Treatment of multiple traumatized anterior teeth associated with an alveolar bone fracture in a 20-year-old patient: A 3-year follow up

Evidence-based management of isolated dentoalveolar fractures: a systematic review

Dentoalveolar (DA) trauma, which can involve tooth, alveolar bone, and surrounding soft tissues, is a significant dentofacial emergency. In emergency settings, physicians might lack comprehensive knowledge of timely procedures, causing delays for specialist referral. This systematic review assesses the literature on isolated DA fractures, emphasizing intervention timing and splinting techniques and duration in both children and adults. This systematic review adhered to PRISMA guidelines and involved a thorough search across PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library from January 1980 to December 2022. Inclusion and exclusion criteria guided study selection, with data extraction and analysis centered on demographics, etiology, injury site, diagnostics, treatment timelines, and outcomes in pediatric (2-12 years) and adult (>12 years) populations. This review analyzed 26 studies, categorized by age into pediatrics (2-12 years) and adults (>12 years). Falls were a common etiology, primarily affecting the anterior maxilla. Immediate management involved replantation, repositioning, and splinting within 24 hours (pediatric) or 48 hours (adult). Composite resin-bonded splints were common. Endodontic treatment was done within a timeframe of 3 days to 12 weeks for children and 2-12 weeks for adults. Tailored management based on patient age, tooth development stage, time elapsed, and resource availability is essential.

Management and Follow-Up of Complicated Crown Fractures with Intrusive Luxation of Maxillary Incisors in an 8-Year-Old Boy

Intrusive luxation is a severe form of dental injury which causes damage to the pulp and supporting structures of a tooth because of its dislocation into the alveolar process. This paper shows the case of the reeruption of maxillary incisors accompanied by complicated crown fractures after 3 months. An 8-year-old boy patient was referred to the Department of Pedodontic Dentistry of Tehran University of Medical Science, Tehran, Iran, 18 hours after a fall at school. Clinical and radiographic examinations revealed intrusive luxation of both incisors with complicated crown fractures. Cervical pulpotomy is the treatment of choice for traumatized immature intruded teeth with pulp exposure. Two months later, the right central incisor teeth reerupted to a normal position and the final aesthetic restorations were done. The left central incisor was spontaneously repositioned with external root resorption, and the team decided to use interim medication (calcium hydroxide) in the root canal for stopping the process of resorption, and by the 9-month follow-up, the process of resorption had been stopped. An MTA plug was placed into the canal, and the final esthetic restorations were done.

A Short Time Period in the Treatment of an Open Apice Intruded Tooth: An 8-year Follow-up

AIM

Among traumatic dental injuries, intrusive dislocation is considered to be one of the most serious injuries. Despite the high success rate in complacent patients, the traditional technique of calcium hydroxide inoculation has drawbacks. The good antimicrobial and sealing properties combined with excellent biocompatibility and high success rates of the mineral trioxide aggregate (MTA) encourage its use.

BACKGROUND

The objective of this study was to report a successful case of intrusive dislocation in a short time with a follow-up of eight years.

CASE DESCRIPTION

A patient, seven years of age, presented intrusive dental dislocation, confirmed by radiographic examination, which revealed besides axial displacement of the central incisor towards the bone, incomplete root development. The passive repositioning was chosen as the treatment modality. After cleansing of the root canal, therapy with hydroxide paste was performed for 30 days, and then the apex was closed using an artificial barrier made with apical MTA buffer to facilitate root canal obturation.

CONCLUSION

Clinical and radiographic signs at 6 months and 8 years of preservation evidence the success of the therapy.

CLINICAL RELEVANCE

Teeth with incomplete root formation when traumatized may have their development process interrupted; consequently their root canals remained ample with thin and fragile walls and the open apex which represents a great challenge to the accomplishment of endodontic therapy. The process of apexification with MTA as in this case is an alternative to traditional therapy based on calcium hydroxide, conferring a faster treatment and a decrease in the odds of fracture of the tooth since from the confection of the apical barrier there is a possibility of being the same restored at an early stage.

HOW TO CITE THIS ARTICLE

de Sá MAB, Nunes E, et al. A Short Time Period in the Treatment of an Open Apice Intruded Tooth: An 8-year Follow-up. Int J Clin Pediatr Dent 2019;12(2):160-163.

A Novel Technique for Minimizing the Metal Artifacts on Anterior Teeth in Cone-Beam Computed Tomography

In endodontics, metal artifacts are the major weak points of employing cone-beam computed tomography (CBCT) in teeth with metallic posts and restorations. The aim of this article is to introduce a novel technique for preparation of beneficial CBCT images of anterior teeth with metal posts and/or crowns. In this novel technique, the patient who was instructed to take CBCT images for reason of implant surgery, was asked to puff out his cheeks/lips during the rotation of x-ray tube. By comparing the image taken with this technique to normal image it was obvious that after applying the cheek puffing technique, the metal artifacts around restored anterior teeth significantly reduced. Then it seems that this novel technique removes the metal artifacts from the crowned teeth to distances far from the tooth structure and enables more accurate diagnosis.

Diagnosis of alveolar and root fractures: an in vitro study comparing CBCT imaging with periapical radiographs

Objective

To compare periapical radiograph (PR) and cone-beam computed tomography (CBCT) in the diagnosis of alveolar and root fractures.

Material and Methods

Sixty incisor teeth (20 higid and 40 with root fracture) from dogs were inserted in 60 anterior alveolar sockets (40 higid and 20 with alveolar fracture) of 15 macerated canine maxillae. Each fractured socket had a root fractured tooth inserted in it. Afterwards, each maxilla was submitted to PR in two different vertical angulation incidences, and to CBCT imaging with a small field of view (FOV) and high-definition protocol. Images were randomized and posteriorly analyzed by two oral and maxillofacial radiologists two times, with a two-week interval between observations.

Results

Sensitivity and specificity values were good for root fractures for PR and CBCT. For alveolar fractures, sensitivity ranged from 0.10 to 0.90 for PR and from 0.50 to 0.65 for CBCT. Specificity for alveolar fractures showed lower results than for root fractures for PR and CBCT. Areas under the ROC curve showed good results for both PR and CBCT for root fractures. However, results were fair for both PR and CBCT for alveolar fractures. When submitted to repeated measures ANOVA tests, there was a statistically significant difference between PR and CBCT for root fractures. Root fracture intraobserver agreement ranged from 0.90 to 0.93, and alveolar fracture intraobserver agreement ranged from 0.30 to 0.57. Interobserver agreement results were substantial for root fractures and poor/fair for alveolar fractures (0.11 for PR and 0.30 for CBCT).

Conclusion

Periapical radiograph with two different vertical angulations may be considered an accurate method to detect root fractures. However, PR showed poorer results than CBCT for the diagnosis of alveolar fractures. When no fractures are diagnosed in PR and the patient describes pain symptoms, the subsequent exam of choice is CBCT.