all diagnoses (TDI: 99% vs 84%, lateral luxation: 80% vs 34%, extrusions: 92% vs 42%, and cortical plate fracture: 58% vs 1%) other than horizontal root fractures in which the results were close to statistical significance (88% vs 69%). CBCT imaging was significantly more accurate for all diagnoses (TDI: 91% vs 70%, lateral luxations: 83% vs 61%, extrusive luxations: 92% vs 68%, alveolar cortical plate fractures: 78% vs 48%, and horizontal root fractures: 93% vs 82%). Examiners had the most confidence with CBCT imaging and the least confidence in diagnosing using PRs + USO radiographs than with PRs alone. Agreement with management plans was significantly better using CBCT imaging compared with PRs and PRs + USO radiographs.

CONCLUSIONS

CBCT imaging improved the clinical diagnosis of TDIs. The addition of USO radiographs to PRs did not improve the diagnosis of TDIs in this investigation. CBCT imaging improved confidence in the diagnosis of TDI cases and treatment planning compared with conventional radiography.

Complex Dentoalveolar Fractures: Main Clinical Variables Description and Analysis

AIMS AND OBJECTIVES

To analyze and evaluate clinical features that define complex dentoalveolar trauma.

MATERIALS AND METHODS

Forty-five patients, with a mean age of 36.1 years, were included in the study; most patients were male (82.2%). The main clinical features defining dentoalveolar fractures were evaluated, including the status of the tooth, alveolar socket and adjacent soft tissues and their relationships with tooth loss. The relationship between splinting and tooth loss was also studied. The data were analyzed using descriptive and statistical methods.

RESULTS

A significant relationship was observed between the different clinical variables and tooth loss, in particular the status of the alveolar socket as the most relevant clinical factor; there was also a significant relationship between splinting and tooth loss, as this was the main protective factor.

CONCLUSIONS

Tooth loss prognosis following complex dentoalveolar trauma is related to the clinical features of the fracture, particularly the status of the alveolar socket and the possibility of using splinting as treatment.

An Update on Maxillary Fractures: A Heterogenous Group

BACKGROUND

The purpose of this study was to review the different types of maxillary fractures and highlight their diagnostic and therapeutic differences.

METHODS

A retrospective chart review of patients who sustained maxillary fractures was conducted through the Einstein Healthcare Network during the years 2016-2017. Descriptive statistics and chi-square analysis were used to categorize continuous and categorical variables, respectively.

RESULTS

The cohort of patients (n = 141) were predominately African American (62%) and male (75%) with a mean age 45.3 years. The most common maxillary fracture was maxillary sinus (29%), followed by zygomaticomaxillary complex (ZMC) (26%), frontal process (20%), dentoalveolar (16%), and LeFort (9%). Dentoalveolar fractures were mostly evaluated by the oral maxillofacial surgery service (74%), while ZMC and LeFort fractures were more commonly referred to an otolaryngologist (56% and 67%, respectively). Patients with dentoalveolar fractures were more likely to undergo wire splinting (61%). All patients with frontal process and maxillary sinus fractures were managed non-operatively. Most patients with ZMC fractures were managed non-operatively (78%) while the remainder underwent open reduction internal fixation (ORIF) (22%). Patients with LeFort fractures more commonly underwent maxillomandibular fixation (MMF)/ORIF (83%). Dentoalveolar fractures were the most likely to be operated on the same day (93%) while ZMC and LeFort fractures were repaired within 1 week (88% and 100%, respectively).

CONCLUSION

Maxillary trauma is very heterogenous in comparison to other maxillofacial trauma patterns. Each fracture type is treated uniquely and can involve one or more provider teams depending on the extent and severity of the injury, as well as hospital resources.

Characteristic changes of traumatic dental injuries in a teaching hospital of Wuhan under transmission control measures during the COVID-19 epidemic

BACKGROUND/AIMS

In December 2019, a novel coronavirus emerged in Wuhan City, and a retrospective analysis is necessary to provide clinicians with the characteristics of traumatic dental injuries (TDIs) during the epidemic. The aim of this study was to evaluate the changes in the characteristics of TDIs under the transmission control measures in Wuhan City utilizing an epidemiologic investigation.

MATERIALS AND METHOD

In this retrospective study, epidemiologic information, including the number of patients, gender, age, and TDI parameters such as time since injury to the clinic visit, etiology, tooth location, and the type of injury was extracted from the records of patients in the hospital from two periods: period 1 (between January 23, 2020, and April 7, 2020) and period 2 (between January 23, 2019, and April 7, 2019). The data from the two periods were compared and analyzed.

RESULT

A total of 158 patients were treated for TDIs (120 in 2019 and 38 in 2020). Males were more likely to suffer from TDIs than females with a ratio of 1.5:1, both in 2020 and 2019. Other than that, there were characteristic changes in TDIs during the transmission control measures in the COVID-19 epidemic, which included the number of patients, age, time since injury to the clinic visit, etiology, tooth location and the type of TDI.

CONCLUSION

The transmission control measures during the COVID-19 epidemic had a significant impact on the epidemiology and etiology of TDIs in Wuhan City.

Diagnosis of alveolar and root fractures in macerated canine maxillae: a comparison between two different CBCT protocols

OBJECTIVES

To compare two small-field-of-view (FOV) CBCT protocols with different voxel sizes and number of frames for the diagnosis of root and alveolar fractures in macerated canine maxillae.

METHODS

80 incisor teeth from the canine species were inserted in 80 anterior alveolar sockets of 20 canine maxillae. An operator randomly divided each maxilla site (80 sites in total) into 4 equal groups of 20 sites: 1 (sound tooth and non-fractured alveolar socket); 2 (sound tooth and fractured alveolar socket); 3 (fractured root and non-fractured alveolar socket); and 4 (fractured root and fractured alveolar socket). The CBCT images were obtained using two different protocols: normal (N) (voxel 0.20 mm, 400 frames and radiation exposure 5.6 mGy) and high definition (HD) (voxel 0.15 mm, 500 frames and radiation exposure 7.0 mGy).

RESULTS

Sensitivity numbers for alveolar fractures were lower than specificity, resulting in comparable areas under the receiver operating characteristic curves (AUC) for both protocols. Sensitivity, specificity and AUC for N and HD protocols were very similar for root fractures. When comparing AUC for both N and HD protocols by submitting them to Student's t-test, the comparison among the curves produced statistically non-significant results for alveolar fractures and root fractures likewise.

CONCLUSIONS

Our findings demonstrated that the elected protocol for the diagnosis of root and alveolar fractures was N. This protocol allowed similar diagnosis results than HD protocol; however, with a lower amount of radiation exposure for the patient (5.6 mGy for N vs 7.0 mGy for HD).