A retrospective cohort study of pulp prognosis in luxated permanent teeth: a competing risk analysis

AIM

The present retrospective cohort study aimed to evaluate luxated permanent teeth for pulp prognosis and risk factors.

METHODOLOGY

Case records and radiographs of 224 patients, involving 427 luxated permanent teeth, referred for treatment at the Dental Trauma Center-School of Dentistry, Universidade Federal de Minas Gerais, (DTC-SD-UFMG) from 2014 to 2022, were assessed for pulp prognosis classified as vitality, necrosis and pulp canal obliteration (PCO). A competing risk survival analysis estimated the hazards of the three outcomes, and the effect of demographic, clinical and treatment variables was tested using a cause specific Cox regression model.

RESULTS

Pulp vitality was found in163 teeth (38.2%), pulp necrosis in 120 teeth (28.1%) and 55 teeth (12.9%) developed PCO. Pulp vitality decreased in the presence of concomitant crown fractures (HR 0.38 95% CI [0.2-0.8] p = 0.006). The risk of pulp necrosis (HR 0.62 95% CI [0.4-0.96] p = 0.03) was lower in cases with open apices but increased with concomitant crown fractures (HR 4.0 95% CI [2.6-6.1] p = 0.001) and intrusions (HR 2.3 95% CI [1.2-4.1] p = 0.007). Lateral or extrusive luxations (HR 3.0 95% CI [1.3-6.9] p = 0.001) and open apices (HR 2.4 95% CI [1.2-4.7] p = 0.01) showed higher rates of PCO.

CONCLUSION

Type of luxation, the diameter of the apical foramen, and the presence of concomitant crown fractures were main determinants of pulp prognosis after luxation injuries in permanent teeth.

CLINICAL RELEVANCE

Pulp prognosis after tooth luxation is dependent on the presence and direction of tooth displacement together with infection control.

CLINICAL TRIAL REGISTRATION

Not applicable.

Treatment outcomes after uncomplicated and complicated crown fractures in permanent teeth

OBJECTIVES

The objectives of this retrospective clinical study were to describe characteristics of crown fractures in permanent teeth and to investigate the survival of pulp vitality and restorations in uncomplicated and complicated crown fractures.

MATERIALS AND METHODS

This retrospective study collected information from patients suffering from dental trauma who were treated between January 2004 and June 2017. The study population consisted of 434 patients (253 males/181 females; mean age 20.7 years) with 489 uncomplicated and 127 complicated crown fractures. The Kaplan-Meier survival curves and Cox proportional hazard regression analyses were performed to explore the data statistically.

RESULTS

The mean observation time was 522 days. Uncomplicated crown fractures without luxation showed a higher success rate of 82.3% (345/419) than complicated crown fractures without luxation (72.3%, 73/101). An additional luxation in uncomplicated crown fractures resulted in significantly reduced success rates in terms of survival of the pulp and restoration. Direct restorations survived significantly better independent of the fracture mode than did adhesively reattached crown fragments. No superiority of mineral trioxide aggregate or calcium hydroxide as pulp capping agent in complicated crown fractures was documented. Approximately 85.5% of all complications occurred within 2 years after the accident.

CONCLUSION

The treatment of crown fractures resulted mostly in successful outcomes and only a moderate number of complications were observed.

CLINICAL RELEVANCE

Primary dental management of crown fractures should follow recently published clinical guidelines, and close monitoring over at least 2 years seems to be justified.

Survival analysis of adhesive reattachments in permanent teeth with crown fractures after dental trauma

BACKGROUND/AIM

When patients have saved tooth fragments in case of crown fractures, reattachment is considered as the treatment of choice. With respect to the need to provide clinical outcome data regarding adhesively reattached fragments, the aim of this practice-based clinical study was to evaluate the survival of reattached fragments after crown fractures in permanent teeth.

MATERIALS AND METHODS

Records from patients treated at Ludwig-Maximilians-University between 2004 and 2017 were analyzed to collect clinical and radiographic data regarding the management of fractured teeth that were treated with an adhesive reattachment. The study population consisted of 109 patients comprising 135 reattached fragments divided into uncomplicated (N = 84/135) and complicated (N = 51/135) crown fractures. The Kaplan-Meier Survival estimator was used to estimate the survival probability of primary reattachments after uncomplicated and complicated crown fractures.

RESULTS

Overall, 77.4% (N = 65/84) and 66.6% (N = 34/51) of the primarily applied reattachments in uncomplicated fractured teeth and complicated fractured teeth, respectively, survived over the period of observation. The survival rate for adhesive reattachment in all teeth was 84.4% (N = 114/135) after 608.2 days (±983.1 days). The data further suggest that in the case of a detachment, repeated reattachment might be a valuable restoration strategy.

CONCLUSIONS

Adhesive reattachment is a good first-choice treatment option in cases of crown fractures when the fractured fragment has been saved.

Evidence mapping and quality assessment of systematic reviews in dental traumatology

BACKGROUND/AIMS

Evidence mapping of systematic reviews (SRs) systematically and comprehensively identifies, organizes, and summarizes the distribution of scientific evidence in a field. The aims of this study were to delineate domains in dental traumatology (DT), evaluate the existing SRs within the domains, and identify the paucity of evidence for future research.

METHODS

Domains and sub-domains of DT were established according to the methods of qualitative research. The protocol for evidence mapping was prepared as per the guidelines of GEM and PRISMA. The search strategy was formulated using words and MeSH terms in eight databases without restriction of languages and year of publication. Gray literature, protocol registries, and references of selected articles were also searched. Duplicates were removed, and the final selection of SRs was completed. Data extraction and quality analysis using the ROBIS tool and the PRISMA checklist were performed.

RESULTS

The overall search resulted in 64 SRs from 1999 to 2020 with 44 published in last six years. The highest number of SRs had been performed in the Prognostic domain (n = 19) followed by the domains of Epidemiology (n = 15), Therapeutics (n = 10), Oral Biology (n = 7), Diagnostics (n = 6), Preventive (n = 5), and Research Methods (n = 2). Within each domain, there were variabilities in the number of reviewers, a priori protocols, search limitations, risk of bias methods, and meta-analysis. Of the SRs, including 4 Cochrane reviews, 28.4% were inconclusive. A low risk of bias was found in 48.4% of the SRs. Among the registered and ongoing SRs, six were from the domain of epidemiology, two in the domain of therapeutics, five from prognostics, and one each in the domains of prevention and research methods.

CONCLUSION

The SRs in DT could be mapped in seven domains with variabilities in the methods. The majority had an a priori registered protocol and a low risk of reporting errors. Within the Epidemiology and Preventive domains, SRs were present in all the sub-domains with the majority demonstrating low-risk of bias (ROB). The domain of prognosis had SRs in most sub-domains but with a high ROB. Insufficient numbers of SRs were present in most sub-domains of the Diagnostics, Therapeutics, Research Methods and Oral Biology domains.

mHealth and Engagement Concerning Persons With Chronic Somatic Health Conditions: Integrative Literature Review

Background

Chronic somatic health conditions are a global public health challenge. Being engaged in one’s own health management for such conditions is important, and mobile health (mHealth) solutions are often suggested as key to promoting engagement.

Objective

The aim of this study was to review, critically appraise, and synthesize the available research regarding engagement through mHealth for persons with chronic somatic health conditions.

Methods

An integrative literature review was conducted. The PubMed, CINAHL, and Inspec databases were used for literature searches. Quality assessment was done with the guidance of Critical Appraisal Skills Programme (CASP) checklists. We used a self-designed study protocol comprising 4 engagement aspects—cognitive, behavioral and emotional, interactional, and the usage of mHealth—as part of the synthesis and analysis.

Results

A total of 44 articles met the inclusion criteria and were included in the analysis. mHealth usage was the most commonly occurring engagement aspect, behavioral and emotional aspects the second, cognitive aspects the third, and interactional aspects of engagement the least common aspect in the included articles. The results showed that there is a mix of enablers and barriers to engagement in relation to the 4 engagement aspects. The perceived meaningfulness and need for the solution and its content were important to create and maintain engagement. When perceived as meaningful, suitable, and usable, mHealth can support knowledge gain and learning, facilitate emotional and behavioral aspects such as a sense of confidence, and improve interactions and communications with health care professionals.

Conclusions

mHealth solutions have the potential to support health care engagement for persons with chronic somatic conditions. More research is needed to further understand how, by which means, when, and among whom mHealth could further improve engagement for this population.

Eden Baysal Dental Trauma Index: Face and content validation

BACKGROUND/AIM

Recording of traumatic dental injuries in the emergency situation with a simple and easily recordable index that will also enable computer registration is advantageous. The aim of this paper is to present a new index to facilitate recording traumatic dental injuries and assess its face and content validity.

MATERIALS AND METHODS

The index included information on the type of injury related to the affected structures (enamel, dentin, cement, pulp, periodontal ligament, and alveolar bone) in accordance with Andreasen's classification. In addition, injuries to the alveolar bone and the maturity of the root were included. Fifteen dental trauma experts from 11 different countries rated the codes and content of the "Eden Baysal Dental Trauma Index" using the RAND modified e-Delphi consensus method. A statement was considered valid after reaching 75% consensus among panel members. Two rounds were necessary for reaching consensus on seven statements and the definition. The last version of the index was then presented online to a feedback group that included 10 experts from five countries to determine the external validity by representative cases.

RESULTS

The wording of the definition showed 92.8% agreement in the first round. Statements 1 and 2 gave information about the structure of the index and both reached 90% agreement in the first round. Definition and statements from 1 to 7 reached agreement as 93.3%, 93.3%, 100%, 93.3%, 80%, 93.3%, 80%, and 93.3%, respectively, in the second round. Most of the experts in the feedback group reported that the index was useful and user-friendly.

CONCLUSION

After a total of two rounds with the panel members and one round with the feedback group, the "Eden Baysal Dental Trauma Index" was approved for face and content validity and external validity was obtained.

Prevalence of traumatic dental injuries and its association with binge drinking among 12-year-olds: a population-based study

OBJECTIVE

To determine the prevalence of traumatic dental injuries and its association with binge drinking among 12-year-old schoolchildren.

METHODS

A cross-sectional study was carried out involving 588 students from a medium-sized city in Brazil. Data were collected through a clinical examination and self-administered questionnaires. Andreasen's classification was used for the determination of traumatic dental injuries. The consumption of alcoholic beverages and binge drinking were evaluated using the Alcohol Use Disorders Identification Test--Consumption. Socio-economic status, overjet, and inadequate lip seal were also analysed. Associations were tested using the multivariate logistic regression analysis.

RESULTS

The prevalence rates of traumatic dental injuries, alcohol consumption in one's lifetime, and binge drinking were 29.9%, 45.6%, and 23.1%, respectively. The prevalence of traumatic dental injuries was significantly higher among those who engaged in binge drinking (PR = 1.410; 95% CI: 1.133-1.754) and even higher among those with inadequate lip protection and accentuated overjet (PR = 3.288; 95% CI: 2.391-4.522 and PR = 1.838; 95% CI: 1.470-2.298, respectively).

CONCLUSIONS

A higher prevalence rate of traumatic dental injuries was found among 12-year-olds who engaged in binge drinking. The high rate of alcohol intake among adolescents is worrisome considering the vulnerability of this population due to the intense transformations that occur in the transition from childhood to adulthood.

Absence of an association between socioeconomic indicators and traumatic dental injury: a systematic review and meta-analysis

OBJECTIVE

The aim of this study was to perform a systematic review and search for scientific evidence on the association between socioeconomic indicators and traumatic dental injury (TDI) in the primary dentition.

METHODOLOGY

The PubMed, ISI, LILACS, Cochrane Library, and Embase databases were searched for articles addressing possible associations between socioeconomic indicators and TDI in the primary teeth in journals dating from the inception of the databases through to December 2013. Two independent reviewers performed data extraction and analyzed the quality of the studies. Meta-analysis was undertaken. Pooled estimates were calculated with a 95% confidence interval (CI) and odds ratios (OR).

RESULTS

Sixteen articles were included in the systematic review. Children from families with household income less than two times average salary (U$ 592) (OR: 0.77; 95% CI: 0.66-0.90) or more than three times the average salary (U$ 888) (OR: 0.76; 95% CI: 0.65-0.89) had a significantly lower chance of having TDI in the primary dentition. TDI was not associated with socioeconomic status (high vs low - OR: 0.77; 95% CI: 0.43-1.36; high vs medium - OR: 1.03; 95% CI: 0.72-1.48; medium vs low - OR: 0.70; 95% CI: 0.42-1.19), house ownership (owned vs rented - OR: 1.28; 95% CI: 0.98-1.66), mother's schooling (OR: 0.89; 95% CI: 0.74-1.08), or father's schooling (OR: 1.01; 95% CI: 0.62-2.74).

CONCLUSION

The scientific evidence demonstrates that socioeconomic indicators are not associated with TDI in the primary dentition. The evidence of an association between a low income and TDI is weak. In general, studies had low risk of bias. Further prospective cohort studies are needed to confirm this association.

Nutritional status and physical activity level as risk factor for traumatic dental injuries occurrence: a systematic review

AIM

To systematically review epidemiological articles assessing traumatic dental injuries (TDI) rates according to the physical activity habits and nutritional status.

METHODS

A search was conducted using PubMed, ISI, Scopus, SciELO, LILACS, and gray literature in Brazilian Theses Databank. We searched for dental trauma, traumatic dental injuries, tooth injuries, tooth fractures, physical activity, motor activity, exercise, sedentary lifestyle, sports, obesity, body mass index (BMI), overweight, and fatness. Databases were searched in duplicate from their earliest records until 2012. Additional studies were identified by searching bibliographies of the articles. Two reviewers performed data extraction and analyzed study procedural quality using the Newcastle-Ottawa scale. PRISMA guidelines for reporting systematic reviews were followed.

RESULTS

We found 1159 articles, of whom 14 reports involving 13 studies were selected. One article was a birth cohort, one had a case-control design, and the others were cross-sectional. The quality of evidence varied across the studies and was high (9) in 3. Eleven of the studies included assessed influence of nutritional status: five show a positive association between dental trauma and overweight and six do not show any association. Regarding physical activity level, five studies assessed its effect on trauma occurrence: two detected that physical activity acts as a protective factor and two that physical active increases the risk of dental injuries, and one showed no differences in TDI occurrence. Physical activity estimated from questionnaires and BMI were the most frequently used measures, but methodological differences prevent the comparison of results.

CONCLUSION

The results suggest that no truly causal relationship exists between dental trauma and physical activity and nutritional status. Due to the relatively low level of evidence currently present, studies with more robust design, for example, prospective cohort should address this question, especially in view of the epidemic of obesity.