Predictors for healing complications in the permanent dentition after dental trauma

Prevalence of Intimate Partner Violence and Endodontic Treatment Needs: Pilot Study

Objective

The aim of this study was to assess the prevalence and potential association between intimate partner violence (IPV) with traumatic dental injuries (TDIs) and the subsequent need for root canal treatment (RCT).

Methods

A total of 100 subjects with TDIs presented at emergency or postgraduate restorative clinics at University Dental Hospital, King Abdulaziz University, Jeddah, Saudi Arabia post-TDI. All study subjects completed the Hurt-Insult-Threaten-Scream (HITS) domestic violence screening tool and were clinically and radiographically examined to determine the type of TDI they suffered along with the pulp and periapical status of affected teeth. Demographic data were also recorded. Based on the findings, management included regular follow-up, splinting, reattachment of broken tooth part, vital pulp therapy and/or RCT as seen appropriate.

Results

Mean age of participants was 28.4±5.7 years. Prevalence of IPV among subjects presented with TDIs was 18%. Most of the IPV victims held a bachelor's degree (67%) and were unemployed (61%). Most of TDI cases were crown fracture (84%) followed by luxation and avulsion (10% and 6%, respectively). Among all TDI cases, 73% required RCT. Crown fracture was the most prevalent TDI among IPV victims followed by luxation and avulsion with prevalence of 56%, 33%, and 11%, respectively. Out of a total of 73 patients requiring RCT, nine were IPV victims (12.3%) which indicated that one of each eight TDI cases requiring RCT might be a potential IPV victim. Half of the IPV victims required RCT to manage their TDIs.

Conclusion

Prevalence of IPV among TDIs was 18%. IPV screening should be included as routine assessment part for TDIs. Identification of IPV victims could be difficult, however, employment status, type of TDI, and RCT needs were suggested as potential predictors of positive IPV cases.

Accidental avulsion of a recently traumatised maxillary anterior tooth during rubber dam application

Avulsion injuries are usually seen in the anterior maxillary teeth as a result of trauma. Avulsion as an endodontic mishap is extremely rare. This report highlights an unusual instance of exarticulation of a recently traumatised maxillary central incisor tooth when the rubber dam was applied during a routine non-surgical endodontic procedure. The tooth was immediately repositioned and stabilised with wire composite splint. Endodontic treatment was initiated after rubber dam isolation with a modified technique. Calcium hydroxide was used as intracanal medicament dressing, and obturation was done after 2 weeks. The treatment was successful with uneventful periodontal healing at 24-month follow-up. The presence of well-demarcated periodontal ligament space and absence of any resorptive area on the radiograph could be defined as a successful outcome for the present case.

Management of severe traumatic intrusion in the permanent dentition

Traumatic intrusion is considered one of the most severe luxation injuries to the permanent dentition. There are limited studies based on minimal evidence supporting suggested management protocols, owing to the rare occurrence of intrusion. The following case report details the multidisciplinary management and 18-month follow-up, in line with current UK guidelines, of a 23-year old adult male who sustained severe intrusion injuries to both permanent maxillary central incisor teeth. Timely, accurate diagnosis and subsequent appropriate management correlates with improved outcomes for traumatic injuries and it is therefore imperative those involved with the acute and long-term management of dentoalveolar trauma are aware of current guidelines.

Traumatic dental injuries and pulp sequelae in an adolescent population

BACKGROUND/AIMS

Traumatic dental injuries (TDI) occur frequently and may result in pulp sequelae. This includes pulp necrosis with infection, pulp canal obliteration and root resorption. The aim of this study was to assess the prevalence and risk factors of pulp sequelae after TDI among Norwegian adolescents.

MATERIAL AND METHODS

A retrospective longitudinal study, including historical clinical data, was conducted with 16-year-old pupils in western Norway. All first-grade pupils, born in 1997 (n = 5184), attending public high schools, were invited to participate and to respond to an electronically administered closed-ended questionnaire (response rate 39.6%, n = 2055). Consent was given to access the dental records in the Public Dental Health Service in Hordaland, where information regarding TDI (diagnosis and treatment) and radiographs were interpreted. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible). Outcome variables of TDI were registered and analysed using logistic regression, Kaplan-Meier survival estimates and log-rank test.

RESULTS

The prevalence of TDI in the sample population was 16.4% (338 pupils), with a total of 637 teeth involved. The number of included teeth for analysis was 571 (90.5%). The prevalence of pulp necrosis with infection was 7.5%. Moderate and severe TDI was associated with a higher frequency of pulp necrosis with infection. Pulp canal obliteration and root resorption were found in 2.8% and 2.3% of teeth with TDI, respectively. Dental hard tissue injuries were more prone to the development of pulp necrosis than luxation injuries and combination injuries. The relationship between root development stage and development of pulp necrosis with infection was not statistically significant.

CONCLUSIONS

Occurrence of different pulp sequelae among teeth affected with TDI was low. Moderate and severe TDI were more at risk of developing pulpal complications and hard tissue injuries were at higher risk of developing pulp necrosis with infection.

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.

Types of External Root Resorption of Replanted Teeth: Analysis of the Clinical Aspects and of Interleukin-4 Gene Polymorphisms Involvement

INTRODUCTION

The absence or presence of root resorption on the surface of a replanted tooth indicates an immune-inflammatory reaction. Recent research even suggests the participation of host predominant immunologic profile on types of resorptions detected on the root surface. Because interleukin 4 (IL-4) is an important anti-inflammatory cytokine, this study aimed to investigate the association of clinical variables and polymorphisms in IL4 with types of resorption of replanted teeth after 1 year of follow-up.

METHODS

One hundred twenty-seven avulsed teeth that were replanted were selected. Periapical radiographs were taken after replantation and for 1 year to detect the types of root resorption. Real-time polymerase chain reaction was used to genotype IL4 polymorphisms. The χ² and Z tests were performed to verify the association of clinical and genetic variables with the outcomes of replanted teeth (P < .05).

RESULTS

An association was observed of extra-alveolar time, storage medium, and development of the root (P < .05), but not of IL4 polymorphisms, with the outcomes of replanted teeth (P > .05).

CONCLUSIONS

Extraoral time, storage medium, and development of the root, but not IL4 polymorphisms, may influence the types of resorption of avulsed and replanted teeth in the first year after trauma.

Comprehensive management of a complex traumatic dental injury

A 24-year-old female patient presented with complaint of palatal swelling and a sinus tract facial to tooth #22. She reported an injury to the tooth 15 years earlier and no recollection of treatment, although there was evidence of an endodontic access into the crown. Radiographically the root appeared to have stopped developing, and it was associated with a large periapical lesion. After 3 unsuccessful attempts at apexification using calcium hydroxide (CH), further examination including use of cone-beam computed tomography (CBCT) was carried out. The latter allowed for better evaluating the situation and for better planning a more comprehensive treatment plan to include surgical removal of the apical lesion. The large radiolucent area extended from tooth #21 to #23. Using a dedicated software tool developed to be used in conjunction with CBCT, volumetric assessment of the lesion was carried out for healing follow up. The root end was filled from the apical direction with newly developed accelerated silicate cement 4-5 mm into the apical part of the canal. Subsequently, the rest of the canal was filled with the same type of cement. At the 1-year postsurgical follow up, the tooth remained asymptomatic, and using the CBCT volumetric program, bony healing could be demonstrated.

Tratamento ortodôntico em pacientes com dentes reimplantados após avulsão traumática: relato de caso

INTRODUÇÃO: a alta prevalência de indivíduos com traumatismo dentário prévio ao tratamento ortodôntico justifica os cuidados a serem observados antes e durante o tratamento, considerando todas as implicações do movimento ortodôntico sobre os dentes traumatizados. Entre as lesões traumáticas dentárias, a avulsão com posterior reimplantação do dente é a que apresenta maior risco de complicações - como necrose pulpar, reabsorção radicular e anquilose -, sendo também a que inspira maiores cuidados pelo ortodontista. OBJETIVO: este trabalho busca, através do relato de um caso clínico, analisar as implicações do reimplante dentário após avulsão traumática, em pacientes que requerem tratamento ortodôntico. CONCLUSÕES: a movimentação ortodôntica de um dente reimplantado, após sua avulsão traumática, é possível desde que não ocorra qualquer sinal de anormalidade. Porém, dentes que sofrem anquilose não são passíveis de movimentação ortodôntica, mas devem ser preservados como mantenedores de espaço, até a reabsorção total da raiz, desde que não apresentem infraposição severa. Ocorrendo infraposição severa do dente anquilosado, é indicada a amputação da coroa e o sepultamento da raiz, como meio de favorecer a manutenção do osso alveolar na região, pois ocorrerá reabsorção por substituição da raiz sepultada, como ocorreu no caso clínico apresentado.

Minor traumatic injuries to the permanent dentition

Treatment of traumatized teeth generally occurs in two phases: short-term emergency treatment and stabilization followed by endodontic management and review. These authors recently reviewed the endodontic considerations in the treatment of traumatized permanent anterior teeth, and in this article review the early management of traumatized permanent teeth. Preoperative assessment and emergency management are emphasized, as is the treatment of immature teeth for which continued development of the root system must be encouraged. Factors influencing long-term prognosis are discussed and the influence of various management strategies evaluated.