Sequelae of trauma to primary maxillary incisors. I. Complications in the primary dentition

Risk of Healing Complications Following Alveolar Process Fractures in the Primary Dentition: A Retrospective Clinical Cohort Study

BACKGROUND/AIM

Alveolar bone process fractures in preschool children are not well documented in the literature. Alveolar process fractures are located very close to primary teeth and permanent tooth germs. This study investigates the risk of healing complications following alveolar process fractures in the primary dentition and potential sequelae in the permanent dentition.

MATERIALS AND METHODS

A retrospective cohort study was conducted involving 21 patients with 49 primary teeth involved in an alveolar fracture. The follow-up protocol included clinical and radiographic examinations at specified intervals up to the age of 6 years. Healing complications in the primary teeth such as pulp necrosis, pulp canal obliteration, ankylosis, infection-related resorption and premature tooth loss were examined. Sequelae in the permanent dentition was also registered when the permanent incisors had erupted.

RESULTS

Over a 3-year follow-up, the incidence of premature tooth loss was 51.2% [95% CI: 34.1%-68.4%], pulp canal obliteration was 42.5% [95% CI: 27.1%-57.8%], and pulp necrosis was 8.9% [95% CI: 0.6%-17.3%] following an alveolar process fracture. No cases of ankylosis were observed. Sequelae in the permanent dentition primarily included demarcated opacities and hypoplasia with a risk estimated at 24% [95% CI: 13%-39%] and 9% [95% CI: 2%-21%] respectively.

CONCLUSION

Alveolar process fractures in primary dentition are associated with several healing complications in the primary teeth. Although the likelihood of severe complications in the permanent dentition is low, young children are still susceptible to developing sequelae in their permanent teeth. These results highlight the importance of awareness of dental injuries following alveolar process bone fractures in the primary dentition.

Biogenic Tooth-Integrated Fixed Functional Space Maintainer for Pediatric Use: A Novel Approach

Preschoolers frequently experience traumatic dental injuries, particularly during their two to four years of life. The majority of these injuries result in tooth avulsion because of the alveolar bone resiliency around the primary teeth. This study explains an instance of damage sustained during play that resulted in an early knockout of the primary incisor. Hence, a biogenic tooth-integrated space maintainer was created using the natural crown of the traumatized tooth, and the child was asked to come for a regular follow-up. This treatment may be viewed as a great alternative for natural aesthetic rehabilitation as it promotes speech development, improves oral cleanliness, restores aesthetics and masticatory function, and inhibits the development of aberrant tongue habits and malocclusions.

Effective Management of a Tooth Eruption Bulge: A Comprehensive Case Report

An eruption bulge is a swelling or an enlargement below the gumline due to the eruption of a tooth. Radiographic images would also illustrate the fact that there may be the presence of a successor tooth (unerupted or unimpacted) under the bulge of the gingiva. Teething refers to the sequence of growth and appearance of the primary as well as permanent teeth within the oral region that varies according to age. A tooth eruption bulge is a lump that occurs due to the eruption of the teeth in the gum tissue. The appearance of the bulge varies according to the amount of fluid or blood present in this engorged organ. It is important to focus on the fact that the dentist will always be able to notice any changes and solve the issue when it comes to the check-ups, which should take place on a regular basis. Parents need to be aware of the possible adverse effects of trauma on primary incisors on the eruption as well as the health of its permanent successors. They need to watch and tell about any oral changes or conditions their child may have, like pain, color change, and swelling as this may tell of something negative to their dentition. Such a condition can only be managed using a multi-disciplinary team that includes a pedodontist, an orthodontist, and in severe cases an oral surgeon who will have to deal with the long-term sequelae of dental trauma. This is why it is necessary to educate them on these matters because then they can be proactive.

Predictors for Dental Intervention in Children After Dental Injury: A Retrospective Analysis and Literature Review

OBJECTIVE

This study aimed to explore risk factors for dental intervention in patients presenting to the pediatric emergency department (PED) after dental injury.

METHODS

We retrospectively explored patients aged 0 to 18 years who presented to our PED between 2017 and 2021 after dental injury.

RESULTS

Of the total of 830 patients (mean age 7.1 ± 3.9 years, 589 [71.0%] male patients), 237 (28.5%) required dental intervention. All patients with alveolar fractures and those with involvement of permanent teeth with extrusive luxation mandated urgent dental consultation. Additional independent predictors for dental intervention for primary tooth injury were: root fracture (adjusted odds ratio [aOR] 38.4; 95% confidence interval [CI], 3.95-373.22; P = 0.002), facial bone involvement (aOR 12.40; 95% CI, 2.33-65.93; P = 0.003), lateral luxation (aOR 6.9; 95% CI, 4.27-11.27; P < 0.001), extrusive luxation (aOR 6.44; 95% CI, 2.74-15.14; P < 0.001), and avulsion (aOR 2.06; 95% CI, 1.23-3.45; P = 0.006). Additional independent predictors for permanent tooth injury were lateral luxation (aOR 27.8; 95% CI, 6.1-126.6; P < 0.001) and avulsion (aOR 6.8; 95% CI, 2.9-15.9; P < 0.001).

CONCLUSIONS

Alveolar fracture is a severe dental injury, requiring intervention, for primary and permanent teeth injuries. Tooth luxation with significant mobility or malocclusion, incomplete avulsion, a suspected root involvement, or facial bone injury in the primary teeth and tooth luxation (extrusive/lateral) and avulsion in the permanent teeth dictate urgent dental consultation and intervention. Clinical algorithms for dental injury management are suggested.

A Case Report of Fracture of the Segment of Maxillary Alveolar Process Involving Primary Incisors

Traumatic dental injuries (TDIs) have significant long-term consequences for the oral cavity's hard and soft tissues. Alveolar process fractures are particularly complicated. This case report describes the management and 12-month follow-up of a segmental maxillary alveolar process fracture involving laterally luxated primary incisors. A case of a 4-year-old boy was reported to the hospital 1 hour after an accidental fall at school, which resulted in a fracture of the maxillary alveolar process. Emergency treatment consisted of fracture reduction and repositioning of the primary incisors, followed by a semirigid splint between maxillary canines. The splints were removed at the end of week 4, and the affected primary incisors remained asymptomatic.

The risk of healing complications in primary teeth with root fractures: A retrospective cohort study

BACKGROUND/AIM

Primary teeth are frequently affected by traumatic dental injuries. Root fractures are rare and have a reported incidence of 2% in the primary dentition. Hence, there is limited evidence on this topic. This study aims to evaluate the risk of healing complications in primary teeth with root fracture and to identify possible sequelae in the permanent dentition following root fracture in the primary dentition.

MATERIALS AND METHODS

A retrospective analysis of a cohort of 53 patients with 74 root fractured primary teeth. The standard follow-up program included clinical and radiographic examination after 4 weeks, 8 weeks, 6 months, and 1 year after the trauma and when the patient was 6 years of age. The following complications were registered: pulp necrosis (PN), pulp canal obliteration (PCO), ankylosis with replacement root resorption (ARR), infection-related root resorption (IRR), premature tooth loss (PTL), and repair-related resorption (RRR).

STATISTICS

The Kaplan-Meier and Aalen-Johansen estimators were employed. The level of significance was 5%.

RESULTS

A total of 74 teeth were included. 42 teeth were extracted at the initial examination. Risks estimated after 3 years: PTL 45.9% [95% CI: 28.8-63.0], PCO 12.9% [95% CI: 2.3-23.4], PN 14.9% [95% CI: 3.9-25.9], RRR 2.6% [95% CI: 0.0-7.5]. No teeth showed ARR or IRR. All complications were diagnosed within the first year. Most common sequelae in the permanent dentition was demarcated opacities, with an estimated risk of 20% [95% CI: 8.2-41.3].

CONCLUSIONS

There is a low risk of healing complications following a root fracture in the primary dentition. Root fractures often result in early extraction of the coronal fragment. The remaining apical fragment will undergo a physiological resorption. Aside from opacities, there is a low risk of sequelae in the permanent dentition.

Biodentine™ Pulpotomy in Stage I primary Molars: A 12-month Follow-up

Aim

This study aims to evaluate, over 12 months of clinical and radiographic follow-ups, the performance and outcomes of Biodentine™ pulpotomy in stage I primary molars.

Materials and methods

A total number of 20 stage I primary molars requiring pulpotomy were selected from eight healthy patients aged between 34 and 45 months. Patients presenting a negative attitude toward dental treatment on the dental chair were scheduled for dental treatments under general anesthesia.Pulpotomy with Biodentine™ as a pulp-dressing material was performed on all selected molars. The patients were called back at 1 and 3 months for clinical follow-ups, then at 6 and 12 months for clinical and radiographic follow-ups. Data were tabulated according to follow-up intervals and occurrence of any changes in root maturation, pulp canal obliteration (PCO), periodontal ligament space (PLS), and bone or root lesion.

Results

No statistically significant differences were recorded at 1, 3, 6, and 12 months. There was a statistically significant increase in number of roots with closed apices from six roots at 6 months to 50 roots at 12 months (p < 0.0005) and the PCO was present in all 50 roots at 12 months, after it was present in 36 roots only at 6 months (p = 0.0001).

Conclusion

This is the first randomized clinical trial that evaluates the performance of Biodentine™ as a pulp-dressing agent in stage I primary molar pulpotomy over 12 months of follow-up. Contrary to previous studies, the present work highlights the continued root formation and apical closure (AC) in pulpotomized immature primary molars.

How to cite this article

Nasrallah H, Noueiri BE. Biodentine™ Pulpotomy in Stage I primary Molars: A 12-month Follow-up. Int J Clin Pediatr Dent 2022;15(6):660-666.

Knowledge, attitude, and practice of autotransplantation among the practicing pediatric dentists in Chennai - A questionnaire study

Background

Autotransplantation is a minor surgical procedure which involves transplantation of teeth within the same oral cavity. For children, autotransplantation may be considered as a provisional measure with good survival probability. It offers a viable biological approach for replacing the missing teeth and also for orthodontic treatments in children.

Aim

The aim of this study is to assess the knowledge, attitude, and practice of autotransplantation among pediatric dentists in Chennai, India.

Methods

An 18-item questionnaire was developed, piloted, and distributed among 100 practicing pediatric dentists in Chennai, India. Descriptive statistical analysis was done using Chi-square test.

Results

Seventy valid responses from the practicing pediatric dentists were obtained. Among them, 39.7% had an experience of 5-10 years, 47.1% practiced less than 5 years, and 13.2% had experience more than 10 years. Analysis of the responses showed that 76.5% of the pediatric dentists were aware of the procedure but have not observed autotransplantation being done. Among the respondents, 95.6% have not performed this technique and 40.6% of them were not sure of the prognosis. Atraumatic extraction of donor tooth was considered to be a major limitation in autotransplantation by 41.8% of the pediatric dentists. From the responses received, 95.6% were interested in gaining more information with majority opting for more hands on workshops on the technique of autotransplantation.

Conclusion

Though most of the respondents were aware of autotransplantation procedure, they have not practiced it due to inadequate training.

Root Fractures in the Primary Teeth and Their Management: A Scoping Review

(1) Background: Traumatic dental injuries constitute a major global health problem. Primary deciduous teeth of the upper frontal group are frequently affected by trauma, especially at an early age. It is important to treat primary traumatic injuries because early tooth loss can lead to aesthetic and functional alterations. The most common injuries are extrusion, lateral luxation, and intrusion. Root fracture is a less common complication that can lead to tooth extraction if not properly diagnosed and managed. However, there are a lack of data regarding primary root fracture treatment. The literature was reviewed to study the current knowledge on the treatment of these injuries, and to propose an operative protocol based on the results obtained. (2) Methods: A literature search was performed on Web of Science, PubMed/MEDLINE, and SCOPUS. The research focused on the following features: age of the patient; localization of the root fracture and type of displacement suffered (intrusive, extrusive, or lateral); type of emergency treatment or diagnostic test performed and their compliance with IADT guidelines; follow-up duration. (2) Results: Only 8 articles fully met the inclusion criteria, with a total of 46 patients and 62 root fractures. Out of a total of 62 root fractures, regarding only upper incisors, the most common treatment was splinting (n = 39) for a period ranging from 3 weeks to 3 months (with an average of six weeks). No treatment was performed for 23 of the root fractures. The splinting performed in most of the included cases was semi-rigid, with the splint held in place using a composite resin material. An orthodontic splint using brackets and 0.5 mm stainless steel wire was used in only in one study. (4) Conclusions: We deduced that the root fracture of primary teeth is a rare traumatic dental injury that can cause numerous complications, such as eruptive problems in the permanent teeth. Correct radiological diagnosis, immediate repositioning and semi-rigid splinting could be conservative methods to prevent premature tooth loss in very young patients.

Prevalence of sequelae after traumatic dental injuries to anterior primary teeth: A systematic review and meta-analysis

BACKGROUND/AIM

Clinical and radiographic sequelae are common following traumatic dental injuries to primary teeth. The aim of this systematic review was to assess the prevalence of such sequelae.

MATERIALS AND METHODS

Searches were conducted in the PubMed, Scopus, Embase, Web of Science, and BBO/LILACS databases as well as the gray literature. The outcome of interest was the prevalence of the most common sequelae following traumatic dental injuries to anterior primary teeth. Observational studies that evaluated such sequelae were included. Data were extracted, and methodological quality was appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. The number of sequelae per tooth and the total number of teeth evaluated in each study were considered to calculate pooled prevalence rates with 95% confidence intervals (CI). The quality of the evidence was determined using the GRADE approach.

RESULTS

Twenty-five articles were included in this systematic review and meta-analysis. The prevalence of each complication in descending order was as follows: 39.7% crown discoloration (95% CI: 29.52-50.32), 24.3% pulp necrosis with infection (95% CI: 17.34-32.06), 16.2% periapical radiolucency (95% CI: 8.88-25.49), 15.9% premature tooth loss (95% CI: 9.93-23.15), 14.8% pulp canal obliteration (95% CI: 8.46-22.73), 11.9% pathological root resorption (95% CI: 7.68-16.98), 7.1% abscess/fistula (95% CI: 4.4-10.6), and 1.8% ankylosis (95% CI: 0.82-3.17). The certainty of the evidence was very low.

CONCLUSIONS

Crown discoloration was the most common sequela in injured primary teeth, but this should be interpreted with caution due to the very low certainty of the evidence. Considerable variation was found in the prevalence of each sequela.

Prognosis of primary teeth following intrusive luxation according to the degree of intrusion: A retrospective cohort study

BACKGROUND/AIM

The degree of intrusion is an important aspect to be evaluated when treating children following intrusive luxation. The aim of this retrospective cohort study was to evaluate re-eruption rates and the occurrence of sequelae in intruded primary teeth according to the degree of intrusion.

MATERIAL AND METHODS

A total of 238 teeth from 168 patients diagnosed with and treated for intrusion over a 16-year period at a specialized trauma center in South Brazil were included in this study. Patient details, including demographic characteristics, tooth affected, presence of sequelae of trauma during the follow up (pulp necrosis and infection, crown discoloration and abnormal mobility), and any effects on the permanent successors, were collected from their records. Photographs were analyzed to determine the degree of intrusion (Grade I, II, or III) and spontaneous re-eruption during follow up. Re-eruption and occurrence of sequelae according to the degree of intrusion were evaluated using the chi-squared test. The level of significance was set at 5%.

RESULTS

Most teeth were maxillary central incisors (87.8%) with Grade I intrusion (32.8%). In the first 30 days, 13.1% had signs of re-eruption. After 3-6 months, the frequency of re-eruption increased to 58.7%. Of the teeth evaluated 6 months or more after intrusion, 68% had re-erupted. Total intrusion (Grade III) was associated with pulp necrosis and infection (p = .002), but the degree of intrusion was not associated with the presence of crown discoloration or abnormal mobility. Of the 78 permanent successors evaluated, 52.6% had developmental disturbances.

CONCLUSION

Most intruded primary teeth re-erupted spontaneously, and the degree of intrusion was associated with a worse prognosis.

Dental trauma characteristics in the primary dentition in Greifswald, Germany: a comparison before and after German unification

BACKGROUND

The data on the distribution and pattern of dental trauma in the primary dentition are very rare.

AIM

To investigate primary dental trauma patterns in relation to gender, age, time and cause for a recent paediatric cohort and to compare this with a historic one before German unification.

METHODS

This retrospective study compared the patterns of dental trauma injuries at the trauma centre at Greifswald University/Germany for a recent paediatric cohort (2014-16, 103 children) with a historic one (1974-1989, n = 120). The data contained details on etiology, injury types and treatment delivered for 450 injured teeth (247 historic, 203 recent).

RESULTS

In both cohorts, the occurrence was more common in males than females (63%/55%, resp.) with an age peak from 2 to 6 years. Maxillary incisors were most affected (89.6%/88.6%, resp.) and periodontal ligament injuries dominated (77.8%/90.3%, resp.). Almost half of the injuries occurred at home (46.6%), mostly due to falling (48.5%) or during playing (37.8%) in the recent paediatric cohort which provided better forensic data due to insurance issues and potential concern about child abuse. Advice and follow up was the most common approach in the recent paediatric cohort (76%).

CONCLUSION

Even after 30 years and a change in the health care system due to German unification, the patterns of dental traumatic injuries in the primary dentition were similar.

Traumatic intrusion of primary tooth: a case Report

Introduction: Anterior teeth are of utmost importance with regard to chewing, speaking, and beauty. Therefore, any traumatic dental injury has psychologically undesirable effects on children and their parents. The present study reported a case of a traumatic dental injury induced by falling off a chair and referral to an emergency department as well as measures taken for dental reconstruction and patient's improvement. Case Report: Parents with a 3-year-old girl came to the Clinic for Pediatric and Preventive Dentistry at University Dental Clinic Center "St. Panteleimon", Skopje with injuries to her face and oral structures resulting from a fall from a chair. The extraoral examination revealed a laceration on the submental skin surface and an injury to the upper lip. The child was examined and it was found that the maxillary left primary central incisor was compressed in the alveoli. The surrounding soft tissue was injured. Intraorally, the anterior segment of the maxilla showed injury consistent with low-velocity blunt-force trauma, including several lacerations of the gingival tissues. The patient's maxillary left central incisor was intruded from the socket. Conclusion: The prognosis of many cases of dental injuries is time-dependent. The intrusion of a tooth can have ramifications and the possibility that it has been fully intruded should be considered. The use of a radiograph is of great importance for the correct diagnosis of deciduous tooth intrusion.

[Children's consultations for dental emergency. Retrospective study in Île-de-France]

BACKGROUND

In France, the children oral health status has improved but the use of care remains insufficient. The complexity of the acts, the access to care difficulties and the programs of prevention and care for children lack of knowledge contribute to late care and often, in emergency. This study aims to describe the young patients' characteristics consulting in dental emergency and analyse the modalities of recourse.

METHODS

A retrospective study was conducted on medical records. An extraction of data was carried out concerning all children under the age of 16, admitted to the Dental Emergency Functional Unit of the Pitié-Salpêtrière Hospital Group in 2015. Several variables of interest were analysed: socio-demographic characteristics, the time of the visit and the diagnostic category (tooth pathologies, facial trauma, infections, periodontal diseases and other emergencies). Descriptive and bivariate analyses were conducted.

RESULTS

On the 62,500 dental emergency consultations in 2015, 5359 were for patients under 16 years of age (8%). Data were available for 5044 children. Among these, children aged 6 to 11 accounted most of consultations (43.9%). There were more boys (57.2%). The most frequent emergency diagnoses were related to a tooth pathology (42.9%) and traumatic event (38.4%). Consultations were more held on the evening schedule on weekdays and the day on weekends. Patients aged 0 to 5 years consulted more at night (P<10^-3) and were, proportionally, the most affected by traumatic events (39.2%). Children aged 6 to 11 and 12 to 16 years consulted more often during the day (P<10^-3), for emergencies related to a carious event (43.9% and 43.6%). Patients residing in Seine-Saint-Denis accounted for 22.6% of total visits and those living in Paris accounted for 20.8%.

CONCLUSION

A large proportion of children presenting for dental emergencies, have most of the time, only the need for usual care. An offer of dental care, adapted to the territory needs, is necessary for the children dental health management. Preventive measures from an early age and early recourse would be favourable.

Pulp necrosis and crown discoloration: a systematic review and meta-analysis

BACKGROUND

The association between pulp necrosis and crown discoloration in traumatized primary teeth has not been clearly determined yet.

AIM

The study verified whether there is an association of pulp necrosis and crown discoloration in traumatized primary teeth through a systematic review and meta-analysis.

METHODS

A systematic literature search was conducted in PubMed/Medline, Lilacs/BBO, Scopus, Web of Science, Cochrane Library databases, and grey literature. A methodological quality assessment appraisal was independently conducted by two researchers. Random-effects models were employed, and heterogeneity was tested (I2 index/P ≤ 0.05).

RESULTS

Eight studies with low risk of bias were included in the analysis. A total of 1,494 traumatized primary teeth participated in the pooled meta-analysis. Diagnosis of pulp necrosis was evaluated in 1,414 teeth through clinical and/or radiographic analyses, and the analysis demonstrated a positive association (P = 0.0005/OR 8.37 [2.51, 27.90], I2  = 87%). Eighty teeth were diagnosed with pulp necrosis through endodontic access, and there was no statistically significant association (P = 0.36/OR 2.46 [0.36, 16.94], I2  = 54%). The pooled meta-analysis showed a positive association (P = 0.0003/OR 5.93 [2.24, 15.72], I2  = 83%).

CONCLUSION

The positive association between pulp necrosis and crown discoloration should be considered with caution once the diagnosis of pulp necrosis was performed by limited criteria.

A retrospective study of traumatic dental injuries in primary dentition: treatment outcomes of splinting

OBJECTIVE

Splinting in primary dentition is limited to several traumatic dental injuries. The prognosis associated with splint use has not been fully investigated. In this study, we investigated the outcomes of traumatic injuries in primary teeth treated with splinting.

MATERIALS AND METHODS

We retrospectively analysed 137 children with root fractures and lateral and extrusive luxation injuries to their primary teeth who were treated with semi-rigid splints between 2010 and 2016. Treatment outcomes were analysed in patients with follow-up periods of >6 months. The outcomes of splinting were based on clinical and radiographic evaluations performed during follow-up examinations.

RESULTS

In total, 182 primary teeth were examined, and of these, 90 teeth were treated using semi-rigid splints. In the splint group, pathological root resorption (31.1%) was the most common complication, whereas pathological tooth loss (25.0%) was found most common in the observation group. Splinting in root fractures showed a good prognosis, whereas in lateral and extrusive luxations, it did not (p < .05). There were no relationship between treatment delay and prognosis (p > .05).

CONCLUSIONS

Depending on the type of luxation, splint therapy results in acceptable outcomes and may be a feasible treatment option.

IMPACT OF DENTAL TRAUMA AND ESTHETIC IMPAIRMENT ON THE QUALITY OF LIFE OF PRESCHOOL CHILDREN

OBJECTIVE

To evaluate the impact of dental trauma and impaired esthetics on the quality of life (QoL) of preschool children and their relatives.

METHODS

Study conducted with 192 children aged 2 to 5 years in 11 preschools in Florianópolis, Santa Catarina, South of Brazil. Parents/caregivers completed a questionnaire on quality of life (Brazilian version of the Early Childhood Oral Health Impact Scales - B-ECOHIS), a socioeconomic survey, and then answered specific questions related to dental trauma. The subjects were examined by three accordant examiners (Kappa>0.7). Dental trauma was evaluated on the basis of indexes adopted by the World Health Organization, and esthetic impairment was then classified. Data were descriptively analyzed and put to bivariate analysis by chi-square and Fisher tests, with significance level at 5%.

RESULTS

The prevalence of dental trauma was 62.5% with 15.6% of esthetic impairment. Almost 12% of parents reported impact on the quality of life of their children. Dental trauma was not significantly associated with gender, age or QoL. Crown color change by trauma was associated with esthetic impairment. Also esthetic impairment had a negative impact on QoL (p<0.05) and was associated with oral limitations (p<0.05).

CONCLUSIONS

Esthetic impairment had a negative impact on children's quality of life, while dental trauma was not associated to it.

Eva Vacuum-Formed Alternative Splinting of Alveolar Fractures in Primary Dentition: A Case Report

Alveolar fractures treatment includes repositioning of displaced segments and splinting. In children, splinting procedures may occasionally present clinical problems resulting from fewer teeth available for splinting or presence of occlusal disturbances. An alternative clinical approach for splinting in alveolar fractures of primary dentition is described.

CLINICAL CASE

A 4.5-year-old girl was referred to our clinic 8 hours after a fall accident. Clinical examination revealed mandibular alveolar process segmental fracture in the right canine area with frontal dislodgement of the labial cortical bone resulting to occluding inability. The area was anaesthetized, cleaned and the dislodged bone was manually repositioned, followed by an EVA copolymer splint for fixation as a result of patient's deep bite impeding regular wire-composite splint. The cap splint that was fabricated on a cast made after an alginate impression, was set on the mandibular dentition and immobilized in the primary molars with acid-etch adhesive and flowable resin composite. Following splint removal after 4 weeks and follow-up visits, successful healing was observed clinically and radiographically with no pathological signs and symptoms.

CONCLUSION

The described alternative splinting method in alveolar fractures of primary dentition is a valuable clinical tool for peediatric dentists, easily accepted by children in cases where regular splinting methods cannot be used.

Delayed Treatment of Traumatized Primary Teeth with Distinct Pulp Response: Follow-Up until Permanent Successors Eruption

Complicated crown fracture and crown-root fracture with pulp involvement expose dental pulp to the oral environment. The pulp outcome is often unpredictable because the patient and injury which are related to variables can influence the treatment of choice and the prognosis of the case. This report presents the case of a 4-year-old boy with complicated crown fracture with pulp polyp in the primary right maxillary central incisor (51) and crown-root fracture with pulp involvement in the primary left maxillary central incisor (61), which was treated only 3 months after the tooth injuries. The treatment of choice was extraction of tooth (61) due to a periapical lesion with disruption of the dental follicle of the permanent successor and pulpotomy (MTA) of the tooth (51), because the pulp presented signs of vitality. At the follow-up visits, no clinical, symptomalogical, and radiographic changes were observed until the primary tooth's exfoliation. However, at 3-year follow-up, the permanent successors showed hypocalcification and the position of the permanent right maxillary central incisors (11) was altered. Besides the conservative and adequate delayed treatment, the sequelae on the permanent successors could not be avoided.

Dental Anomalies in Permanent Teeth after Trauma in Primary Dentition

OBJECTIVE

This retrospective study aims to evaluate the prevalence of dental anomalies in permanent teeth as a result of a trauma concerning the predecessor primary teeth.

STUDY DESIGN

A total of 241 records of children (118 males and 123 females, mean age 3.62 &plusmn; 1.40) affected by trauma on primary teeth were analyzed. All patients were recalled to evaluate the status of the permanent successor teeth by clinical and radiographic investigations.

RESULTS

Out of 241 patients, 106 patients (for a total of 179 traumatized primary teeth) presented at the recall. Dental anomalies on successor permanent teeth were detected in 21 patients (19.8%), for a total of 26 teeth (14.5%) and 28 anomalies. Anomalies of the eruptive process were the most observed disturbances (60.7%), followed by enamel hypoplasia (25%) and white spots (14.3%). A higher percentage of anomalies on permanent teeth was observed when trauma occurred at an age less than 36 months (38.5% of cases). Intrusive and extrusive luxation were related with the most cases of clinical disturbances in the successor permanent teeth.

CONCLUSIONS

The results of this study highlight the risk of dental anomalies after a trauma in primary dentition, especially in early-aged children and in case of intrusive luxation.

Osseo-gingival pathology as sequelae of dental trauma to the primary upper incisor: a case series

BACKGROUND

Osseo-gingival pathology (OGP) may be observed in traumatized primary teeth, and its knowledge is essential for treatment decision.

AIM

To describe the occurrence and treatment of OGP in traumatized primary upper incisors.

DESIGN

One examiner collected data from patients' charts of the Clinic of Trauma in Primary Teeth of the University of Sao Paulo. OGP was divided into apical fenestration (AF), total gingival recession (TGR), and partial gingival recession (PGR).

RESULTS

From 2516 charts, 61 patients (2.4%) presented 73 teeth with OGP (9.6% AF, 19.2% TGR and 71.2% PGR). OGP was observed in 63% of male and 43.8% of children aged 4-5 years old. Mean time between trauma and diagnosis was 15 months AF, 23.5 months TGR, and 7.5 months PGR. Periodontal trauma occurred in 86.3% of teeth with OGP. Pulp necrosis was observed in all cases of AF and 92.9% of TGR; however, 76.9% of PGR were vital. All teeth with AF and 85.7% of TGR were extracted, and 44.2% of PGR were monitored.

CONCLUSIONS

Osseo-gingival pathology has low occurrence in traumatized primary upper incisors. The treatment for AF and TGR is tooth extraction, and for PGR is tooth monitoring or extraction depending on the case severity.

Tooth loss and survival analysis after traumatic injuries in primary dentition

Background/Aim: The aim of the present study was to investigate the treatment options, survival rate of traumatized primary teeth and evaluate the factors influencing the outcome. Material and Methods: The sample consisted of all dental trauma cases treated over a 14 years period at the Department of Pediatric and Preventive Dentistry, Dental Clinic of Vojvodina, Novi Sad. Criteria for inclusion in this study were: dental trauma to primary teeth and age in the moment of injury up to seven years. Dental trauma records were analyzed in order to obtain the following: gender and age of the child at the time of trauma, type of trauma, as well as the type and timing of treatment received. After data analysis a survival rate of traumatized primary teeth was evaluated. Results: The study was designed as retrospective and it included 225 children, with 346 traumatized primary teeth. The occurrence of trauma was higher in male patients (60,4%) and in children up to 4 years of age. Luxations were more frequent (72.8%) compared to isolated teeth fractures (20.8%), while the two types of injury combined were rare (6,3%). One year following dental trauma 231 teeth (0.67%) developed complications. Falls were the main cause of trauma (68.9%) and the presence of more than one traumatized tooth was frequent. A percentage of 48.8 children received dental care during first 24 h after the injury. Conclusions: Survival of injured primary teeth is relatively low, regardless of trauma type, time interval between injury and treatment and the type of provided treatment.

Management and Sequelae of Intruded Anterior Primary Teeth: A Systematic Review

Objective

The objective of this systematic review is to analyze the various treatment modalities and sequelae of intruded anterior primary teeth.

Materials and methods

Electronic search in PubMed, Cochrane, and Science Direct databases was done. Hand search was performed using the reference list of chosen articles from electronic search. Three reviewers analyzed the articles independently, assessed the quality of the studies, and derived data.

Results

Ten case series were identified from the electronic and hand search. No randomized control studies were available. In the observational studies treatment of intruded primary teeth ranged from conservative management, which includes waiting for spontaneous re-eruption as well as repositioning to invasive procedure, such as extraction.

Conclusion

Spontaneous eruption is a treatment option of intruded primary teeth in absence of damage to a permanent tooth. Surgical repositioning of intruded primary teeth has also shown as a viable alternative treatment modality. Extraction to be performed if complications develop.

How to cite this article

Gurunathan D, Murugan M, Somasundaram S. Management and Sequelae of Intruded Anterior Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2016;9(3):240-250.

In Vitro Periodontal Ligament Cell Viability in Different Storage Media

Abstract The aim of this study was to evaluate the viability of periodontal ligament cells of avulsed teeth in three different storage media. Forty-five mature premolars extracted for orthodontic therapeutic purposes were randomly and equally divided into three groups according to the storage medium: milk (control), rice water and egg white. After placing extracted teeth for 30 min in storage media, the scrapings of the periodontal ligament (PDL) were collected in Falcon tubes containing collagenase in 2.5 mL of phosphate buffer saline and were incubated for 30 min and centrifuged for 5 min at 800 rpm. Cell viability was analyzed by Trypan blue exclusion. Rice water had a significantly higher number of viable cells compared to egg white and milk. There was no statistically significant difference between egg white and milk. Rice water may be able to maintain PDL cell viability of avulsed teeth better than egg white or milk.

The post-traumatic colour change of primary incisors: a colourimetric and longitudinal study

BACKGROUND

Tooth colour change after trauma has been described subjectively as ranging from yellow/pink to grey/black.

AIM

To investigate the longitudinal colourimetric change of post-traumatic discoloured primary incisor using an intraoral colourimeter.

DESIGN

A total of 34 primary incisors from 15 boys and eight girls were studied. The mean post-injury day during clinic visits (SD) and number of visit was 205.4 (194.8) and 3.9 (2.0). CIE L* (lightness), a* (green-red) and b* (blue-yellow) of the maxillary primary incisors were measured at every visit. The colour difference (ΔE*ab ) was calculated between the traumatized tooth and the control. Scatter graphs were made depicting the colour change of discoloured teeth and the ΔE*ab over time.

RESULTS

Mean CIE L*, a* and b* of the unaffected control were 80.8 (2.29), 0.9 (0.77) and 13.1 (2.67), respectively. L* gradually decreased to 70.7 (on day 71), then slowly recovered. a* increased to 3.7 (day 29) and decreased slowly. b* only demonstrated a small change that was within the control range during the follow-up. ΔE*ab increased to 9.58 (day 56) and decreased slowly.

CONCLUSION

The earlier recovery of a* was followed by the recovery of L*. During the post-traumatic period, ΔE*ab failed to reach the clinically acceptable threshold.

The prevalence of premature loss of primary teeth and its impact on malocclusion in the Eastern Province of Saudi Arabia

OBJECTIVES

The present study was designed to determine the prevalence of premature loss of primary teeth and its effect on malocclusion in Eastern Province, Saudi Arabia.

MATERIALS AND METHODS

This is an observational, cross-sectional study that included 307 male children aged 9-11 years old. Clinical examinations were performed using a disposable sharp explorer, a UNC periodontal probe and a dental mirror. The samples were examined clinically to detect the following traits: Angle's classification of malocclusion, overjet, overbite, anterior open-bite, lateral open-bite, midline shift and cross-bite. Additionally, a dental caries examination was performed using WHO methods. Questionnaires in Arabic were coded and sent to the students' parents.

RESULTS

The mean DMFT was 5.61 (SD = 3.01). The d-component was the highest, with a mean of 4 (SD = 2.83). Of the 307 children, it was found that 204 (66.4%) had a high DMFT score, which is defined as a score above 4. It was found that 156/307 (51%) children had premature loss of deciduous teeth.

CONCLUSION

A high prevalence of premature loss of teeth was found in this study. This finding emphasizes the importance of increasing awareness levels about this issue and focuses attention on the need for more preventive efforts to maintain healthy and normal dentitions that would improve the masticatory function and aesthetics of individuals and the whole population. In addition, the findings emphasize the importance of the early detection of premature loss of primary teeth to prevent future malocclusion.

Distinctive genetic activity pattern of the human dental pulp between deciduous and permanent teeth

Human deciduous and permanent teeth exhibit different developmental processes, morphologies, histological characteristics and life cycles. In addition, their pulp tissues react differently to external stimuli, such as the pulp sensitivity test, dental trauma and pulp therapy materials. These suggest differences in gene expression and regulation, and in this study we compared gene-expression profiles of the human dental pulp from deciduous and permanent teeth. Pulp tissues from permanent premolars and deciduous molars aged 11–14 years were extirpated and mRNA was isolated for cDNA microarray analysis, and quantitative real-time PCR (qPCR). Other teeth were used for immunohistochemical analysis (IHC). Microarray analysis identified 263 genes with a twofold or greater difference in expression level between the two types of pulp tissue, 43 and 220 of which were more abundant in deciduous and permanent pulp tissues, respectively. qPCR analysis was conducted for eight randomly selected genes, and the findings were consistent with the cDNA microarray results. IHC confirmed that insulin-like growth factor 2 mRNA-binding protein 1 (IGF2BP1) was broadly expressed in deciduous dental pulp tissue, but minimally expressed in permanent dental pulp tissue. Immunohistochemical analysis showed that calbindin 1 (CALB1), leucine-rich repeat-containing G-protein-coupled receptor 5 (LGR5), and gamma-aminobutyric acid A receptor beta 1 (GABRB1) were abundantly expressed in permanent predentin/odontoblasts, but only minimally expressed in deciduous dental pulp tissue. These results show that deciduous and permanent pulp tissues have different characteristics and gene expression, suggesting that they may have different functions and responses to therapies focused on pulp or dentin regeneration.

Dilaceration and Eruption Disturbances in Permanent Teeth: A Sequelae of Trauma to Their Predecessors-Diagnosis and Treatment Using Cone Beam CT

Alterations in the morphology of permanent teeth following trauma to their predecessors is a challenging task for diagnosis and it may require advanced imaging techniques. Newer imaging modalities have replaced the conventional radiological procedures, as they allow 3D reconstruction images and views which are free of superimposition. Cone Beam CT (CBCT) offers a three-dimensional view, which the conventional two-dimensional dental radiography fails to provide. The current article highlights the advantages of CBCT which are seen in evaluation of the morphological variations and eruptive disturbances in the permanent teeth, as sequelae to trauma in their predecessors.

Management of an intruded primary central incisor with a natural crown under general anesthesia

Tooth intrusion is the most common trauma during early infancy. Primary maxillary central incisors are the most affected teeth. There are a few treatment approaches which depend upon the severity of the trauma, and the treatment must be managed professionally. In this case report, a 3-year-old girl with a history of trauma 40 days before referring to our pediatric clinic is presented. Deciduous maxillary right central incisor was intruded through labial and alveolar socket and completely covered with soft tissue. The intruded deciduous incisor tooth was surgically extracted and impression was taken under general anesthesia. The removable partial prosthesis was completed by using the patient's own extracted tooth. Using natural crown on removable prosthesis gives psychological satisfaction to the patient and his/her family, and can be better tolerated since its shape, size, and color are exactly in harmony.

Predictive factors for pulp necrosis in traumatized primary incisors: a longitudinal study

BACKGROUND

This study aimed to assess factors associated with occurrence of pulp necrosis (PN) in traumatized primary incisors, which may contribute to the prognosis of this outcome.

DESIGN

Data were collected by single examiner through the analysis of clinical files of traumatized patients. The occurrence of PN in traumatized teeth was the evaluated outcome. Poisson regression analysis was applied to calculate the relative risk (RR) and the respective 95% confidence interval.

RESULTS

Five hundred and twenty-one files were assessed, summing up 727 traumatized primary incisors. The proportion of teeth affected by PN was 23.8%. Multiple regression analysis indicated the following factors as positively associated with PN: trauma with displacement, pulp exposure fracture, self-report of pain, yellow, grey and brown crown discoloration, internal root resorption, and bone loss. Trauma in 4- to 5-year old and more than 5-year-old children, pulp canal obliteration, and external root resorption with bone formation were negatively associated with PN.

CONCLUSIONS

Teeth that suffered more aggressive injuries, pain, some types of discoloration, and other radiographic findings (for instance, internal root resorption) are positively associated with the occurrence of PN. On the other hand, trauma in older children, canal obliteration, or external resorption show less probability of PN.

Radicular maturity level of primary teeth and its association with trauma sequelae

AIM

This study aimed to investigate the influence of the radicular maturity level of primary teeth on the sequelae of traumatic dental injury (TDI).

MATERIALS AND METHODS

A longitudinal retrospective study that collected data from dental records and radiographs of patients with TDI in one or both maxillary primary central incisors was conducted. Sequelae such as crown discoloration, pulp canal obliteration (PCO) and inflammatory root resorption (IRR) were evaluated during a 12- to 18-month follow-up period after the trauma.

RESULTS

Of the 132 patients included in the study, 103 (78%) had luxations and 29 (22%) had dental fractures. At the initial postinjury examination, 12 teeth (9.1%) were found to have immature roots, 107 (81.1%) had closed apexes and 13 (9.8%) had visible root resorption. Inflammatory root resorption occurred mostly in traumatized teeth that presented with physiological root resorption at the moment of trauma (P = 0.004). The frequency of PCO was higher in teeth with a closed apex at the moment of the injury (P = 0.026). There was also an association between the type of injury and the occurrence of crown discoloration (P = 0.008) as well as between the type of injury and the development of PCO (P = 0.001).

CONCLUSIONS

The occurrence of TDI sequelae can be determined by the type of injury as well as by the radicular maturity level of the primary teeth at the moment of injury.