Aetiology, treatment patterns and long-term outcomes of tooth avulsion in children and adolescents

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.

2020 International Consensus on First Aid Science With Treatment Recommendations

This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life- threatening bleeding through the use of tourniquets, haemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research. The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual summary publications from the International Liaison Committee on Resuscitation (ILCOR). This 2020 CoSTR for first aid includes new topics addressed by systematic reviews performed within the past 12 months. It also includes updates of the first aid treatment recommendations published from 2010 through 2019 that are based on additional evidence evaluations and updates. As a result, this 2020 CoSTR for first aid represents the most comprehensive update since 2010.

2020 International Consensus on First Aid Science With Treatment Recommendations

This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life-threatening bleeding through the use of tourniquets, hemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.

Effect of root surface treatment with denusomab after delayed tooth replantation

OBJECTIVES

To evaluate denosumab, a human monoclonal antibody that mimics the effects of osteoprotegerin in bone metabolism, as a topical treatment of root surface to be used prior to delayed tooth replantation.

MATERIALS AND METHODS

Thirty-six rats' right incisors were used. Teeth were extracted and divided into: delayed replantation without root surface treatment (control); delayed replantation with root surface treatment with denosumab 60 mg/mL and 30 mg/mL, respectively, for 10 min both experimentals groups. After that, the root canals were filled with calcium hydroxide and replanted. After 15 and 60 days, the animals were euthanized, and the samples were collected and processed for microscopic analysis. Histological sections were performed, and stained with HE to describe the dental characteristics, measure ankylosis, replacement resorption, and dental resorption by conventional microscopy. Also, was performed Brown & Brenn staining and immunohistochemistry for RANKL, OPG, and periostin.

RESULTS

Denosumab 60 mg/mL reducted ankylosis (p < 0.0001), replacement resorption (p < 0.0001), and tooth resorption, 60 days after replantation, compared to untreated replanted teeth (p < 0.005). Lower bacterial contamination in root surface in the denosumab treatment groups was found, regardless of the concentration used (p < 0.001). Also, denosumab treatment inhibited the expression of RANKL without modulating OPG. Periostin was observed in periodontal ligament of replanted tooth, although this labelling was absent in the ankylosis areas, in both experimental periods.

CONCLUSION

Treatment of the root surface with denosumab at 60 mg/mL of rat teeth before delayed replantation reduced dental root resorption compared with the untreated teeth after 60 days.

CLINICAL RELEVANCE

Survival of a replanted tooth has been a challenge in clinical practice. The use of a medication, such as denosumab, to limit dental root resorption represents an important therapeutical approach.

Storage of an avulsed tooth prior to replantation: A systematic review and meta-analysis

BACKGROUND/AIM

It is crucial to store an avulsed tooth appropriately to preserve the viability of the periodontal ligament cells prior to replantation. The aim of this systematic review was to identify the best available evidence for the effectiveness of any technique available to laypeople for storing an avulsed tooth compared with storage in milk or saliva.

METHODS

The following databases were searched (September 2019): Cochrane Library, MEDLINE, and Embase. Two reviewers independently considered trial eligibility, then extracted and analyzed data, and assessed the risk of bias. The certainty of the body of evidence was appraised according to the GRADE methodology.

RESULTS

Out of 4118 references, 33 studies were included and reported 23 comparisons of which 10 were synthesized in a meta-analysis. The limited evidence available favors storing an avulsed tooth in Hank's balanced salt solution (pooled SMD 2.47, 95% CI [1.59;3.34], P < .00001), propolis solution (pooled SMD 1.73, 95% CI [1.12;2.33], P < .00001), oral rehydration salts (pooled SMD 4.16, 95% CI [2.10;6.23], P < .0001), rice water, and cling film compared with storage in milk. The cell viability rate was significantly lower in teeth stored in saline solutions (pooled SMD -4.35, 95% CI [-7.55;-1.14], P = .008), tap water, buttermilk, castor oil, GC Tooth Mousse, and turmeric extract than those stored in milk. There is insufficient evidence to recommend for or against temporary storage of an avulsed tooth in saliva compared with alternative solutions. The certainty of evidence was considered low to very low due to limitations in study design, indirect study populations and outcome measures, and imprecision.

CONCLUSION

Although milk was shown to extend the periodontal ligament cell viability before replantation compared with saline or tap water, the following media have also demonstrated efficacy at preserving the cell viability: Hank's balanced salt solution, propolis, oral rehydration salts, rice water, and cling film.

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.

Changes in the aetiological factors of dental trauma in children over time: An 18-year retrospective study

BACKGROUND/AIM

Dental trauma causes significant aesthetic, functional and psychosocial problems that often require emergency attention in children. The aim of this retrospective study was to assess the factors related to dental injuries in children. A secondary aim was to better understand how to improve the education given to children, parents and teachers in schools regarding dental trauma.

MATERIALS AND METHODS

Records of children who were referred to the Department of Pedodontics at Suleyman Demirel University were reviewed. A total of 1971 patients with a history of dental trauma who attended the clinic from 1999 to 2017 were evaluated. The following information was recorded: age, gender, year, aetiology, location, season and time elapsed after trauma. Results were evaluated using the Pearson chi-square test.

RESULTS

The patients' average age was 8.56 ± 0.08. Dental injuries were frequent in the 7- to 12-year age group (55.9%). Children in the 0- to 6-year age group attended the clinic more frequently during the years 2013 and 2017 compared to previous years. Boys had a higher frequency of trauma than girls (P < 0.05). The most frequent cause of trauma was falls (46%). The accidents occurred predominantly in the street (41.8%). Trauma that took place at home increased in the later years of the study period, whereas the percentage of injuries occurring in schools decreased. The ratio of patients who attended the clinic within the first two days after trauma was 33.4% between 1999 and 2007, and this increased to 59.8% between 2013 and 2017. The majority of the injuries occurred during the summer.

CONCLUSIONS

The aetiological factors related to trauma in children, and the number of patients who attended the clinic, have not changed over the 18-year period but the elapsed time to attend the clinic has changed. Education will increase the awareness regarding the importance of emergency intervention immediately following dental trauma.

Reasonable Outcome of Avulsed Permanent Upper Incisor after Seven Years Follow-Up Period: a Case Report

Background

Avulsion of the permanent teeth is one of the most serious oral health problems among active children and adolescents. Traumatized patients require immediate and correct treatment in order to restore damaged structures and function that have major impact on daily patient's life. As a result, proper guidelines and fast treatment methods are necessary. This case report discusses treatment of maxillary right central incisor with an open apex that had been avulsed and replanted. We review applied treatment procedures to manage dental avulsion and restore function and aesthetics.

Methods

A 10-year-old male presented with avulsion of his maxillary right central incisor as a result of unintentional playground injury. The tooth had been stored dry before the patient received immediate care. The avulsed tooth was reimplanted and splinted. The applied treatment procedures include endodontic and restorative treatment as well as careful follow-up visits.

Results

The patient underwent endodontic therapy of his maxillary right central incisor with calcium hydroxide as an intracanal medicament in apexification technique and the closure of apex was achieved. Canal was obturated and the tooth was restored with composite resin. Clinical and radiographic imaging follow-up showed endodontic success with closed apex. However, severe infra-position of maxillary right central incisor developed due to ankylosis.

Conclusions

Ankylosis due to tooth avulsion is a common complication of reimplanted permanent incisors and must be taken into consideration. While addressing ankylosis and its results is supported by little evidence, every case must be diagnosed correctly and treated according to its negative outcomes.

16-Year follow-up of an avulsed maxillary central incisor after replantation following 10-h storage: An unusual case

Tooth avulsion is a type of dental injury defined as the complete displacement of a tooth out of the alveolar socket, and the lack of prompt treatment measures can result in the loss of function, poor quality of life, and psychological and social problems. However, several factors may not permit the immediate replantation of an avulsed tooth; therefore, delayed replantation has emerged as an alternative to meet the esthetic, functional, and psychological demands of patients. Here it was described that the successful replantation of an avulsed maxillary central incisor in a 9-year-old boy who presented at the clinic with the tooth stored in unfavorable conditions as dry and then in olive oil-milk mixture almost 10 h after the event. The tooth has remained in its socket healthy for 16 years after treatment. The patient was satisfied with both esthetics and function.

Dental avulsions: Review and recommendations

Tooth avulsion injuries are common. This article will review causes of tooth avulsion and provide management guidelines. Recommendations for NP education and practice will be reviewed.

Continued root formation after delayed replantation of an avulsed immature permanent tooth

Introduction. Tooth avulsion in the young permanent dentition is a frequent finding, and its prognosis depends on the treatment of the avulsed tooth before replantation, the extra-alveolar time, the storage medium, and the patient's general health. The present report describes management of an immature avulsed lower central incisor 90 minutes after the accident. Methods. A right lower central incisor of a 7-year-old girl was avulsed, and it was soaked in a glass of milk. 90 minutes after avulsion, replantation was performed, and the tooth was splinted; but after two weeks the replanted tooth's pulp was necrotic. Thus, endodontic treatment was performed and root canal was filled using a calcium hydroxide and iodoform paste (Metapex). Three months later, the intracanal medication was washed out and the canal was sealed using an apical plug of calcium enriched mixture (CEM) cement. Results. 20 months after replantation the tooth was completely asymptomatic, with physiologic mobility. Also, continued root formation including an apical segment beyond the artificial apical plug was observed. Conclusion. Creation of an appropriate apical barrier following the disinfection of root canal system promoted continued root-end growth in a replanted immature permanent tooth.