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Cvijic A, Åstrøm A, Kvernenes M, Tsilingaridis G, Bletsa A. Traumatic dental injuries: Knowledge assessment of dentists in the Norwegian Public Dental Service of Vestland. Dent Traumatol 2024; 40:398-409. [PMID: 38459663 DOI: 10.1111/edt.12945] [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: 11/12/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND/AIM Most children and adolescents in Norway attend the Public Dental Service (PDS) where they are treated free-of-charge until the age of 19 years. Thus, general dentists employed in the PDS are the primary care providers for traumatic dental injuries (TDI) in young patients. This cross-sectional study assessed the knowledge of PDS general dentists on the acute management and follow-up of TDI and its socio-demographic and attitudinal covariates. MATERIALS AND METHODS All general dentists employed in the Vestland County PDS, Western Norway, (N = 170) received an online questionnaire. Socio-demographic and professional profiles of respondents as well as attitudinal indicators were queried. Clinical case scenarios on emergency treatment and further follow-ups of TDI were used to calculate a dental trauma knowledge score (DTKS; range: 0-21). Mann-Whitney U tests and Kruskal-Wallis tests determined differences between the demographic subgroups. Logistic regressions determined the potential of single factors in explaining the variability in dental trauma knowledge. RESULTS The response rate was 46%. Most participants (60.5%) had not participated in a TDI course after graduation but would like such a course (84.2%). Mean DTKS was 13.82 (±2.6). Knowledge scores differed significantly between age groups (p = .014) and years since graduation (p = .0018). Younger dentists and recently graduated dentists scored highest. Dentists under the age of 30 years scored higher than 30-39- and 40-49-year-old dentists in these areas: emergency treatment of crown fractures with pulp exposure, identification of complications after avulsion, and management of severe intrusive luxation injury. CONCLUSION Younger dentists had a higher theoretical knowledge of TDI. Continuing professional development among dentists in the Norwegian PDS is needed for emergency treatment and complication management after TDI.
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Affiliation(s)
- Andjelka Cvijic
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
| | - Anne Åstrøm
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Monika Kvernenes
- Department of Clinical Medicine, Center for Medical Education and Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Georgios Tsilingaridis
- Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
- Centre of Paediatric Oral Health, Stockholm, Sweden
| | - Athanasia Bletsa
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
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Yang J, Liu Z, Chen Z, Yang G, Yuan G. Application of Oxygen Saturation Test after Replantation of Avulsed Immature Permanent Teeth: A Prospective Observational Study. J Endod 2024; 50:954-961. [PMID: 38604473 DOI: 10.1016/j.joen.2024.04.003] [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: 12/19/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION The evaluation of pulp status is crucial for avulsed immature permanent teeth after replantation. In addition to commonly used clinical and radiographic examinations providing clinical evidence, the oxygen saturation test may offer valuable assistance. The aim of this study was to analyze the efficacy of a pulse oximeter in evaluating pulp status in avulsed and replanted immature permanent teeth. METHODS A prospective observational study was performed including 51 avulsed and replanted immature permanent teeth. Routine clinical and radiographic examinations were performed and used as the basis for the diagnosis of pulp status during the 1-year follow-up period. Meanwhile, the oxygen saturation values of these teeth were recorded using a modified pulse oximeter at each visit. RESULTS Seven teeth completed pulp revascularization (success group), whereas 44 teeth failed to revascularize (failure group). Abnormal clinical and/or radiographic manifestations in the failure group were observed at an average period of 42.7 days, which was too late because a high incidence of inflammatory root resorption (43.18%) had occurred. For oxygen saturation tests, teeth in the success group showed an immediate postreplantation oxygen value of 70.71 ± 3.35, then an upward trend starting from the 2-week postreplantation visit, and a significantly increased final value of 81.86 ± 2.34 at the 1-year visit. In contrast, no increase trend was found for teeth in the failure group because abnormal clinical and/or radiographic manifestations emerged. CONCLUSIONS The oxygen saturation test is a reliable diagnostic method to evaluate pulp status of avulsed teeth as early as 2 weeks after replantation.
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Affiliation(s)
- Jinghui Yang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Wuhan University, Wuhan, China; Department of Pediatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhengyan Liu
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Wuhan University, Wuhan, China; Department of Pediatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhi Chen
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Wuhan University, Wuhan, China
| | - Guobin Yang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Wuhan University, Wuhan, China; General and Emergency Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Guohua Yuan
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Wuhan University, Wuhan, China; Department of Pediatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Frontier Science Center for Immunology and Metabolism, Wuhan University, Wuhan, China.
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Wikström A, Brundin M, Mohmud A, Anderson M, Tsilingaridis G. Outcomes of apexification in immature traumatised necrotic teeth and risk factors for premature tooth loss: A 20-year longitudinal study. Dent Traumatol 2024. [PMID: 38840386 DOI: 10.1111/edt.12973] [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: 03/15/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND/AIM To evaluate the long-term survival of immature traumatized incisors with pulp necrosis and apical periodontitis after endodontic treatment with two apexification techniques (calcium hydroxide apexification and MTA-apical plug) and to identify major factors affecting the survival of these teeth. MATERIALS AND METHODS Records of 2400 children and adolescents were screened for presence of traumatic dental injuries to immature incisors where endodontic treatment with the two apexification techniques was performed during January 2003 and December 2022, compared to a control group of mature teeth treated with conventional endodontic techniques. The studied variables were age; sex; apexification technique, presence of luxation and hard tissue injuries; preoperative root development stage (RDS), preoperative and postoperative periapical index (PAI), the time-point for tooth loss, and overall survival time in years. Kaplan-Meier estimates were used to graphically present the survival functions and Cox proportional hazard model to calculate hazard ratios (HR, 95% CI). RESULTS The median survival time was 10 years for calcium hydroxide apexification, 16.1 for MTA-apexification, for luxation injuries other than intrusions and avulsions 15.5 years, for intrusions 12.5 years and for avulsions 6.8 years. The variables with significant negative impact on tooth survival were calcium hydroxide apexification, avulsion and postoperative PAI 3-5. No significant relationships were found for the variables MTA apexification, concussion; subluxation; lateral luxation; extrusion, intrusion, hard tissue injuries, preoperative RDS and PAI scores and postoperative PAI 1-2. After adjustment, the risk for premature tooth loss was 13.5 times higher in calcium hydroxide apexification, approximately 2 to 4 times higher in PAI 3-5, and 5.6 times higher in avulsions. CONCLUSIONS Calcium hydroxide apexification, avulsion, and postoperative PAI 3-5 were identified as prognostic variables with significant negative impact on the risk for premature tooth loss.
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Affiliation(s)
- Alina Wikström
- Division of Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Paediatric Oral Health, Stockholm, Sweden
- Department of Endodontics, Eastmaninstitutet, Folktandvården Stockholm AB, Public Dental Services, Stockholm, Sweden
| | - Malin Brundin
- Department of Endodontics, Umeå University, Umeå, Sweden
| | - Afrah Mohmud
- Department of Endodontics, Eastmaninstitutet, Folktandvården Stockholm AB, Public Dental Services, Stockholm, Sweden
| | - Maria Anderson
- Division of Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Paediatric Oral Health, Stockholm, Sweden
- Department of Paediatric Dentistry, Eastmaninstitutet, Folktandvården Stockholm AB, Public Dental Services, Stockholm, Sweden
| | - Georgios Tsilingaridis
- Division of Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Paediatric Oral Health, Stockholm, Sweden
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Gul A, Lauridsen E, Gerds TA, Andersson L. Risk of ankylosis of avulsed teeth immediately replanted or stored under favorable storage conditions before replantation: A long-term clinical study. Dent Traumatol 2024; 40:137-143. [PMID: 37864425 DOI: 10.1111/edt.12898] [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: 07/24/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND/AIM There are few long-term clinical follow-up studies on human teeth replanted immediately or after storage in a suitable storage medium prior to replantation. This study aimed to assess the risk of ankylosis in avulsed human teeth replanted immediately or after storage in physiological media for a short time. MATERIAL Data from 116 patients with 145 replanted avulsed permanent teeth were selected from a comprehensive dental trauma database in Copenhagen University Hospital. The following teeth were selected: Group 1 comprised 36 teeth replanted immediately (dry time <6 min; wet time <6 min). Group 2 comprised 61 teeth replanted after physiologic storage media (saliva and saline) (dry time <6 min; wet time >5 min; wet time ranged from 7 to 170 min, and mean wet time was 59 min). Group 3 (control) included 48 teeth replanted after dry storage (dry time > 60 min). METHOD Clinical and radiographic registrations were carried out according to a standardized protocol; follow-up ranged from 7 months to 23 years. Ankylosis was diagnosed by percussion test and radiographs and related to the conditions prior to replantation and stage of root development. RESULTS The overall risk of ankylosis was 17.2% [95% CI: 4.61; 29.79] for immediately replanted teeth, 55.3% [95% CI: 42.54; 68.00] for teeth stored in physiologic media before replantation, and 85.7% [95% CI: 75.70; 95.73] for teeth stored dry more than 1 h. Mature teeth showed a significantly higher risk of ankylosis than immature teeth. CONCLUSION This clinical long-term study has verified earlier experimental studies showing that immediate reimplantation has the lowest risk of ankylosis. Physiologic storage media are good alternatives that also reduce the risk of ankylosis compared to dry storage, where ankylosis is more likely although not always seen. Mature teeth are significantly more likely to develop ankylosis.
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Affiliation(s)
- Abdulaziz Gul
- Department of Oral and Maxillofacial Surgery, Malmö University, Malmö, Sweden
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Eva Lauridsen
- Department of Oral and Maxillofacial Surgery, University Hospital, Copenhagen, Denmark
| | - Thomas A Gerds
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Lars Andersson
- Department of Oral and Maxillofacial Surgery, Malmö University, Malmö, Sweden
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Silva MT, Costa LC, Moura MS, Lima CCB, Almeida de Deus Moura LDF, Martins-Júnior PA, Lima MDDM. The Top 100 Most-Cited Articles on Permanent Teeth Avulsion: A Bibliometric Analysis. J Endod 2023; 49:1595-1604. [PMID: 37690496 DOI: 10.1016/j.joen.2023.09.001] [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: 06/25/2023] [Revised: 08/22/2023] [Accepted: 09/02/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Knowledge of bibliometric indices on the avulsion of permanent teeth can help researchers to identify gaps in the literature. The aim of this study was to analyze the bibliometric characteristics of the 100 most-cited articles on the avulsion of permanent teeth. MATERIALS AND METHODS Two researchers conducted an unfiltered search in the Core Collection section of the Web of Science (WoS-CC) database. The following data were extracted: position in the citation list, total number and density of citations, title, authors, institution, country, year of publication, journal, keywords, study design, tooth storage medium, and other topics of interest. Bibliometric networks were generated and analyzed using the VOSviewer software. Descriptive analysis and a Poisson regression analysis were performed (P < .05). RESULTS The number of citations per article varied between 31 and 407. The average was 70.05, and 13 articles received more than 100 citations. J.O. Andreasen (n = 13) and M. Trope (n = 15) were the authors who contributed most often to publications. The United States was the country with the highest number of articles (n = 31). Authors associated with the University of Copenhagen, Denmark (n = 9) and University of North Carolina, USA (n = 10) showed higher productivity. In vitro/animal model studies were the most frequent study designs (n = 50), and the most-discussed topic of interest was prognosis (n = 47). There was strong clustering among 13 research groups. CONCLUSION Observational studies, published by authors from Europe and about prognosis or treatment presented more citation ratio in WoS-CC. Clinical studies on permanent tooth avulsion are needed to increase the quality of scientific evidence and provide insights for health professionals and public policy makers.
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Affiliation(s)
| | - Lara Carvalho Costa
- Postgraduate Program in Dentistry, Federal University of Piauí (UFPI), Teresina, Brazil
| | - Marcoeli Silva Moura
- Department of Pathology and Dental Clinic, Federal University of Piauí (UFPI), Teresina, Brazil
| | | | | | - Paulo Antônio Martins-Júnior
- Department of Child and Adolescent Oral Health, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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Loureiro JM, Chaves VCV, Risso PA, Magno MB, Maia LC, Pithon MDM. YouTube™ as a source of tooth avulsion information: A video analysis study. Dent Traumatol 2023; 39:616-624. [PMID: 37638632 DOI: 10.1111/edt.12873] [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: 03/13/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND/AIM Evaluate the informative content in tooth avulsion videos intended for dentists available on YouTube™ and analyse their compliance with the International Association of Dental Traumatology (IADT) guidelines 2020. MATERIALS AND METHODS Google Trends was used to identify the most searched term for tooth avulsion. Tooth avulsion-related videos in Brazilian Portuguese intended for dentists were searched on YouTube™ with a 12-month filter. Two raters reviewed these videos to extract their features and evaluate and qualify them with two 9-point checklists based on the IADT 2020 guidelines. The emergency steps for tooth avulsion at the accident site were assessed before, during and after clinical management; each step received 1 point if present and 0 points if absent. The final score ranged from 0 to 9 points on each checklist (18 points total), and the total score was used to classify the videos as having poor, moderate or rich content. Reliability and video quality were evaluated by an adapted version of the DISCERN tool and global quality scale (GQS), respectively. The data were analysed with the Mann-Whitney U-test, Pearson chi-square test, and the Kappa statistic (p < .05). RESULTS Of 60 videos, 8 were included. All were uploaded by dental professionals or undergraduate students; the average duration was 11 min (range: 0.40-65 min), and the average number of views was 56.75. Half the videos (50%) had maximum completeness scores for questions about emergency dentist referral before clinical management, and more than half (75%) had maximum completeness regarding the steps required during and after treatment. Rich videos had higher GQS scores (p = .049) without significant correlation. CONCLUSIONS Although most videos in Brazilian Portuguese were considered high-quality according to the IADT checklist, half of them presented partial absence of information regarding orientations at the accident site.
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Affiliation(s)
- Jéssica Muniz Loureiro
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Victor Carvalho Vitolo Chaves
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patrícia A Risso
- Department of Dental Clinic, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade Veiga de Almeida, Rio de Janeiro, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Matheus de Melo Pithon
- School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Health, Southwest Bahia State University, Jequié, Brazil
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Kaur IP, Kumar A, Kumar M, Jha K. Successful outcome of permanent maxillary incisor reimplanted after 30 hours of extra-oral time-a case report with 5-year follow-up. Clin Case Rep 2023; 11:e7721. [PMID: 37484750 PMCID: PMC10359447 DOI: 10.1002/ccr3.7721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/30/2023] [Accepted: 04/17/2023] [Indexed: 07/25/2023] Open
Abstract
Key Clinical Message Tooth reimplantation should be attempted in every possible case with thorough disinfection and impervious obturation. Integration of progressive innovations with recommended protocols can enhance complication free survival in intense situations. Abstract The present case describes the unique successful outcome of a tooth reimplanted after the delay of 30 hours. A 21-year old male patient presented with an avulsed #21 after a fall due to electric shock. It was reimplanted according IADT guidelines with the addition of specific irrigation sequence proposed for regenerative endodontic procedures during the endodontic treatment. The final obturation was accomplished by combination of Biodentine and BioRCS root-canal sealer. Subluxated #11 developed symptoms at 6 months and was further managed using recommended endodontic procedure. Both teeth had complication free survival during 5 year follow-up.
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Affiliation(s)
| | - Ashok Kumar
- Department of Pedodontics and Preventive DentistryESIC Dental College and HospitalNew DelhiIndia
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Kadulkar N, Kataki R, Deka A, Thonai S. Replantation of an Avulsed Tooth: A Case Report. Cureus 2023; 15:e39198. [PMID: 37332457 PMCID: PMC10276759 DOI: 10.7759/cureus.39198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Avulsion is a rare and serious traumatic dental injury that needs immediate and complex management. This case report highlights the successful management of an avulsed maxillary central incisor by replantation after a lapse of 120 minutes of being in an extra-oral environment and preserved in milk. A female patient aged 17 years presented with a traumatic dental injury sustained to the anterior maxillary region due to an accidental fall. Clinical examination revealed an avulsed tooth 21 that was replanted according to the International Association of Dental Traumatology (IADT) guidelines and stabilised in place with splinting. Conventional root canal therapy was initiated one week post-replantation. The root canal treatment was completed two weeks post-replantation followed by removal of the splint. Follow up done at regular intervals of one, three, six, and 12 months showed a lack of clinical signs and symptoms and no resorption on radiographic interpretation.
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Affiliation(s)
- Nishad Kadulkar
- Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, IND
| | - Rubi Kataki
- Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, IND
| | - Adrija Deka
- Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, IND
| | - Salouno Thonai
- Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, IND
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Implications of Post-Traumatic Treatment of Immature Maxillary Incisors. Int Dent J 2023; 73:337-345. [PMID: 36804746 DOI: 10.1016/j.identj.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 02/20/2023] Open
Abstract
The aim of this review was to discuss traumatic dental injuries in view of their treatment implications to provide an evidence-based resource for clinicians when planning treatment for traumatised immature maxillary incisors. Dental trauma to immature maxillary incisors can result in various complications, such as critical fractures, resorptions, or ankylosis, and might lead to tooth loss. Traumatised teeth may exhibit various unaesthetic discolourations as a result of different dental trauma sequelae or materials used for treatment. All of the above can influence patients' social experience, including self-esteem, confidence, eating and speaking abilities, as well as proper development and growth of the jaw bones. Treatment of traumatised immature incisors should focus not only on the acute phase but on the long-term consequences. Any time gained with the tooth in the jaw bone, free of infection, is an achievement, as it allows normal growth and development. All these aspects are discussed in this narrative review, and an evidence-based summary resource is suggested for clinicians to use when planning treatment for traumatised immature maxillary incisors.
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10
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Kotsanos IN, Tzika E, Economides N, Kotsanos N. Intentional replantation and management of avulsion related ankylosis and external cervical resorption. A 10-year follow up case report. Dent Traumatol 2023. [PMID: 36740825 DOI: 10.1111/edt.12828] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/22/2023] [Accepted: 01/22/2023] [Indexed: 02/07/2023]
Abstract
Replantation is the treatment of choice for avulsed permanent teeth; ankylosis and cervical root resorption are among survival complications. A 9.5-year-old boy presented with an avulsed maxillary permanent central incisor with an open root apex following a school accident. The tooth was kept in milk, after a dry time of 15-20 min. Its replantation was performed 60 min after the accident. At 8 months, apexification with apical plug was attempted upon radiographic evidence of apical periodontitis. Ankylosis sound with infraocclusion and radiographic evidence of external cervical root resorption (ECR) were evident at 3 years and 3 months. At the patient's return one year later with esthetic concerns (2 mm infraocclusion) there was a 5 mm diameter ECR cavity. After intentional atraumatic extraction the resorptive cavity was debrided and restored with Biodentine; subsequently the tooth was reimplanted and splinted at an extruded position. At the 10-year follow up since the first avulsion the tooth remains esthetically pleasing, asymptomatic, non-ankylotic and functional. The present case supports intentional replantation as an option in managing infraoccluded teeth with advanced ECR.
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Affiliation(s)
| | - Eleftheria Tzika
- Department of Pediatric Dentistry, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Economides
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Kotsanos
- Department of Pediatric Dentistry, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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11
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Ideno H, Komatsu K, Nakashima K, Nifuji A. Tooth transplantation and replantation: Biological insights towards therapeutic improvements. Genesis 2022; 60:e23496. [PMID: 35916605 DOI: 10.1002/dvg.23496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/10/2022] [Accepted: 06/18/2022] [Indexed: 11/06/2022]
Abstract
Transplantation and replantation of teeth are effective therapeutic approaches for tooth repositioning and avulsion, respectively. Transplantation involves transplanting an extracted tooth from the original site into another site, regenerating tissue including the periodontal ligament (PDL) and alveolar bone, around the transplanted tooth. Replantation places the avulsed tooth back to its original site, regenerating functional periodontal tissue. In clinical settings, transplantation and replantation result in favorable outcomes with regenerated PDL tissue in many cases. However, they often result in poor outcomes with two major complications: tooth ankylosis and root resorption. In tooth ankylosis, the root surface and alveolar bone are fused, reducing the PDL tissue between them. The root is subjected to remodeling processes and is partially replaced by bone. In severe cases, the resorbed root is completely replaced by bone tissue, which is called as "replacement resorption." Resorption is sometimes accompanied by infection-mediated inflammation. The molecular mechanisms of ankylosis and root resorption remain unclear, although some signaling mechanisms have been proposed. In this mini-review, we summarized the biological basis of repair mechanisms of tissues in transplantation and replantation and the pathogenesis of their healing failure. We also discussed possible therapeutic interventions to improve treatment success rates.
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Affiliation(s)
- Hisashi Ideno
- Department of Pharmacology, School of Dental Medicine Tsurumi University, Yokohama, Japan
| | - Koichiro Komatsu
- Department of Pharmacology, School of Dental Medicine Tsurumi University, Yokohama, Japan
| | - Kazuhisa Nakashima
- Department of Pharmacology, School of Dental Medicine Tsurumi University, Yokohama, Japan
| | - Akira Nifuji
- Department of Pharmacology, School of Dental Medicine Tsurumi University, Yokohama, Japan
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12
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Bourgeois J, Carvalho JC, De Bruyne M, Declerck D, Eloot A, Leroy R. Antibiotics at replantation of avulsed permanent teeth? A systematic review. J Evid Based Dent Pract 2022; 22:101706. [DOI: 10.1016/j.jebdp.2022.101706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 11/15/2021] [Accepted: 02/16/2022] [Indexed: 11/26/2022]
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13
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Parthasarathy R, Srinivasan S, C V, Thanikachalam Y, Ramachandran A. An Interdisciplinary Management of Avulsed Maxillary Incisors: A Case Report. Cureus 2022; 14:e23891. [PMID: 35530845 PMCID: PMC9075823 DOI: 10.7759/cureus.23891] [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] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
The current case report presents a case of a road traffic accident comprising dental avulsion of maxillary incisors. A 30-year-old male reported missing teeth following trauma in his upper front tooth region. The avulsion of maxillary right central and lateral incisors along with laceration in upper and lower lips was evident. The avulsed teeth were stored in milk after a brief extra-oral dry time of one hour and were carried to the department with a one-hour delay. After clinical and radiographic investigations, no mobility or fractures were apparently noticed. The avulsed 11 and 12 had closed apices with intact crown and root surfaces. Following an extra-oral endodontic therapy, immediate replantation was scheduled. Subsequently, the alveolar sockets were irrigated with saline to dislodge the clot and any gross debris that was present. Teeth were reimplanted into the socket after placement of PRF membrane around the root surface. A semi-rigid wire and composite splinting were done for a span of two weeks and antibiotics were prescribed. An exploratory CBCT taken revealed a cortical bone loss in the buccal region of 12 and 11. An interdisciplinary approach to regenerate the osseous defect was then carried out. A follow-up of two weeks, four weeks, three months, six months, and a year was done. Evaluation performed after a year revealed the absence of clinical symptoms and satisfactory healing with no signs of resorption radiographically.
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Affiliation(s)
- Revathy Parthasarathy
- Conservative Dentistry and Endodontics, Chettinad Dental College and Research Institute, Chennai, IND
| | - Srividhya Srinivasan
- Conservative Dentistry and Endodontics, Chettinad Dental College and Research Institute, Chennai, IND
| | - Vikram C
- Periodontics, Chettinad Dental College and Research Institute, Chennai, IND
| | - Yashini Thanikachalam
- Conservative Dentistry and Endodontics, Chettinad Dental College and Research Institute, Chennai, IND
| | - Anupama Ramachandran
- Conservative Dentistry and Endodontics, Chettinad Dental College and Research Institute, Chennai, IND
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Treatment Outcomes of Regenerative Endodontic Procedures in Traumatized Immature Permanent Necrotic Teeth: A Retrospective Study. J Endod 2022; 48:1129-1136. [DOI: 10.1016/j.joen.2022.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/11/2022]
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Hashim R, Odeh R, Salah AH, Mathew S. The Influence of Dental Trauma Education on Undergraduate Students at Ajman University, United Arab Emirates: An Interventional Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1237-1243. [PMID: 34729029 PMCID: PMC8557803 DOI: 10.2147/amep.s336765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/07/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The main objective of this study was to assess the impact of a lecture on dental trauma on the knowledge of undergraduate dental students at Ajman University in the United Arab Emirates (UAE). METHODS Fourth-year dental students were asked to attend a lecture on dental trauma and then respond to an online questionnaire containing 10 close-ended questions related to their approach to managing dental trauma cases and tooth avulsion before (T0) and directly after (T1) the lecture. They were given 5 min for filling the questionnaire either time. McNemars test was used to compare the accuracy of their answers based on the correct or incorrect response for each question. The level of significance was set at p < 0.05. RESULTS The questionnaire was sent to 164 students, out of which 157 responded, giving a response rate of 95.7%. After receiving the educational intervention, the students showed a significant improvement in their knowledge on managing permanent tooth avulsion, especially regarding the handling of an avulsed tooth before replantation, extra-alveolar time, and media used for the storage and transportation of avulsed teeth (< 0.001). CONCLUSION The study reveals that the lecture on dental trauma had an excellent outcome on the knowledge of the students. Therefore, it is essential to emphasize the importance of this information among undergraduate dental students in order to save teeth exposed to trauma and to reduce the social burden of such cases. This study contributes to better understanding of the effect of dental trauma education on undergraduate dental students' knowledge of the subject.
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Affiliation(s)
- Raghad Hashim
- Department of Basic Medical and Dental Sciences, Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Ruba Odeh
- Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
| | - Afraa Hussain Salah
- Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
| | - Simy Mathew
- Department of Basic Medical and Dental Sciences, Ajman University, Ajman, United Arab Emirates
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16
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Silva RAB, Vieira HAO, de Gregorio C, Cohenca N, Lucisano MP, Pucinelli CM, Paula-Silva FWG, Nelson-Filho P, Romano FL, Assed Bezerra Silva L. Periodontal ligament repair after active splinting of replanted dogs' teeth. Dent Traumatol 2021; 37:758-771. [PMID: 34198370 DOI: 10.1111/edt.12698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM The high rate of root resorption resulting from tooth replantation represents a serious clinical problem. In order to prevent ankylosis and replacement resorption, the contemporary literature highlights the importance of using a flexible stabilization for traumatized teeth. For this purpose, orthodontic devices may be promising for obtaining a better prognosis and periodontal repair. The aim of this study was to evaluate the effect of an active splinting protocol with controlled force in dog's teeth following replantation. MATERIAL AND METHODS Sixty premolar roots from three dogs were used. They were submitted to endodontic treatment, hemisected, atraumatically extracted and subsequently replanted. They were divided into four groups: Passive Stabilization (n = 20)-after 20 min in a dry medium; Active Stabilization (n = 20)-after 20 min in a dry medium; Negative control (n = 10)-immediate replantation and passive Stabilization; and Positive control (n = 10)-90 min of extra-alveolar time and passive Stabilization. The samples were collected and submitted to histologic processing. They were then evaluated for the count of inflammatory cells, expression of neurotrophin 4, osteoclasts, apoptotic cells and collagen fibres. The results were submitted to ANOVA or Kruskal-Wallis statistical tests followed by Tukey or Dunn post-tests (α = 5%). RESULTS Passive Stabilization with orthodontic brackets without traction used after replantation had the highest number of inflammatory cells (p = .0122), osteoclasts (p = .0013) and percentage of collagen fibres in the periodontal ligament (p < .0001) when compared to Active Stabilization with orthodontic brackets applying amild tensile force. Neurotrophin 4 had no statistically significant difference (p = .05), regardless of the treatment. The apoptotic cells count revealed statistical differences (p < .0001) between Active Stabilization (189.70 ± 47.99) and Positive Control (198.90 ± 88.92) when compared to Passive Stabilization (21.19 ± 32.94). CONCLUSION The active splinting protocol using orthodontic appliances generating a light and controlled force favoured periodontal ligament repair of replanted teeth.
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Affiliation(s)
- Raquel Assed Bezerra Silva
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | | | - Nestor Cohenca
- Department of Endodontics, University of Washington, Seattle, WA, USA
| | - Marília Pacífico Lucisano
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Carolina Maschietto Pucinelli
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | - Paulo Nelson-Filho
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Fábio Lourenço Romano
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Lea Assed Bezerra Silva
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Meng M, Chen Y, Ren H, Zhang Q, Chen S, Zhou X, Zou J. Effect of tetracyclines on pulpal and periodontal healing after tooth replantation: a systematic review of human and animal studies. BMC Oral Health 2021; 21:289. [PMID: 34090399 PMCID: PMC8180113 DOI: 10.1186/s12903-021-01615-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/09/2021] [Indexed: 02/08/2023] Open
Abstract
Background Pulpal and periodontal healing are two main concerns of delayed replantation of avulsed teeth. The objective of this review was to evaluate the effectiveness of topical and systemic application of tetracyclines on pulpal and periodontal healing after tooth replantation. Methods A comprehensive electronic search was conducted in six databases. This systematic review was carried out according to Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results After exclusion of 246 irrelevant papers, 14 animal studies and one human study were included in this review. The human study showed that avulsed permanent teeth treated with doxycycline did not show a better clinical outcome for pulp and periodontal healing compared with treatment with normal saline. As for animal studies, significant more pulpal healing was observed in immature teeth treated with topical doxycycline in two researches, while another one study showed that there is no difference between teeth treated with normal saline and teeth treated with doxycycline. Systemic doxycycline exerted no significant effect on pulpal revascularization illustrated by one research. Only one out of four articles illustrated the positive effect of systemic tetracyclines on periodontal healing. One paper reported that intracanal application of demeclocycline promoted favorable periodontal healing. Two articles showed topical doxycycline contributed to favorable periodontal healing, while five studies showed no significant effect of topical tetracyclines on periodontal healing. Conclusions As a result of data heterogeneity and limitations of the studies, the effect of topical or systemic application of tetracyclines on pulpal and periodontal healing is inconclusive. More studies are required to get more clinically significant conclusions.
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Affiliation(s)
- Mingmei Meng
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China.,Departments of Pediatric Dentistry and Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Yandi Chen
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China.,Departments of Pediatric Dentistry and Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Huidi Ren
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China.,Departments of Pediatric Dentistry and Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Qiong Zhang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China.,Departments of Pediatric Dentistry and Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Song Chen
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China.,Departments of Pediatric Dentistry and Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China. .,Department of Endodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China.
| | - Jing Zou
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China. .,Departments of Pediatric Dentistry and Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China.
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18
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Dental Trauma Management in a Young Teenager through Endodontics and Implantology: A Case Report. Healthcare (Basel) 2021; 9:healthcare9050542. [PMID: 34066633 PMCID: PMC8148519 DOI: 10.3390/healthcare9050542] [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: 03/10/2021] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 11/20/2022] Open
Abstract
Endodontic treatment is often the first-line procedure to manage the immediate or long-term aftermath of dental trauma, particularly in cases of luxation or avulsion. Failure to manage trauma in the short or medium term leads to significant functional or aesthetic consequences, especially in the adolescence period. Under this specific conditions, endodontic treatment could provide a temporary solution by keeping teeth with poor prognosis on the arch while waiting for better anatomical conditions for implantology. This clinical case aimed to describe the management of a maxilla-facial dental trauma and the following consequences in a 10-year-old male patient. Clinical and radiological examination showed complete extrusive luxation of 11 and 21 and intrusive luxation of 12 and 22. Endodontic treatment of 11 and 21 was performed six months after the trauma. Two years later, the patient was referred to the endodontic department because pink spot lesions appeared on 12 and 22 due to cervical invasive resorptions (class III for 12 and class II for 22). Endodontic treatment of 12 and filling with resin composite of 22 were performed. During the following two years, complication management finally led to placement of four OBI® (Euroteknika, Sallanches, France)-type mini-implants after avulsion of all four maxillary incisors. Palliative endodontic treatment helped maintain the prosthetic space and the volume of supporting tissue needed for future implant placement. The interest of using delaying procedures (palliative endodontic treatments and mini-implants) was to allow the patient to complete growth. Managing early treatment failure of trauma in adolescents has to be pluridisciplinary and should take into account the evaluation of the treatment’s difficulty, the prognosis of the endodontic treatment, the available bone volume and the pubertal growth stage.
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TURA İ, ERDEN S. Evidence-Based Recommendations For Non-Cpr First Aid Applications. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.907345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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20
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Albertsson J, Lauridsen E, Andreasen JO, Gerds TA, Andersson L. The risks of ankylosis of 89 avulsed human teeth stored in saliva prior to replantation-A re-evaluation of a long-term clinical study. Dent Traumatol 2021; 37:537-545. [PMID: 33527633 DOI: 10.1111/edt.12659] [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: 10/26/2020] [Revised: 01/02/2021] [Accepted: 01/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIM The survival of an avulsed tooth highly depends on the emergency management. The aim of this study was to evaluate the risk of ankylosis for avulsed human teeth stored in saliva preceded by various dry storage conditions prior to replantation. MATERIAL AND METHODS Data include 74 patients (54 male and 20 female) with 89 avulsed and replanted teeth (16 immature teeth, 73 mature teeth). Patient ages ranged from 6 to 36 years (median: 13.0 years). All teeth were stored in saliva before replantation. Treatment and follow-up were performed according to a standardized procedure. Follow-up periods ranged from 7 months to 20 years (mean 5.3 years). The risk of ankylosis over time was estimated by the Aalen-Johansen method in relation to the length of dry storage and the stage of root development. The effect of risk factors (root development and length of dry time) on the risk of ankylosis was analysed by Cox regression analysis. RESULTS For mature teeth, dry storage for 5 min or less before saliva storage resulted in a 47.4% (95% confidence interval (CI): 32.8-60.7) ankylosis rate. When dry storage was >5 min and <20 min, the risk of ankylosis was 76.8% (95% CI: 45.7-91.5). When dry storage exceeded 20 min prior to saliva storage, ankylosis increased to 89.3% (95% CI: 68.0-96.7). Ankylosis also increased with increasing saliva storage time. Specifically, one additional minute of wet time increased the ankylosis hazard rate (HR) by approximately 1% (CI = [0%, 2%], p = .052). Teeth with mature root development were significantly more frequently affected by ankylosis than teeth with immature root development (HR: 2.4 (95% CI: 1.0-5.5), p = .04). CONCLUSION Temporary storage in saliva should be encouraged if an avulsed permanent tooth cannot be immediately replanted or a suitable storage medium such as milk or saline is not immediately available at the place of the accident.
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Affiliation(s)
- Josefin Albertsson
- Department of Oral and Maxillofacial Surgery and Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Eva Lauridsen
- Department of Oral and Maxillofacial Surgery, University Hospital, Copenhagen, Denmark
| | - Jens O Andreasen
- Department of Oral and Maxillofacial Surgery, University Hospital, Copenhagen, Denmark
| | - Thomas A Gerds
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Lars Andersson
- Department of Oral and Maxillofacial Surgery and Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
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21
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Korolenkova MV, Starikova NV, Rakhmanova MS. [Modern approach to the treatment of children with constant teeth avulsion]. STOMATOLOGII︠A︡ 2021; 99:38-43. [PMID: 33416232 DOI: 10.17116/stomat20209906238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
THE AIM OF THE STUDY Was to analyze treatment outcomes in children with constant teeth avulsion treated in Central Research Institute of Dentistry and Maxillofacial Surgery (CRIDMS). MATERIALS AND METHODS The study comprised 39 children aged 7-16 years treated in CRIDMS in 2015-2020. In 38 cases from 39 replantation was performed more than 24 hours after trauma. Because of delayed replantation endodontic treatment was needed in 35 cases from 38 (in one case the avulsed tooth was missing). In all 38 cases replantation was followed by splinting with either resin splint made according to original technique proposed by the authors or semi-flexible splints from orthodontic wire fixed with resin composite. RESULTS In one case from 39 the avulsed tooth was missing because a dentist the child first consulted was unaware of the possibility of replantation. In 38 children followed-up for 6-57 months the replanted teeth survived and were clinically asymptomatic. There were, however, obvious radiological signs of replacement resorption in 27 (71.1%) cases. Inflammatory resorption was detected in two cases (5.2%) with immature teeth undergoing apexification with calcium hydroxide. CONCLUSION Replacement root resorption after tooth avulsion may be seen as relatively favorable outcome preserving more bone tissue than early tooth removal. The rate of replacement resorption, however, would be less in less delayed replantation. The study results proved the necessity for additional education of parents and pediatric dentists on the first aid and treatment tactics for teeth avulsion.
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Affiliation(s)
- M V Korolenkova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - N V Starikova
- 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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22
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Amaro RG, Dos Santos LCM, Lima TCDS, Coste SC, Barbato Ferreira DA, Côrtes MIDS, Colosimo EA, Bastos JV. Pulp healing in immature replanted permanent teeth: A competing risk analysis. Dent Traumatol 2021; 37:447-456. [PMID: 33421350 DOI: 10.1111/edt.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM Tooth displacement during avulsion causes total rupture of the pulp's neurovascular supply. Revascularization and pulp healing may occur in immature teeth, which gives rise to the recommendation that root canal treatment may not be required. The aim of this study was to evaluate the prognostic factors for the pulp's response after replantation of young permanent teeth. METHODS Records from 117 patients with 133 replanted permanent immature teeth were reviewed, and pulp outcomes were classified as healing (hard tissue deposition on the dentinal walls followed by narrowing of the pulp lumen or ingrowth of bone-like tissue inside the pulp canal) or non-healing (pulp necrosis with infection). The effect of clinical and demographic co-variates on the hazards of both outcomes was assessed performing a competing risk model. RESULTS Pulp necrosis with infection was diagnosed in 78.2% of the teeth, and healing was observed in 12.8% of the teeth. A total of 12 teeth (9.0%) were censored due to prophylactic removal of the pulp or severe external root resorption caused by eruption of adjacent canines. The cs-Cox model demonstrated that the hazards of pulp healing increased in teeth with extra-alveolar periods <15 min (csHR: 7.83, 95% CI 1.76-34.80, p = .01), while the hazards of pulp necrosis with infection decreased (csHR: 0.31, 95% CI: 0.10-0.92, p = .04). Teeth replanted with Moorrees' stages 4 and 5 of root development had higher hazards of pulp necrosis with infection than teeth with stage 2 of root development (csHR: 2.23, 95% CI 1.11-4.50, p = .03; csHR: 2.89, 95% CI: 1.40-5.95; p = .01). CONCLUSIONS Pulp healing rarely occurred after replantation of young permanent teeth being associated with short extra-alveolar periods <15 min. Early stages of root development decreased the hazards of pulp necrosis with infection.
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Affiliation(s)
- Roberta Gabriela Amaro
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Thiago César da Silva Lima
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sylvia Cury Coste
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Daniela Augusta Barbato Ferreira
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Ilma de Souza Côrtes
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Dentistry, Pontifical University of Minas Gerais, Belo Horizonte, Brazil
| | - Enrico Antonio Colosimo
- Departament of Statistics, Institute of Exact Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Juliana Vilela Bastos
- Dental Trauma Program, Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Stojanović S, Tijanić M, Burić K, Burić N, Spasić M, Todorović K, Stojković B, Jovanović M, Petrović M, Mitić D. Permanent tooth avulsion in children and adults: Therapeutic options for longer survival. ACTA STOMATOLOGICA NAISSI 2021. [DOI: 10.5937/asn2183213s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction: Permanent tooth avulsions (traumatic extraction; total luxation) are one ofthe most severe permanent tooth injuries and can occur as single injuries or associated with other dental injuries or injuries to the face and jaws region. They are defined as the luxation of teeth from the alveoli with complete rupture of periodontal fibres, or with one part attached to the rootcementum and the other to the alveolar bone, thus compromising the dental pulp, root cementum,and alveolar bone. The high prevalence and numerous negative consequences on the stomatognathic systems they have suggest permanent tooth avulsions should be regarded as an important public health problem. The aim: is to point out the therapeutic possibilities of permanent tooth avulsion that can ensure their longer survival in the oral cavity. Conclusion: The treatment strategy for avulsed permanent teeth is always based on limiting root canal infection and periradicular inflammation, shifting the balance from unfavourable (replacement resorption) to favourable (periodontal) healing. The success of therapy and periodontal healing depend on the duration and conditions of extraoral tooth preservation, the degree of damage to the periodontal ligament, and the condition of the pulp.
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Pellegrino JL, Charlton NP, Carlson JN, Flores GE, Goolsby CA, Hoover AV, Kule A, Magid DJ, Orkin AM, Singletary EM, Slater TM, Swain JM. 2020 American Heart Association and American Red Cross Focused Update for First Aid. Circulation 2020; 142:e287-e303. [PMID: 33084370 DOI: 10.1161/cir.0000000000000900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Singletary EM, Zideman DA, Bendall JC, Berry DA, Borra V, Carlson JN, Cassan P, Chang WT, Charlton NP, Djärv T, Douma MJ, Epstein JL, Hood NA, Markenson DS, Meyran D, Orkin A, Sakamoto T, Swain JM, Woodin JA, De Buck E, De Brier N, O D, Picard C, Goolsby C, Oliver E, Klaassen B, Poole K, Aves T, Lin S, Handley AJ, Jensen J, Allan KS, Lee CC. 2020 International Consensus on First Aid Science With Treatment Recommendations. Resuscitation 2020; 156:A240-A282. [PMID: 33098920 DOI: 10.1016/j.resuscitation.2020.09.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life- threatening bleeding through the use of tourniquets, haemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research. The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual summary publications from the International Liaison Committee on Resuscitation (ILCOR). This 2020 CoSTR for first aid includes new topics addressed by systematic reviews performed within the past 12 months. It also includes updates of the first aid treatment recommendations published from 2010 through 2019 that are based on additional evidence evaluations and updates. As a result, this 2020 CoSTR for first aid represents the most comprehensive update since 2010.
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Singletary EM, Zideman DA, Bendall JC, Berry DC, Borra V, Carlson JN, Cassan P, Chang WT, Charlton NP, Djärv T, Douma MJ, Epstein JL, Hood NA, Markenson DS, Meyran D, Orkin AM, Sakamoto T, Swain JM, Woodin JA. 2020 International Consensus on First Aid Science With Treatment Recommendations. Circulation 2020; 142:S284-S334. [PMID: 33084394 DOI: 10.1161/cir.0000000000000897] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life-threatening bleeding through the use of tourniquets, hemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.
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Lopes LB, Botelho J, Machado V. Severe Case of Delayed Replantation of Avulsed Permanent Central Incisor: A Case Report with Four-Year Follow-Up. ACTA ACUST UNITED AC 2020; 56:medicina56100503. [PMID: 32992684 PMCID: PMC7599862 DOI: 10.3390/medicina56100503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 12/30/2022]
Abstract
Avulsion is one of the most serious dental traumatic injuries with a reserved prognosis. This case report describes multiple trauma lesions in permanent central incisors of an eight-year-old girl and a four-year follow-up. The right upper incisor suffered avulsion, remained 16 h extraorally, and was replanted after extraoral endodontic therapy. The left maxillary central incisor suffered a noncomplicated crown fracture with concomitant subluxation. The present case adds to the literature a rare occurrence of success in a severe case with poor prognosis. For this reason, the International Association for Dental Traumatology (IADT) guidelines should be followed and, even in extreme situations, replantation should always be considered.
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Affiliation(s)
- Luísa Bandeira Lopes
- Pediatric Department, Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz Cooperativa de Ensino Superior, 2829-511 Almada, Portugal
- Correspondence:
| | - João Botelho
- Evidence-Based Hub, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal; (J.B.); (V.M.)
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal
| | - Vanessa Machado
- Evidence-Based Hub, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal; (J.B.); (V.M.)
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal
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De Brier N, O D, Borra V, Singletary EM, Zideman DA, De Buck E. Storage of an avulsed tooth prior to replantation: A systematic review and meta-analysis. Dent Traumatol 2020; 36:453-476. [PMID: 32344468 DOI: 10.1111/edt.12564] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND/AIM It is crucial to store an avulsed tooth appropriately to preserve the viability of the periodontal ligament cells prior to replantation. The aim of this systematic review was to identify the best available evidence for the effectiveness of any technique available to laypeople for storing an avulsed tooth compared with storage in milk or saliva. METHODS The following databases were searched (September 2019): Cochrane Library, MEDLINE, and Embase. Two reviewers independently considered trial eligibility, then extracted and analyzed data, and assessed the risk of bias. The certainty of the body of evidence was appraised according to the GRADE methodology. RESULTS Out of 4118 references, 33 studies were included and reported 23 comparisons of which 10 were synthesized in a meta-analysis. The limited evidence available favors storing an avulsed tooth in Hank's balanced salt solution (pooled SMD 2.47, 95% CI [1.59;3.34], P < .00001), propolis solution (pooled SMD 1.73, 95% CI [1.12;2.33], P < .00001), oral rehydration salts (pooled SMD 4.16, 95% CI [2.10;6.23], P < .0001), rice water, and cling film compared with storage in milk. The cell viability rate was significantly lower in teeth stored in saline solutions (pooled SMD -4.35, 95% CI [-7.55;-1.14], P = .008), tap water, buttermilk, castor oil, GC Tooth Mousse, and turmeric extract than those stored in milk. There is insufficient evidence to recommend for or against temporary storage of an avulsed tooth in saliva compared with alternative solutions. The certainty of evidence was considered low to very low due to limitations in study design, indirect study populations and outcome measures, and imprecision. CONCLUSION Although milk was shown to extend the periodontal ligament cell viability before replantation compared with saline or tap water, the following media have also demonstrated efficacy at preserving the cell viability: Hank's balanced salt solution, propolis, oral rehydration salts, rice water, and cling film.
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Affiliation(s)
- Niels De Brier
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium
| | - Dorien O
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium
| | - Vere Borra
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium.,Cochrane First Aid, Belgian Red Cross, Mechelen, Belgium
| | - Eunice M Singletary
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Emmy De Buck
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium.,Cochrane First Aid, Belgian Red Cross, Mechelen, Belgium.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Fouad AF, Abbott PV, Tsilingaridis G, Cohenca N, Lauridsen E, Bourguignon C, O'Connell A, Flores MT, Day PF, Hicks L, Andreasen JO, Cehreli ZC, Harlamb S, Kahler B, Oginni A, Semper M, Levin L. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2020; 36:331-342. [DOI: 10.1111/edt.12573] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Ashraf F. Fouad
- Adams School of Dentistry University of North Carolina Chapel Hill NC USA
| | - Paul V. Abbott
- UWA Dental School University of Western Australia Crawley WA Australia
| | - Georgios Tsilingaridis
- Division of Orthodontics and Pediatric Dentistry Department of Dental Medicine Karolinska Institutet Huddinge Sweden
- Center for Pediatric Oral Health Research Stockholm Sweden
| | - Nestor Cohenca
- Department of Pediatric Dentistry University of Washington and Seattle Children’s Hospital Seattle WA Australia
| | - Eva Lauridsen
- Resource Center for Rare Oral Diseases Copenhagen University Hospital Copenhagen Denmark
| | | | - Anne O'Connell
- Paediatric Dentistry Dublin Dental University Hospital Trinity College Dublin The University of Dublin Dublin Ireland
| | - Marie Therese Flores
- Department of Pediatric Dentistry Faculty of Dentistry Universidad de Valparaíso Valparaíso Chile
| | - Peter F. Day
- School of Dentistry Community Dental Service Bradford District Care NHS Trust University of Leeds Leeds UK
| | - Lamar Hicks
- Division of Endodontics University of Maryland School of DentistryUMB Baltimore MD USA
| | - Jens Ove Andreasen
- Department of Oral and Maxillofacial Surgery Resource Centre for Rare Oral Diseases University Hospital in Copenhagen (Rigshospitalet) Copenhagen Denmark
| | - Zafer C. Cehreli
- Department of Pediatric Dentistry Faculty of Dentistry Hacettepe University Ankara Turkey
| | - Stephen Harlamb
- Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
| | - Bill Kahler
- School of Dentistry The University of Queensland St Lucia QLD Australia
| | - Adeleke Oginni
- Faculty of Dentistry College of Health Sciences Obafemi Awolowo University Ile‐Ife Nigeria
| | | | - Liran Levin
- Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
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Zeitlin BD. Banking on teeth - Stem cells and the dental office. Biomed J 2020; 43:124-133. [PMID: 32381462 PMCID: PMC7283549 DOI: 10.1016/j.bj.2020.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/29/2020] [Accepted: 02/12/2020] [Indexed: 12/23/2022] Open
Abstract
Science and commerce advance together and the stem cell field is no exception. With the promise of cures for conditions as diverse as cancer, autism, neural degeneration, organ replacement and addiction, long-term preservation of dental stem cells is a growth market. The discovery nearly twenty years ago, of viable, multipotent, stem cells in dental pulp from both baby and adult teeth initiated, and drives, this market.The dental stem cell preservation services, "tooth banks", focus on the collection of a child's baby teeth, as they are shed naturally, and storage of the stem cells from within the pulp for therapeutic use in later years should the child require them. This review focuses on the procedures related to these stem cell storage services and may serve as an introduction for many to the practice of "tooth banking".
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Affiliation(s)
- Benjamin D Zeitlin
- University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA.
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Müller DD, Bissinger R, Reymus M, Bücher K, Hickel R, Kühnisch J. Survival and complication analyses of avulsed and replanted permanent teeth. Sci Rep 2020; 10:2841. [PMID: 32071357 PMCID: PMC7028940 DOI: 10.1038/s41598-020-59843-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/10/2020] [Indexed: 12/02/2022] Open
Abstract
This retrospective clinical study investigated the survival probability of avulsed and replanted permanent teeth in relation to functional healing, replacement and inflammatory resorption. The explorative data analysis included data from 36 patients and 49 replanted permanent teeth with a minimum observation time of 60 days; the patients were generally treated according to the current guidelines of the International Association of Dental Traumatology at the university hospital in Munich, Germany, between 2004 and 2017. The mean observation period was 3.5 years. Functional healing was observed in 26.5% (N = 13/49) of the included avulsion cases. In comparison, replacement resorption affected 51.0% (N = 25/49) of the replanted teeth, of which 24.0% (N = 6/25) were lost over the course of years (mean, 6.1 years). In contrast, inflammatory resorption resulted in the early loss of all replanted teeth (mean, 1.7 years) and affected 22.5% (N = 11/49) of all the monitored teeth. Therefore, it can be concluded that tooth avulsion remains a severe dental injury with an unpredictable prognosis. This topic demands further fundamental research aiming to maintain and/or regenerate the periodontal ligament after tooth avulsion, particularly in association with non-physiological tooth rescue.
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Affiliation(s)
- Daniel David Müller
- Department of Conservative Dentistry and Periodontology, School of Dentistry, Ludwig-Maximilians Universität, München, Munich, Germany
| | - Ricarda Bissinger
- Department of Conservative Dentistry and Periodontology, School of Dentistry, Ludwig-Maximilians Universität, München, Munich, Germany
| | - Marcel Reymus
- Department of Conservative Dentistry and Periodontology, School of Dentistry, Ludwig-Maximilians Universität, München, Munich, Germany
| | - Katharina Bücher
- Department of Conservative Dentistry and Periodontology, School of Dentistry, Ludwig-Maximilians Universität, München, Munich, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, School of Dentistry, Ludwig-Maximilians Universität, München, Munich, Germany
| | - Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, School of Dentistry, Ludwig-Maximilians Universität, München, Munich, Germany.
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