Factors related to treatment and outcomes of avulsed teeth

Clinical Management of Orofacial Trauma Including Multiple Avulsions, Lateral Luxation, and Alveolar Fracture: A Case Report with 7-Years of Follow-Up

The occurrence of different types of trauma concomitantly can complicate the establishment of the most appropriate treatment. This report describes the clinical management of orofacial trauma including multiple avulsions, lateral luxation, alveolar fracture, and their sequelae after 7 years of follow-up. A 19-year-old woman presented to emergency care 4 hours after an accidental fall that resulted in the avulsion of teeth #8, #9, and #25; a complicated crown fracture and lateral luxation of tooth #7; an uncomplicated crown fracture of tooth #10; and a fracture of the maxillary alveolar bone. Only teeth #8 and #9 were located by the patient. The immediate treatment included surgical reduction and extrusion of the lateral luxation, delayed replantation of the avulsed central incisors, nonrigid splint stabilization, and suturing of gingival lacerations. Subsequent visits involved removal of the splint, root canal treatment of the maxillary incisors, implant placement to replace the avulsed mandibular incisor, and esthetic rehabilitation with composite resin. At the 5-year follow-up, cone beam computed tomography revealed advanced surface root resorption in the replanted incisors. At the 7-year follow-up, an aggravation of inflammatory resorption in the replanted incisors was observed. This report demonstrates that adequate knowledge of trauma management by clinicians is essential for the effective management of more complex cases. It also highlights the importance of long-term follow-up in cases of avulsion and replantation due to potential long-term sequelae.

Appropriate Terminology for the Time Elapsed From Avulsion of a Permanent Tooth to Replantation: A Scoping Review and Delphi Consensus

BACKGROUND

The prognosis of an avulsed permanent tooth depends on the time elapsed from injury to replantation in the injured socket. Wide variability exists in the terminologies used to describe this period. Hence, the aim of this study was to identify and categorize the terminologies related to this aspect of tooth avulsion, grade the explanations provided by the authors, and develop a consensus about the most appropriate terminology through a Delphi approach.

METHODS

This study involved a scoping review to identify and analyze the terminologies. It was performed according to PRISMA-ScR with a systematic search performed in PubMed, Scopus, EMBASE, LILACS, and Web of Science. The terminologies were extracted, categorized, and evaluated for correctness. On the basis of the results of the review and expert group discussion, an ideal terminology was proposed. A Delphi study with 20 global experts in dental traumatology was conducted to develop a consensus for the proposed terminology and its description.

RESULTS

A total of 92 studies were included. They were distributed into five categories according to the terminology used: (a) dry period alone, (b) total period with dry and/or wet times, (c) extra-alveolar period, (d) extraoral period, and (e) miscellaneous. The explanations provided were correct in 37.5% of the studies that used an extraoral period. In the Delphi study, the lowest scores were given to the term dry period. There was an agreement of 95% for the proposed terminology.

CONCLUSION

A wide variation in terminologies was observed that could be distributed into five categories. The correctness of explanations was highest in the studies that described total periods with dry and wet times. The Delphi study revealed excellent agreement for the proposed term "total extra-alveolar period," with precise and clear recordings of both nonphysiologic (dry) periods and physiologic (wet) periods.

Evaluation of Long-Term Clinical and Radiographic Prognosis of Avulsed Teeth: A Retrospective Study

BACKGROUND/AIM

Avulsion injuries have an uncertain prognosis. This study aims to evaluate periodontal ligament healing patterns and factors affecting the survival of replanted avulsed teeth.

MATERIALS AND METHODS

In this retrospective study, data from 204 avulsed teeth in 143 children (mean age: 9.6 ± 2 years) who sustained avulsion injuries were reviewed. Primary teeth, non-replanted permanent teeth, and cases with follow-up shorter than 60 days were excluded. Data analysis included 60 replanted permanent teeth from 41 patients (18 girls and 23 boys), with a follow-up period ranging from 2 to 147 months. Collected data covered age, gender, extra-alveolar storage time, root development stage, and periodontal ligament healing patterns. Statistical analysis was performed on the data.

RESULTS

Avulsion injuries predominantly occurred during outdoor activities (n = 22, 59.5%), followed by school (n = 10, 27%) and home (n = 5, 13.5%). The main causes were falls (n = 20, 50%), bicycle accidents (n = 6, 15%), sports injuries (n = 5, 12.5%), traffic accidents (n = 2, 5%), and violence (n = 1, 2.5%). Among replanted teeth, 51.7% were immature. Treatments included root canal therapy (n = 30, 50%), apexification (n = 12, 20%), and regeneration (n = 2, 3.3%), while 16 teeth received no treatment. Inflammatory resorption was not observed in teeth replanted within 1 h of injury (8.4%). Functional healing/ankylosis was observed in 14 (23.3%) of the replanted teeth, replacement resorption in 40 (66.7%), and inflammatory resorption in 6 (10%). Replacement resorption affected 66.7% of the replanted teeth, with 62.5% lost over time. Functional healing/ankylosis was more common in mature teeth, while inflammatory resorption was higher in immature teeth. According to Kaplan-Meier estimated survival curves, the survival rate during the 5-year observation period was 47.5%. Survival times were longer in boys and in mature teeth (p < 0.05).

CONCLUSIONS

Gender and root development stages were observed to significantly impact the prognosis of replanted avulsed teeth.

Enamel matrix derivative in the treatment of tooth replantation: from a biological basis to clinical application

BACKGROUND

An efficient therapeutic strategy for patients with replanted teeth has been extremely challenging because complete displacement of the teeth is inevitably accompanied by severe damage to periodontal tissue. Enamel matrix derivative (EMD) shows promise for periodontal regeneration, but its effects on replanted teeth remain unknown. This study systematically summarized the biological basis of EMD in replantation dental therapy and assessed its effect on clinical prognosis.

METHODS

Potential studies were searched via the Cochrane Library, Web of Science and PubMed databases from inception to November 23, 2023.

RESULTS

A total of 329 patients with 375 replanted teeth met the inclusion criteria. Our pooling results indicated that EMD did not provide a numerical advantage for restoring normal PDL healing in replanted teeth (RR=0.38, P=0.161). A significantly lower extraction risk was observed in EMD-treated group than non-EMD-treated group (RR=0.47, P=0.001). Moreover, the survival rate of replanted teeth with root resorption was significantly increased by the application of EMD (RR=2.21, P=0.017). Although the pooled outcomes suggested increased incidence of surface resorption (RR=1.19, P=0.730) and decreased risk of inflammation resorption (RR=0.68, P=0.560) among replanted teeth with resorption in the EMD-treated group, neither difference was statistically significant.

CONCLUSION

For patients with replanted teeth, EMD treatment may not result in a numerical increase in normal PDL healing. However, as a biological regulator, EMD may arrest the progression of resorption, thus reducing the risk of extraction in the early stage. Well-designed randomized trials are required to validate these results due to the poor quality of evidence.

Instant Re-Implantation of Avulsed Teeth

Successful re-plantation of avulsed tooth in children demands instantaneous management. This case report emphasizes the efficient treatment of a 09-Year-old boy who suffered an avulsion of the maxillary right central incisor at his school. The patient reported within half an hour of the traumatic dental injury with the avulsed tooth in his hand wrapped in a piece of newspaper. Immediately the tooth was placed in normal saline (0.7%) when the patient arrived and conventional Root Canal Therapy (RCT) was done extra-orally. After the root canal, the tooth was re-planted according to the IADT guidelines and stabilized in place with splinting. Our interpretation suggests that re-plantation of an avulsed tooth as quickly as possible, using appropriate splint and planned root canal therapy, promotes faster periapical healing and yields a better prognosis.

Permanent tooth avulsions: A retrospective analysis of the demographics and aetiology of cases at a tertiary hospital in Sydney, Australia

This retrospective analysis reviewed the demographics of patients sustaining dental avulsion injuries at a tertiary dental hospital in Sydney, Australia. Data were extracted from dental records of patients who presented with avulsed permanent anterior teeth and were treated between 1 January 2001 and 30 June 2021. Demographic, clinical and radiographic data from 91 patients with 117 avulsed permanent anterior teeth were available for analysis. The median age of the patients was 12 years (IQR 9.0-17.0). Males accounted for 68.4% of avulsion injuries. Non-organised sports were the most common cause of injury (42.7%). Maxillary central incisors were the most frequently avulsed tooth (83.3%). Peak prevalence of injuries occurred on the weekend. The findings from this study may reflect regional factors such as climate and participation in sport. Anticipatory guidance should be provided to patients at elevated risk of dental avulsion.

Enhancing Nursing Competencies: An Assessment of Knowledge and Attitudes Toward Dental Trauma Management Among Nursing Students-An Interventional Study

INTRODUCTION

Traumatic dental injuries (TDIs) present a significant challenge for healthcare professionals. Nurses, often the first point of contact for patients, may lack essential knowledge in dental trauma first aid, as noted in the existing literature.

OBJECTIVE

To assess the knowledge of traumatic dental injuries (TDIs) among undergraduate nursing students before and after a targeted educational intervention.

MATERIALS AND METHODS

This quasi-experimental study evaluated the effectiveness of an educational intervention involving 300 nursing students from two universities in Seville. The educational intervention was led by specialist dentists. A pre-test survey was administered to assess students' baseline knowledge. The session included a lecture on TDI management, followed by a simulation in which students practiced emergency splinting techniques for referral to a dentist. A post-test survey was then conducted to measure changes in students' knowledge and attitudes towards dental trauma.

RESULTS

Only 25.4% of students had prior training in dental trauma. After the intervention, there was a significant improvement in students' self-assessed knowledge of first aid for TDIs (p < 0.05). A high percentage of students also reported increased confidence in their ability to reimplant a tooth. Statistical analysis of pre- and post-intervention survey results showed a substantial increase in average scores (p < 0.05).

CONCLUSIONS

Nursing students initially exhibited limited knowledge in managing dental trauma but demonstrated a positive attitude toward learning this new skill. The targeted educational intervention significantly enhanced their understanding, underscoring the need to incorporate such training into nursing curricula. By improving nursing students' competence in managing dental injuries, this training can help better preserve dental structures and improve the prognosis for dental trauma cases.

Utility of Orthodontic Braces as Flexible Splint for Stabilizing an Avulsed Tooth: A Case Report

Dental avulsion is a traumatic dental injury with complete displacement of the tooth outside the bony socket. Both primary and permanent teeth are predisposed to such traumatic incidents. The most effective treatment in such cases is tooth replantation. Additionally, a short-term flexible splint is needed to stabilize the avulsed/replanted tooth. This case report describes orthodontic braces as a standardized flexible splint option for the treatment of tooth avulsion. Herein, the case of a 9-year-old female patient who presented to a private dental clinic with an avulsed upper left central incisor, 1 h after the accident has occurred. Once the tooth was replanted with all the necessary precautions, orthodontic braces and wire were utilized to stabilize the tooth. Most dental splints are custom-made, requiring thorough professional knowledge and expertise for their fabrication and placement. The protocol described in this report is aimed at easing tooth stabilization using materials within the scope of a basic dental setup consultation room.

Evaluating the effect of strontium ranelate and photobiomodulation on cementogenic and osteogenic differentiation of buccal fat pad-derived stem cells: An in vitro study

This study aimed to analyze the impact of strontium ranelate (Str), photobiomodulation (PBM), or their combination of the proliferation, osteogenic differentiation, and cementogenic differentiation of buccal fat pad-derived stem cells. BFPdSCs were exposed to one of the following interventions: (1) PBM (660 nm), (2) PBM (660 nm) + Str, (3) PBM (880 nm), (4) PBM (880 nm) + Str, (5) Str. All study groups had significantly higher osteogenic differentiation than the control group (p < 0.05), and no significant difference existed between the 660 and 808 nm groups (p = 0.97). Compared to the Str group, 660 nm and 880 nm group samples had significantly lower osteogenic differentiation (p < 0.0001), while other groups did not show a significant difference. Regarding cementogenic differentiation, the 660 nm group showed higher values than the 808 nm group (p < 0.01). Compared with the Str group, 660 nm, 660 nm + Str, and 808 nm + Str groups showed significantly higher gene expression (p < 0.05). In the case of osteogenic differentiation, although photobiomodulation alone had a lower inducing effect than strontium ranelate, combining 808 nm diode lasers and strontium ranelate may provide the best results. Moreover, using a 660 nm diode laser and exposing stem cells to strontium ranelate can be the most effective approach to induce cementogenic differentiation.

The Top 100 Most-Cited Articles on Permanent Teeth Avulsion: A Bibliometric Analysis

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.

Replantation of an Avulsed Tooth: A Case Report

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.

Rescuing “hopeless” avulsed teeth using autologous platelet-rich fibrin following delayed reimplantation: Two case reports

BACKGROUND

Tooth avulsion is one of the most severe types of dental trauma. Most avulsed teeth undergo long-term ankylosis and replacement resorption after delayed reimplantation and exhibit a poor prognosis. The aim of this work was to improve the success rate of avulsed teeth after delayed reimplantation using autologous platelet-rich fibrin (PRF).

CASE SUMMARY

Case 1 was a 14-year-old boy who fell and knocked out his left upper central incisor 18 h prior to his arrival at the department. The diagnoses were avulsion of tooth 21, lateral luxation of tooth 11 and alveolar fracture of teeth 11 and 21. In case 2, a 17-year-old boy fell 2 h prior to his presentation to the hospital, and his left upper lateral incisor was completely knocked out of the alveolar socket. The diagnoses included avulsion of tooth 22, complicated crown fracture of tooth 11 and complicated crown-root fracture of tooth 21. The avulsed teeth were reimplanted along with autologous PRF granules and splinted using a semiflexible titanium preshaped labial arch. The root canals of the avulsed teeth were filled with calcium hydroxide paste, and root canal filling was performed 4 wk after reimplantation. The reimplanted teeth showed no symptoms of inflammatory root resorption or ankylosis at the 3-, 6-, and 12-mo follow-up examinations after reimplantation with autologous PRF. In addition to the avulsed teeth, the other injured teeth were treated using corresponding conventional treatment methods.

CONCLUSION

These cases provide examples of the successful use of PRF to reduce pathological root resorption of the avulsed teeth, and the application of PRF may provide new healing opportunities for traditionally “hopeless” avulsed teeth.

Avulsion of Permanent Mandibular Incisors: A Report of Two Cases with Pertinent Literature

Introduction. This study reports two rare cases of avulsion of permanent mandibular incisors with their sequelae after being reimplanted by two contrary methods. The relevant literature regarding the avulsion of permanent mandibular incisors is also being discussed. Case Presentation. In Case I, a 9-year-old girl reported an avulsion of the permanent mandibular left lateral incisor that was immediately reimplanted within 20 minutes after injury, whereas in Case II, all four permanent mandibular incisors were avulsed and reimplanted after a prolonged extraoral dry time of 36 hours in an 18-year-old female. Both cases missed their scheduled follow-up visits and were reported after 3.5 years and 7 months, respectively, with severe root and alveolar bone resorption that was confirmed by clinical examination and Intra oral periapical radiograph (IOPA) radiographs. Discussion. Avulsion of permanent mandibular incisors is rare. The similar unfavorable outcome of contrary cases at a variable duration of time after missed follow-up illustrates the role of the appropriate treatment protocol and regular follow-up visits for the long-term success of reimplanted teeth.

Management of 3 Avulsed Permanent Teeth: Case Report of a 3-Year Follow-up

Dental avulsion is one of the most serious dental injuries. When the tooth is knocked out, the blood supply to the pulp is interrupted and the periodontal ligament cells are exposed to injuries caused by the external environment. In recent years, research findings have shown the possibility of complete healing under favorable conditions: replanting the tooth according to the criteria required by the guideline such as the extra oral time which should be very short, the time of pulp removal after replantation, and the appropriate storage medium. This set of criteria may lead to a slower progression of the phenomenon of resorption with a better prognosis over time; however, there is a high risk of complications such as external root resorption which lies in late replantation. The research results of many research-groups around the world have given us a better understanding of healing and complications. Nowadays, even teeth that are replanted after a delay can be saved. The dentist remains the key person in the case of dental trauma, namely, dental avulsion as his role is the management of the emergency situations. The objective of this case study is to present a successful management of 3 avulsed permanent incisors, replanted and remained with no complications for over a period of 3 years.

Influence of clinical factors, IL4 and IL6 genes polymorphisms in functional healing in late replantation

Abstract To investigate the genetic association in a sample of replanted teeth, it is necessary to observe the extreme phenotypes, such as, teeth that underwent functional healing and those extracted due to severe external root resorption. Thus, this study aimed to investigate the association of age of the patients, root development, storage media, and polymorphisms in the interleukin 4 (IL4) and interleukin 6 (IL6) genes with teeth that presented extreme outcomes, as functional healing or extraction, in a group whose replantation techniques did not follow the International Association of Dental Traumatology (IADT) 2012 guidelines. Forty-three avulsed and replanted teeth that did not follow IADT 2012 guidelines and underwent functional healing or were extracted were included. Periapical radiographs employed for this study were taken soon after tooth replantation and after 1 year. For genotypic IL4 and IL6 genes analysis, DNA of oral mucosa cells was extracted. Real-time- PCR performed for genotyping polymorphisms in IL4 and IL6 genes. Clinical and genetic variables were analyzed by the Chi-square test and the “Z” test. P values < .05 were considered significant. The results showed that functional healing and extraction were associated with storage media and with the rs2243268 of IL- 4 gene polymorphisms. As conclusion, the C rs2243268 allele of IL4 gene may have a positive relationship with functional healing teeth that were replanted not following the 2012 IADT guidelines. Keeping the tooth dry is associated to a fast loss of avulsed and replanted teeth after 1-year follow-up.

LeFort Fractures

Consultations for management of facial fractures in the emergency setting are not uncommon for the oral maxillofacial surgeon, otolaryngologist, and/or plastic surgeon. This necessitates a knowledge foundation and working understanding of the evaluation, assessment, and timely management. Here, we will focus on the workup and management of LeFort fractures.

Regenerative Endodontic Treatment of Maxillary Incisors with a History of Severe Traumatic Injury

The treatment objective for children with avulsed anterior teeth should concentrate on preserving the alveolar bone volume and contour. Posttraumatic external inflammatory root resorption (EIRR) is also a high-risk complication often observed in children. Regenerative endodontic procedure (REP) has been considered a successful treatment to arrest EIRR, especially in posttraumatic cases. This case report presents clinical outcomes of REP in two teeth of an 8-year-old systemically healthy patient with a history of severe dentoalveolar traumatic injury, one with a history of avulsion, and the other with an EIRR. The treatment consisted of REP on both teeth #8 and #9. The results showed some evidence of maturation in the apical third of tooth #9 and resolution of signs and symptoms on tooth #8.

Nuclear factor-kappa B (NF-κB) decoy oligodeoxynucleotide-loaded poly lactic-co-glycolic acid (PLGA) nanospheres promote periodontal tissue healing after tooth replantation in rats

BACKGROUND

Excessive inflammation in the periodontal tissue after tooth replantation can lead to inflammatory root resorption and interrupt periodontal tissue regeneration. We tested the hypothesis that NF-κB decoy oligodeoxynucleotide-loaded poly lactic-co-glycolic acid nanospheres (NF-PLGA) inhibit excessive inflammation and promote healing of periodontal tissue after replantation in rats.

METHODS

The upper right incisors of rats were extracted, immersed in different specific solutions, and replanted. The rats were euthanized at 7, 14, and 28 days after replantation. Morphological evaluation with micro-CT and histological assessment with hematoxylin and eosin and tartrate-resistant acid phosphatase (TRAP) staining was performed. Additionally, we examined the expression of interleukin (IL)-1β, IL-6, transforming growth factor-β1 (TGF-β1), and fibroblast growth factor-2 (FGF-2) in the periodontal ligament (PDL) by performing immunohistological assessment.

RESULTS

The NF-PLGA group showed significantly greater dental root thickness than the other experimental groups. Root resorption was not observed after the application of NF-PLGA on day 7. The application of NF-PLGA also resulted in a significantly lower number of TRAP-positive osteoclasts on days 7 and 14 after replantation. Significantly lower expression of IL-1β and IL-6 and higher expression of TGF-β1 and FGF-2 were observed under the application of NF-PLGA in the PDL.

CONCLUSIONS

NF-PLGA promoted the healing process by inhibiting the initial excessive inflammatory response in the PDL, preventing root resorption, and promoting periodontal tissue regeneration. The findings also suggested that the PLGA nanospheres-mediated transfection of the decoy oligodeoxynucleotides can be useful for the clinical application of replanted tooth root surfaces. This article is protected by copyright. All rights reserved.

Low-intensity pulsed ultrasound attenuates replacement root resorption of avulsed teeth stored in dry condition in dogs

This study aimed to investigate the effects of low-intensity pulsed ultrasound (LIPUS) on replacement root resorption after replantation of avulsed teeth stored in a dry condition in dogs. A total of 73 premolar roots from four male mongrel dogs were intentionally avulsed with forceps and divided into four groups—HN, HL, DN, and DL—according to storage conditions and whether or not they received LIPUS treatment. Thirty-eight roots were kept in Hanks’ Balanced Salt Solution for 30 min (HN and HL groups), whereas the remaining 35 roots were left to dry in the air for an hour (DN and DL groups) prior to replantation. Following replantation, the roots in the HL and DL groups (21 and 18 roots, respectively) received a 20-min daily LIPUS treatment for 2 weeks. The animals were euthanized 4 weeks after the operation. Micro-computed tomography images were acquired for each root and the amount of replacement root resorption was measured three-dimensionally. Histological assessments were also carried out. There was significantly less replacement root resorption for the roots in the DL group compared to the DN group (p < 0.01). Histological findings in the DN group demonstrated evident replacement root resorption, whereas the DL group revealed less severe resorption compared to the DN group. Within the limitations, these results suggest that LIPUS could attenuate the replacement resorption of avulsed teeth stored in a dry condition, thereby improving their prognosis.

Effect of tetracyclines on pulpal and periodontal healing after tooth replantation: a systematic review of human and animal studies

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.

Knowledge of dental trauma among dental students. Lecture intervention protocol and follow-up over four academic courses

BACKGROUND AND AIMS

A study was made to evaluate knowledge of dental trauma among first-year dental students at the start of the career; assess the knowledge gained immediately after a lecture intervention; and evaluate persisting knowledge on an annual basis until the fourth year of the career.

MATERIAL AND METHODS

The study involved 29 volunteers from the first year of dentistry (School of Dentistry, Madrid Complutense University, Madrid, Spain). All the participants completed a previously validated questionnaire including questions referred to the management of dental trauma at the site of the accident, and other related aspects. This was followed by a brief lecture on the subject, and then the same questionnaire was administered again. Completion of the original questionnaire was subsequently repeated on an annual basis up until the fourth year of the career. Repeated measures analysis was used to assess the evolution of student knowledge.

RESULTS

Knowledge of the subject was seen to be lacking at the start of the career, but increased significantly as a result of the lecture intervention (P < .001). Over the subsequent courses, although the notions referred to dental trauma were seen to decrease with respect to the first evaluation, they remained high. All of the participants agreed on the need for informative campaigns referred to dental trauma targeted to students in the first courses of the health sciences.

CONCLUSIONS

It is necessary to impart knowledge on the prevention and immediate management of dental traumatisms in order to improve their prognosis. This learning is especially relevant to students in the first courses of the health sciences.

Combined Management of Apical Root Fracture and Avulsion of Two Maxillary Permanent Central Incisors: A Case Report

As a result of a skiing accident, a ten-year-old girl suffered combined injuries to both maxillary central incisor teeth (#1.1 and #2.1). The injuries were uncomplicated crown fractures, apical horizontal root fractures, and a severe extrusive luxation of the coronal segments of the teeth. Her mother repositioned the teeth immediately, resulting in good initial healing. Nine months later, the patient was referred to a specialist to manage the endodontic consequences of the trauma. The apexification treatment of the fractured roots, using a preformed apical barrier technique with bioactive cement, was the treatment of choice, administered to both the avulsed roots at two separate recall visits. The best option for managing the fractured apical segments was to continue with the follow-up, which was conducted to assess the overall case at 30 months. The fractured apexes remained normally positioned inside the socket and were asymptomatic (as they presumably maintained a physiological vascular-nerve supply and, consequently, their vitality), while the apexification treatment led to the healing of the periodontal tissues and to hard tissue formation in the area of the interrupted roots in the avulsed portion of the teeth. The management of traumatic injuries in teeth often requires multiple treatment approaches, because these injuries rarely represent one single type of trauma.

Unexpected formation of root-like structures subsequent to the avulsion of immature permanent teeth: Case report

This report describes the unexpected formation of root-like structures following the avulsion of immature permanent teeth without replantation. A 6-year-old female patient had avulsed the four permanent mandibular incisors and the two deciduous mandibular canines. The patient was seen in an emergency healthcare unit but did not receive specialized treatment for tooth replantation. As follow-up treatment, she received a removable prosthesis. After 4 years of follow-up, an image obtained by panoramic radiography showed formations similar to four root structures in the alveolus of the previously avulsed permanent teeth. This finding was confirmed by periapical radiography and computed tomography. This case report demonstrates that in teeth with incomplete root development, even after avulsion without replantation, cells from the pulp stump may have the capacity to form mineralized structures that appear radiographically comparable to root dentin.

Long-Term Retention of Avulsed Maxillary Incisors with Replacement Root Resorption: A 9-Year Follow-Up

The purpose of this case report is to present a case of long-term retention of avulsed upper maxillary incisors with external replacement root resorption in a 15-year-old boy. The avulsed teeth, #11, 21, and 22, were stored under dry conditions for 40 min and replanted. Endodontic treatment was initiated after two weeks, and the nonrigid splint was removed after 3.5 months. A year after replantation of the teeth, replacement root resorption was detected radiographically. For the following 9 years, the resorption progressed slowly, but the teeth were maintained without any adverse effects on esthetic appearance. Under dry storage conditions, replacement root resorption was expected. In this case, the patient was a growing 15-year-old boy; thus, replantation was performed despite a possible poor prognosis. Consequently, root resorption progressed. Nevertheless, maintenance of the tooth crowns led to satisfying results for the patient both esthetically and psychologically. Ankylosis or replacement root resorption is a complication occurring after replantation of avulsed teeth, which could require additional treatment. However, in young patients, replantation could be considered to maintain the teeth until growth is complete.

Knowledge of Emergency Management of Avulsed Teeth among Italian Dentists-Questionnaire Study and Next Future Perspectives

(1) Background: In Italy, about one fourth of all schoolchildren experience a trauma to the permanent dentition. Management of avulsion trauma is challenging and requires adherence to clinical protocols. The aim of this study was to investigate the management knowledge of avulsed teeth among Italian dentists and to promote the guidelines’ dissemination through the use of new social media. (2) Methods: The survey was carried out during the COVID-19 lockdown in Italy (March–May 2020). The questionnaire was sent anonymously to a total of 600 dentists. The questionnaire consisted of two parts. Part A—demographic and professional data and Part B—management of traumatic avulsion. (3) Results: The response rate was 50.6% and the mean fraction of correct responses was 0.524. Issues related to the therapeutic management of avulsed teeth were shown to be not well understood by the respondents. Professionals with qualifications in dentistry and those who declared to know the guidelines responded better, while other demographic and professional factors were insignificant. (4) Conclusions: Italian dentists’ knowledge of the management of avulsion trauma should be improved. Educational programs and campaigns must be undertaken to improve their awareness and adherence to the Italian and international guidelines.

Pulp healing in immature replanted permanent teeth: A competing risk analysis

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.

Dry extraoral storage and delayed replantation of avulsed tooth: Therapy and outcome

Introduction: The aim of this study was to present the therapeutic procedure and the outcome of replantation of the avulsed permanent central maxillary incisor, found at the site of high contamination, after an extraoral period of 15 hours and dry transport. Case report: By clinical examination it was determined that the root reached the full length, with parallel edges, which corresponded to the age of the girl-8.5 years. After carefully removing the necrotic periodontal ligament from the root of the tooth, extraoral endodontic treatment was performed. The pulp was removed, the multi-sessional intracanal medicament fillings were avoided and the definitive obturation of the root canal was performed. The tooth was returned to the alveolar socket and immobilized with a wire-composite splint. After replantation, the condition of the tooth was monitored. Replacement resorption and dentoalveolar ankylosis occurred after nine months, and then cervical inflammatory resorption led to tooth loss after three and a half years. Conclusion: The achieved result can be considered as a success because during this time the replanted tooth met the developmental, functional and aesthetic requirements, which is especially important in the period of intensive growth and development of the child.

Knowledge, attitude, and practice of Chennai school teachers on traumatic dental injuries management – A cross-sectional study

Aim:

To assess the knowledge, attitude, and practice of traumatic dental injury (TDI) management among school teachers of Chennai.

Materials and Methods:

Forty-seven schools were selected from various parts of Chennai for the cross-sectional survey by simple random sampling. Four hundred school teachers who participated were from 26 regular schools and 21 special schools. Questionnaire with 32 close-ended questions assessing knowledge, attitude, and practice of TDI management was devised, face validated by experts, and pilot tested. Link to the online survey questions was provided after obtaining the informed consent. Responses were analyzed using Microsoft Excel.

Results:

Twenty-two percent reported to have undergone first aid training and among them, 4% were trained on TDIs management. 27% had a false sense of knowledge and practice of TDIs management. 12% were confident in replanting an avulsed tooth by themselves. Ten percent were aware of using milk as a storage media. 86% were willing to learn about TDIs management.

Conclusions:

Within the limitations of the present study, it can be concluded that despite the lack of knowledge and practice regarding TDI management, school teachers of Chennai had a good attitude towards TDI education. Emergency management training is by itself a necessity in schools and it should be inclusive of TDI management.

Management of Dental Avulsion Injuries: A Survey of Dental Support Staff in Cairns, Australia

Background/Aim: The aim of this study was to assess the knowledge of dental support staff in providing appropriate first-aid advice regarding dental avulsion emergencies. Methods: This study was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies. Dental support staff (includes dental assistants, administrative staff and other non-clinical staff) were contacted and data were collected from 50 private dental clinics across the Greater Cairns Area, Queensland, Australia. These data were collected through an online survey throughout 2020. Descriptive statistics and Pearson’s Chi-squared test was used to analyze the data and any associations between categorical outcomes. Results: This survey yielded a response rate of 34.1% with a margin of error of 10.3%. More than four-tenths of participants (42%) reported that they had received some form of dental avulsion management training previously. All but five participants (92%) denoted that they would immediately replant an avulsed permanent tooth. More than half of all participants would choose to rinse a soiled avulsed tooth with fresh milk (55%) and transport that tooth in fresh milk (65%) should they not be able to replant the tooth at the site. Almost nine in every ten participants (85%) expressed willingness to further their training in this area. Knowledge in replanting avulsed permanent teeth was found to be significantly impacted by gender, age, years of experience and participation in formal avulsion training. Male participants were found to be significantly more likely (p = 0.025) to replant a permanent avulsed tooth than their female counterparts. Participants who were 40 years of age and above were found to be significantly more likely to choose fresh milk to transport avulsed teeth (p = 0.0478). Older participants (p = 0.0021), alongside those who had greater years of experience (p = 0.0112) and those who had undertaken formal avulsion training (p = 0.0106) were all significantly more likely to express greater confidence in their ability to manage dental avulsion injuries. Participants who had previously received some form of education regarding avulsion injury management were also most likely to warrant further education and training in this area (p < 0.0001). Conclusion: This study demonstrated that dental support staff in the Greater Cairns Area seem to have a fair grasp of first-aid knowledge regarding the management of dental avulsion injuries. This result indicates that this knowledge has been picked up through years of experience, rather than a formal education. Despite this, one would expect people who work in the dental industry to be able to provide accurate and appropriate assistance during dental emergencies, hence, further training is warranted to ensure optimum patient outcomes.

What can we do with a dental avulsion? A multidisciplinary Clinical Protocol

Purpose

The aim of this case report was to explain a multidisciplinary and conservative approach carrying out the replantation of an avulsed closed apex central incisor stored in dry conditions for a 16-hour period from the moment of trauma.

Case Report

This report describes a case of a 28 year-old male who suffered contusion of the upper lip, avulsion of right upper central incisor, enamel cracks after trauma of left upper central incisor and upper left lateral incisor crown fracture due to an accident. Avulsed tooth was dry stored and it was replanted 16h after the trauma. The root was disinfected and the necrotic periodontal tissue removed, the endodontic treatment was done before replantation and a flexible splint was applied to tooth 13 to tooth 23. Two months later a contralateral tooth presented crown discoloration occurred due to pulp necrosis an endodontic treatment as well as bleaching were carried out. An esthetic restoration for lateral incisor crown fracture was also done. In the one year review the patient remains asymptomatic, with no signs of root resorption or ankylosis of the damaged teeth.

Conclusions

A conservative approach of tooth with delayed reimplantation can be a stable and functional with the appropriate treatment procedures. A clinical protocol for patients and professionals for the treatment of the avulsed tooth is proposed.

Key words:Endodontics, dental avulsion, avulsed tooth protocol.

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.

Assessment of Parents’ Knowledge and Attitudes on Emergency Management of Permanent Avulsed Teeth in Western Saudi Arabia

Objective:

One of the most common dental injuries is dental avulsion. This study, conducted in the western region of Saudi Arabia, aimed to evaluate parent’s knowledge and attitudes regarding the emergency management of avulsed permanent and deciduous teeth in children.

Methods:

A cross-sectional study was conducted among 393 parents recruited from six dental clinics and hospitals in Makkah and Jeddah, Saudi Arabia. The data were collected with a self-administered questionnaire that assesses the level of knowledge for managing deciduous and permanent avulsed teeth.

Results:

The total score for correct answers about managing permanent avulsed teeth had a mean of 4.77 and a standard deviation of 2.14 (out of 10 questions). With a permanent avulsed tooth, 35.37% were aware of dental reimplanting, 27.7% identified milk as an appropriate medium, and 57.5% would seek professional help immediately after dental trauma. Females and participants with a bachelor’s or higher degree had significantly higher levels of knowledge than males and participants with a high school or lower education. There were 28.5% of respondents who had a previous history of dental trauma for a child. A total of 62.1% knew that there is a difference in managing deciduous versus permanent teeth, but only 40.7% knew the proper management for deciduous avulsed teeth. Previous history of child dental avulsion was not found to be associated with more knowledge on managing avulsed deciduous or permanent teeth.

Conclusion:

Parents in the western region of Saudi Arabia have inadequate levels of knowledge to manage deciduous and permanent tooth avulsion. More efforts should be applied for conducting promotional health campaigns aimed at improving parents’ knowledge.

Survival and complication analyses of avulsed and replanted permanent teeth

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.

Atypical extraction treatment for failing replanted maxillary and mandibular incisors with space closure of 2 mandibular incisors in the same quadrant

We report the successful orthodontic treatment of a 13-year-old girl who had been involved in an accident with avulsion of her maxillary right central incisor and both mandibular left incisors. Fifteen months after replantation of the teeth, all showed severe root resorption with apical inflammation and had to be extracted. After compensatory removal of the maxillary left central incisor, all 4 extraction sites were closed within 20 months of active orthodontic treatment to avoid implant-prosthodontic replacement. By sequential extraction of the 2 hopeless replanted equilateral mandibular left incisors and common-sense management of straightwire mechanics, it was possible to move the right central incisor across the mandibular midline and close the large space completely. To our knowledge, no case report about orthodontic closure of 2 adjacent extraction spaces in the same quadrant has been published.

Clinical and histopathological characterization of root resorption in replanted teeth: Two case reports

RATIONALE

The frequency of tooth avulsion is on the rise due to increasing rates of maxillofacial trauma. Avulsed teeth present with varying degrees of root resorption, and are generally asymptomatic; therefore, they often go undiagnosed. The etiopathogenesis of root resorption in replanted teeth following avulsion remains unclear.

PATIENT CONCERNS

In case 1, the left upper lateral incisor became loose after 10 years of replantation. In case 2, the patient underwent tooth replantation after external root canal treatment due to tooth dislocation caused by trauma 8 years ago.

DIAGNOSIS

According to the medical history, clinical manifestations and imaging studies of the 2 patients, root resorption after replantation was diagnosed.

INTERVENTIONS

The teeth extraction was given to one patient. Besides the histological examination of extracted teeth was performed.

OUTCOMES

Teeth that underwent pulp treatment presented with external resorption. On the other hand, the tooth that had received no pulp treatment showed both external and internal resorption; residual vital pulp tissue was detected within the pulp cavity.

LESSONS

The dental pulp tissues may be involved in the initiation or development of internal resorption. Trauma to the periodontal ligament might play a major role in external resorption, whereas internal tooth resorption may be caused as a result of injury to the residual pulp tissue. Thus, the effective management of these tissues during the treatment of replanted teeth is essential.

Assessment of platelet-rich fibrin in the maintenance and recovery of cell viability of the periodontal ligament

This study analyzed the efficacy of autologous platelet-rich fibrin (PRF) in maintaining and recovering cell viability of the periodontal ligament (PDL). The PDL cells were isolated from 45 extracted teeth randomly distributed among 6 groups: 5 min, 1 h, 2 h, PRF 30 min, PRF 1 h and PRF 2 h. In the groups 5 min, 1 h and 2 h (n = 5), the teeth were kept dry in extra-alveolar times of 5 min, 1 h and 2 h respectively. The teeth of the groups PRF 30 min, PRF 1 h and PRF 2 h (n = 10) were kept dry at extra-alveolar times of 30 min, 1 and 2 h followed by immersion in PRF for 45 min. PDL cells were isolated by enzymatic digestion with type II collagenase and dispase, counted and analyzed for viability with Trypan blue vital dye in Neubauer chamber. The variables total number of cells and cell viability demonstrated that in the 5 min, 1 h and 2 h groups there was a decrease after the extra-alveolar dry times of 1 and 2 h. In comparison with the total number of cells, group 1 h, considered immediate reimplantation, did not present statistical difference when compared to the groups PRF 30 min, PRF 1 h and 2 h, a result that demonstrates that PRF assists in cell maintenance and recovery. PRF provided increased cell viability in relation to the different dry extra-alveolar times analyzed (p < 0.001). Autologous PRF presented effectiveness in maintaining and recovering PDL cells from extracted teeth and kept dry for up to 2 h.

Knowledge of Australian primary education providers towards dental avulsion injuries: a cross-sectional study

BACKGROUND/AIM

The aim of this study was to evaluate the knowledge of school professionals regarding the emergency management of dental avulsion.

METHODS

This cross-sectional study utilised a self-administered, pilot-tested questionnaire for school staff from primary schools. Descriptive statistics were used for the analysis - the prevalence and univariate associations between a categorical outcome and the variables under consideration, were evaluated using Pearson's Chi-squared test.

RESULTS

This survey yielded a response rate of 43.5% (n = 313). Approximately 60% of participants held valid first-aid certificates and 23% had received avulsion advice previously. Over 80% of participants expressed an unwillingness to replant an avulsed tooth, and over 90% believed that there should be greater awareness in this area. This unwillingness to replant was influenced by respondents' age (x2 = 8.13 df = 3, P = 0.043) and receiving advice previously (x2 = 13.15, df = 1, P < 0.001). Under-preparedness was related to years of experience (x2 = 15.03, df = 5, P = 0.010), first-aid training (x2 = 6.41, df = 1, P = 0.011) and receiving advice previously (x2 = 43.47, df = 1, P < 0.001). It was also evident that first-aid training positively influenced appropriate dental referral in the management pathway (x2 = 10.49, df = 1, P = 0.001).

CONCLUSION

This study suggests that there is an inadequate level of knowledge on the appropriate management of dental avulsion injuries amongst primary school professionals in Australia.

Anti-inflammatory and anti-resorptive efficacy of adrenergic blockers on late replanted rat incisors

BACKGROUND/AIM

In addition to their anti-inflammatory and anti-osteoclastogenesis properties, adrenergic blockers may also have promising anti-resorptive effects that can prevent root resorption when teeth are replanted because of avulsion. The aim of this study was to investigate the effects of phentolamine (Ph) and propranolol (Pr) in gels on the repair process of late replanted rat incisors. A further aim was to evaluate the biocompatibility of both drugs to human periodontal ligament fibroblasts (HPDLFs).

MATERIALS AND METHODS

Forty-eight maxillary right incisors were extracted from male Wistar rats, stored in paper napkins for 60 minutes, and randomly allocated to one of eight groups (n = 6). The root canal, root surface, and alveolus were treated with 0.75 µg/mL Ph gel (Ph0.75), 10 µg/mL Ph gel (Ph10), 100 µg/mL Ph gel (Ph100), 2.5 µg/mL Pr gel (Pr2.5), 10 µg/mL Pr gel (Pr10), 100 µg/mL Pr gel (Pr100), or sodium carboxymethylcellulose gel (CMC) before replantation. In the control group (CH), only the root canal was treated with calcium hydroxide paste. Thirty days following surgery, the animals were euthanized, and the right hemimaxilla was removed to perform micro-CT and histomorphometric analysis to determine osteoclastic activity. Ethanolic solutions of Ph10 and Pr10 were selected based on the in vivo study, and the viability of HPDLFs stimulated with lipopolysaccharide was determined by MTT assays.

RESULTS

The micro-CT and histomorphometric analysis revealed no significant differences among the treatments (P > .05). The presence of active osteoclasts was significantly decreased in the Ph10 and Pr10 groups (P < .05). Ph10 and Pr10 produced statistically similar cell survival rates compared to the control group (P > .05).

CONCLUSIONS

Ph10 and Pr10 significantly decreased osteoclastogenesis in delayed replanted rat teeth and were not cytotoxic toward HPDLFs.

Retrospective study on sequelae in traumatized permanent teeth

Objective:

This study aimed to identify possible associations of the presence or absence of posttrauma sequelae with the factors inherent to the traumatized tooth and treatment.

Materials and Methods:

This retrospective study was performed through the evaluation of records and radiographs of a center of reference for dental trauma between January 2008 and December 2014. The factors were analyzed and associated with posttrauma sequelae, such as pulp necrosis and root resorption.

Statistical Analysis Used:

A binomial logistic regression model was fit (P < 0.05).

Results:

In luxations, it was possible to observe 37% pulp necrosis, 16% inflammatory root resorption, and 8% replacement resorption. The binomial logistic regression revealed that male gender (P = 0.0392, odds ratio [OR] = 2.79), avulsion injury (P = 0.0009, OR = 12.27), and elapsed time >16 days between the time of trauma to the beginning of the endodontic treatment (P = 0.0450, OR = 7.53) showed a greater chance of presenting a posttrauma complication.

Conclusions:

Gender, type of injury, stage of root development, and time after trauma until the beginning of the endodontic intervention were related to the appearance of sequelae.

Parental self-perceived knowledge and attitudes toward emergency management of avulsed permanent teeth in Imphal: A cross-sectional study

Introduction:

Dental avulsion is one of the dental traumatic injuries commonly affecting children aged between 6 and 12 years. One of the major limitations in obtaining a successful outcome while treating dental avulsions is the lack of knowledge on its first aid management among parents. The present study aims to assess the knowledge and attitude of parents in Imphal toward the emergency management of avulsed permanent tooth using a self-reported questionnaire method.

Materials and Methods:

The present cross-sectional study was undertaken among 777 parents of 6–12-year-old children who were recruited through 2 private schools in Imphal. A questionnaire consisting of 14 closed-ended questions used to assess the parental knowledge and attitude on emergency management of avulsed permanent teeth was distributed to the respondents after obtaining official consent from the respective schools and informed consent from the respondents.

Statistical Analysis:

Chi-square test was used to assess the association between the results and the educational status, gender, and geographical location of the respondents.

Results:

The study revealed that only a fraction of the respondents, i.e., 11.8% gave a positive response on attempting “self-replantation” and higher fractions (76.1%) of the respondents reported to have received no previous information on the emergency management of dental avulsion.

Conclusion:

About 96.1% of the respondents showed interest on acquiring knowledge on the emergency management of dental avulsion. This warrants the urgent need on educating the parents on the first aid emergency management of avulsed tooth.

[Outcomes of traumatic dental injuries in children]

The aim of the study was to review literature data on incidence and outcomes of traumatic dental injuries (TDI) in pediatric population. A systematic search was conducted using Elibray, Pubmed/Medline, Scopus databases in October 2018. Reference lists were also hand-searched to identify additional literature. The most prevalent complication of TDI is pulp necrosis (PN) which triggers inflammatory root resorption (IRR). PN and IRR are however much more specific for mature permanent teeth. In immature teeth pulp revascularization may occur even after avulsion. Pulpectomy timing is well defined for mature teeth only. It is accepted that pulp extirpation should be performed in the first 10 days after trauma. In immature teeth no criteria exist with pulp electrosensitivity having very low negative prognostic value as drop of pulp sensitivity because of trauma not necessary indicate PN. Follow-up protocol for immature teeth with various TDI would be useful for proper timing of pulpectomy and prevention of IRR.

Long-term retention of avulsed maxillary permanent incisors replanted after prolonged non-physiological storage

Ankylosis and external replacement resorption (ERR) are two typical biological responses to delayed replantation of avulsed teeth in cases where adequate root canal treatment is performed. The patient's growth stage affects the progression of root resorption and the long-term outcome of the affected teeth. This case report describes the long-term outcome of an 18.5-year-old patient following an accident in which both of his maxillary central incisors were avulsed and replanted after four hours of non-physiological storage. ERR and ankylosis of teeth 11 and 21 were detected clinically and radiographically during the second year of follow-up. Sixteen years after replantation, replacement resorption was progressing very slowly, enabling functional tooth retention with favorable esthetics. Young adults, with delayed replantation of avulsed teeth, may benefit from tooth retention with slow ERR.

Incidence of Root Resorption after the Replantation of Avulsed Teeth: A Meta-analysis

INTRODUCTION

An avulsion injury is a serious trauma to pulp and periodontal tissues. After avulsion and replantation, teeth are at risk of infection and root resorption, which may affect treatment outcome and survival rate. Thus, the purpose of this systematic review was to evaluate the incidence of root resorption after the replantation of avulsed teeth.

METHODS

Two reviewers searched 7 electronic databases for observational studies involving human subjects that evaluated the incidence of root resorption after tooth avulsion. Risk of bias (RoB) was evaluated using the Meta-Analysis of Statistics Assessment and Review Instrument, and the quality of available evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool.

RESULTS

Of the 1507 articles, 23 met the inclusion criteria. A meta-analysis was conducted and showed that the incidence of internal root resorption was 1.2% (95% confidence interval [CI], 0.02-5.50). Regarding external root resorption, the incidence of surface root resorption was 13.3% (95% CI, 6.21-22.62), that of inflammatory root resorption was 23.2% (95% CI, 13.94-34.19), and that of replacement root resorption was 51.0% (95% CI, 40.10-62.00). Two studies presented a high RoB, 16 had a moderate RoB, and 11 had a low RoB. The overall level of evidence identified was very low.

CONCLUSIONS

The incidence of root resorption after avulsion and replantation in descending order was replacement root resorption > inflammatory root resorption > surface root resorption > internal root resorption.