Dento-alveolar and maxillofacial injuries: a 5-year multi-center study. Part 2: Severity and location

Regenerative endodontic therapy for external inflammatory lateral resorption following traumatic dental injuries: Evidence assessment of best practices

BACKGROUND

External inflammatory lateral resorption (EILR) following dental trauma is a severe complication that can lead to significant root loss and tooth extraction.

OBJECTIVE

The aim of this project was to review current evidence in the literature on regenerative endodontic therapy (RET) for EILR following traumatic injuries and assess the best treatment practices.

METHODS

Publications appearing in PubMed, from January 1, 2001 to January 9, 2022 were studied. Inclusion criteria were: (a) Publications in English; (b) Publications on RET and EILR; (c) Teeth subjected to dental trauma; and (d) Presence of intracanal bleeding and blood clots. Exclusion criteria were: (a) Conference proceedings; (b) Lectures; (c) Abstracts; and (d) Letters to editor; (e) Non-English publications.

RESULTS

355 publications were analysed. Nine met all inclusion criteria. In 10 (58.8%) teeth, triple antibiotic paste was used for an average of 26 days. Double antibiotic paste was used in 3 (17.6%) teeth for an average of 14 days. In 3 (17.6%) cases, calcium hydroxide (Ca(OH)₂ ) was used for 14 days and negative pressure irrigation was applied once on 1 (6%) tooth.

DISCUSSION

Using RET to treat EILR has some advantages compared to long term CA(OH)₂ dressing. RET requires shorter dressing time compared to CA(OH)₂ . This can significantly improve patient compliance. Additionally, in immature teeth, RET helps to arrest root resorption leading to continued root maturogenesis and revascularization. It is recommended that a meticulous follow-up should be conducted when RET is performed to assure early detection of treatment failure.

CONCLUSIONS

RET appears to be a good treatment modality producing biologic repair and improving prognosis in cases of EILR in post-traumatic tooth/pulp injuries. The key limitation of this study is that all publications included were either case reports or case series that usually tend to report successful outcome.

What Are Possible Contributors to Associated Dental Injury in Mandibular Fractures?

PURPOSE

Among previous reports on dental injuries associated with mandibular fractures, there are few investigating the conditions under which dental injuries commonly occur. The aim of this study was to determine specific characteristics of mandibular fractures accompanied by dental injuries.

METHODS

This retrospective cohort study included dentate patients with mandibular fractures treated at a tertiary trauma center between 2011 and 2019. The data were analyzed according to 2 outcome variables: patients with additional dental injuries and patients without. The predictor variables were patient age, sex, accident mechanism, number and location of mandibular fractures, and presence of submental lacerations. Odds ratios for the risk factors for dental injury were calculated in conjunction with descriptive statistics. Binary logistic regression analysis was also performed to identify the factors associated with dental injuries as dependent variables.

RESULTS

Of 252 patients who had only mandibular fractures, 95 (37.7%) had associated dental injuries. In the group with dental injuries, 55.8% of mandibular fractures were caused by a fall (P = .003). Condyle fractures (77.9%) with dislocation (67.6%) and bilateral involvement (41.9%) were more common than in the group without dental injuries (P < .001). In patients with dental injuries, the incidence of 3 or more fractures (29.5%) was significantly higher than in the group without dental injuries. Dental injuries were more likely to occur in patients with concomitant submental lacerations (confidence interval (CI) 1.135-4.983, P = .02), and the risk of dental injury was significantly lower in the presence of angle fractures (CI 0.113-0.999, P = .045).

CONCLUSIONS

A frontal impact involving the anterior part of the mandible is often associated with condyle and multiple mandibular fractures. This seems to be the typical mechanism for concomitant dental injuries. Submental laceration can be considered a prime sign of associated dental injuries.

Complex Dentoalveolar Fractures: Main Clinical Variables Description and Analysis

AIMS AND OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Prosthetic, orthodontic and implant-supported rehabilitation of five maxillary anterior teeth with alveolar bone loss

INTRODUCTION

Treatment of maxillofacial injuries is complex and requires the establishment of a comprehensive and accurate diagnosis and correct treatment planning.

OBJECTIVE

The objective of this case report was to describe the re-treatment of a 27-year-old woman who was involved in a severe car accident that resulted in the loss of five anterior teeth and alveolar bone, and whose previous orthodontic and surgical treatments had been unsuccessful.

CASE REPORT

In this case, the space for the missing mandibular molar was reopened to allow for rehabilitation. The positions of the mandibular incisors were improved. The right mandibular canine was moved to the mesial, allowing for correction of the Class II canine relationship on that side, and implants were placed to replace the maxillary anterior teeth.

CONCLUSION

Anterior aesthetic and functional rehabilitation using a multidisciplinary approach was essential to improve the patient's facial aesthetics, to obtain great improvement in function and to achieve occlusal stability after 2 years of follow-up.

Evaluation of Dentoalveolar Trauma in Children and Adolescents: a Modified Classification System and Surgical Treatment Strategies for Its Management

OBJECTIVE

To retrospectively analyze dentoalveolar trauma in pediatric patients, propose a modified classification, and delineate an approach for its urgent care from the surgeon's perspective.

PATIENTS AND METHODS

Clinical records of patients, attended at the 'A. and P. Kyriakou' Children's Hospital Department of Oral and Maxillofacial Surgery from 2000 to 2015, were retrieved and data were analyzed.

RESULTS

A total of 365 cases of dentoalveolar trauma, affecting 363 children and adolescents (221 males and 142 females), with an age range from 1 to 15 years, were treated in the authors' department. The most common injury mechanism was falls. The trauma was graded as class II in most patients (41.65%). The anterior maxilla was injured in the majority of the patients (78.35%). In 230 patients (63%) the trauma involved the primary dentition. Two hundred eighty-nine of the patients were treated with local anesthesia on an emergency basis, while in the rest 76 patients general anesthesia was considered mandatory.

CONCLUSIONS

Accurate diagnosis, timely treatment, and follow-up are critical for the management of dentoalveolar trauma in pediatric patients. A modified more detailed and severity-specific classification and guidelines for its surgical management may assist practitioners in decision making and effective treatment planning.

Maxillofacial Trauma Following Road Accidents and Falls

INTRODUCTION

Motor vehicle accidents (MVA) and falls are major causes of maxillofacial injuries posing real challenges for the medical staff.

PURPOSE

To describe the demographic and injury characteristics, as well as the treatment procedures of casualties diagnosed with maxillofacial injuries.

METHODS

The investigators implemented a multicenter retrospective study composed of hospitalized maxillofacial trauma patients recorded in the Israel Trauma Registry for 2000 to 2011. The predictor variable was mechanism of injury and the outcome variable was type of injury, severity, and hospital resources utilization. Descriptive and bivariate statistics with P values was set at 0.05.

RESULTS

The study included 11,592 reported hospitalized maxillofacial trauma patients (39.4% of them were MVA, 33.5% were falls), with a male predominance of a 3:1 ratio. The high-risk age groups were the first 3 decades of life in both etiologies, while age groups above 75 years were also frequent in falls. Severity of maxillofacial injuries, multiple injuries, admission to intensive care units, hospitalization for more than 15 days, inpatient mortality, and rehabilitation after discharge was significantly higher in MVA compared with falls. Conversely, maxillofacial surgeries were performed slightly more among patients injured in falls (34.1% and 31.1% respectively), as tongue and mouth are more prone targets in falls, compared with zygoma, maxilla, mandible, and teeth in MVA.

CONCLUSION

The results of this study suggest that the etiologies present an entire separate pattern of trauma. A better understanding and proper identification of their high-risk groups should lead to appropriate prevention programs and treatment protocols.

Alveolar Bone Fracture: Pathognomonic Sign for Clinical Diagnosis

Aim:

Dental injuries, especially luxation and avulsion, are common. Dental trauma can cause alveolar bone fracture that can lead to tooth loss and malocclusion. Single tooth alveolar bone fractures are difficult to identify unless it protrudes through the overlying mucosa and can be visualized. Pain, malocclusion, and tooth mobility provide signs of suspected alveolar bone fractures. Integrity of the proximate alveolar bone should be examined for fractures where avulsion, luxation, or other tooth trauma is detected. Any suggestion of alveolar fractures should be further investigated with an appropriate radiograph.

Summary:

This case report shows a pathognomonic sign that detects and diagnosis single tooth alveolar bone fractures, i.e., a localized hematoma crossing the attached gingiva from the free gingival margin to the vestibular mucosa. This should serve as a warning for localized alveolar bone fracture.

A visualized hematoma and gentle, careful palpation may help detect covered fractures when the overlying mucosa is not perforated.

An 11-year review of dental injuries associated with maxillofacial fractures in Turin, Italy

INTRODUCTION

The aim of the study was to analyze the incidence, characteristics, and correlations between maxillofacial fractures and dental injuries in patients who were treated at a first-level trauma center in a metropolitan center in northwest Italy in the last 11 years.

MATERIAL AND METHODS

Between January 1, 2001 and December 31, 2011, 2,110 patients with maxillofacial fractures were admitted. Only dentulous patients with complete clinical records who presented with associated dental injuries were included in this study. Data on the age, gender, mechanism of injury, damaged tooth, type of dental injury, site of facial fractures, and concomitant injuries were recorded.

RESULTS

On the whole, 267 patients (13.1%), mainly males aged 20-29 years, presented with 759 dental injuries associated with maxillofacial fractures, especially following motor vehicle accidents. The maxillary teeth, most often the anterior elements with decreasing involvement from the incisors to the molars, were the teeth most frequently damaged overall. The main types of dental trauma in patients with maxillofacial fractures were luxations and dental fractures.

DISCUSSION

Our findings show that patients with mandibular fractures were statistically and significantly associated with dental injury, and the teeth in the upper jaw were the most frequently injured teeth, exhibiting mainly luxations and crown fractures. Confirmation of the predominant impact site in patients with dental injuries associated with maxillofacial fractures comes from the 177 lacerations noted in the chin and lip regions in 267 patients.

Applying extrusive orthodontic force without compromising the obturated canal space

BACKGROUND

Complicated tooth fractures can be the unfortunate result of orofacial trauma and can offer a therapeutic challenge for the dentist. A conservative solution for gaining supragingival sound tooth structure often includes orthodontic forced eruption. Usually, this procedure is carried out by applying extrusive force after placing a provisional acrylic Richmond crown on the tooth. However, this long-lasting dental treatment may jeopardize the coronal seal of the root canal space, leading to microleakage and endodontic failure.

CASE DESCRIPTION

Orthodontic forced eruption demands application of force to an attachment connected to the remaining short clinical crown. In this article, the authors describe a case in which they used a new technique for orthodontic forced eruption of a traumatized tooth, using an extracanal attachment to apply extrusion force, and discuss its possible advantages and limitations.

CONCLUSIONS

An extracanal attachment approach for orthodontic forced eruption without compromising the obturated canal space can be a solution for posttraumatic crown fracture. Practical Implications. The described procedure for forced eruption by using an extracanal pin attachment is efficient and convenient and does not require the clinician to apply force directly to the provisional crown. Therefore, during the application of force, there is less risk of loosening the provisional crown, and the canal space is kept intact with either the final restoration or dressing material.

Analysis of 627 hospitalized maxillofacial-oral injuries in Xi'an, China

BACKGROUND

Maxillofacial-oral injuries is a serious health problem in China. The main aetiologic factors and types of maxillofacial-oral injuries differ according to different geographical areas and socio-economic statuses of populations in different countries or within the same country.

AIM

The aim of this study was to analyze the types and external causes of maxillofacial-oral injuries among hospitalized patients in Xi'an, China, and thereafter to determine the status of maxillofacial-oral injuries in this region and to provide clinical clues for a future prevention of these injuries.

MATERIAL AND METHODS

Totally, 627 patients aged 3-64 years with maxillofacial-oral injuries, who were hospitalized in two public stomatological hospitals in Xi'an from 1 January 2008 to 31 December 2008, were included in this study. The types and external causes of injuries were analyzed in terms of age, gender and urban and rural location.

RESULTS

The results showed that jaw fractures (n = 406, 64.8%) and contusion/laceration injuries (n = 161, 25.7%) were the most frequent injuries. Injuries were 4.6 times more common in males than in females. Most maxillofacial-oral injuries occurred in those aged 18-59 years (71.1%), with a peak incidence in the 15- to 39-year-old group (31.4%). The proportion of patients from urban areas (45.5%) was lower than that from rural areas (54.4%). Regardless of gender, age and location, vehicle traffic accidents was the most common cause (n = 263, 41.9%), followed by falls (n = 109, 17.2%) and fighting-induced injuries (n = 87, 13.9%).

CONCLUSIONS

Preventive strategies for maxillofacial-oral injuries due to traffic accidents should be emphasized and promoted in the first hand, especially for males, rural residents and those aged between 18 and 59 years.

Etiology, diagnosis, and characteristics of facial fracture at a midwestern level I trauma center

Study purpose was to describe facial fracture frequency, demography, injury characteristics, and diagnostic modalities at a Midwestern level I trauma center. A retrospective review was conducted on a Midwestern trauma center registry for years 2008 and 2009. Patient and injury data were collected along with diagnostic modality for facial fracture patients. Comparative statistics were conducted on the basis of the number of facial fractures, route of admission, presence of traumatic brain injury, and gender. There were 154 patients diagnosed with 443 facial fractures, representing 5% of the trauma population. Median patient age was 45 years. Median number of fractures was 2. Fractures were frequently present in orbit (32%), malar bone and maxilla (26%), and the nasal bones (19%). Motor vehicle crash was the most common mechanism (47%). Most fractures were diagnosed with maxillofacial computed tomography (78%). Males had an odds ratio of 2.5 (95% confidence interval, 1.15-5.43) for multiple facial fractures and composed 67% of the sample. Traumatic brain injury was diagnosed in 71% of patients. This study of a medium-sized city and its surrounding rural areas revealed differences from studies in large urban centers. Differences included lower gender ratio, older average age, and mechanism of injury. While urban trauma centers report assault as a leading cause of facial fracture, this study noted higher frequencies of motor vehicle crash and falls and fewer assaults.