[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Hebrew edition]

Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can maximize the chances of a positive outcome. The Hebrew Edition is part of the IADT global effort to provide a worldwide accessibility to these guidelines. This third part will discuss injuries in the primary dentition.

[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Hebrew edition]

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth. The Hebrew Edition is part of the IADT global effort to provide a worldwide accessibility to these guidelines. This scond part of the guidelines will focus on avulsion of permanent teeth.

[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Hebrew edition]

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and follow up are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented. The Hebrew Edition is part of the IADT global effort to provide accessibility to these guidelines worldwide.

Auto-alloplastic transplantation of a primary canine after traumatic loss of a permanent central incisor

This report describes the transplantation of a primary canine after traumatic loss of a central incisor in an 8-year-old boy. The 7-month follow-up revealed normal periodontal healing with absence of infection, ankylosis or progressive resorption. The patient was then lost for control. After 16 months another trauma in the same patient resulted in an avulsion of the transplant. However, the alveolar bone was maintained in vertical and sagittal dimensions. Another primary canine was transplanted and followed for further 11 months. Again normal periodontal healing could be observed. The transplantation of a primary canine is seen as a promising method to replace a lost permanent tooth and maintain the surrounding tissues in very young patients.

Treatment of replacement resorption with Emdogain--preliminary results after 10 months

Ankylosis of traumatized teeth in children and adolescents may inhibit further development and growth of the corresponding jawbone. Therefore, ankylosed teeth should be removed. As an alternative treatment option to autotransplantation of a premolar, intentional replantation using Emdogain may be considered, provided the ankylosis is detected at an early stage or has only affected a small area of the root. Eleven ankylosed teeth presenting with replacement resorption were treated as follows: after tooth extraction, the root canal was treated extraorally and obturated by retrograde insertion of a titanium post. Emdogain was applied to the root surface and into the extraction socket with subsequent replantation of the tooth. During a mean follow-up period of 6.3 months, no signs of recurrence of ankylosis were noted. The horizontally and vertically measured Periotest scores were identical to those obtained on the adjacent teeth. These results suggest that intentional replantation using Emdogain may prevent or delay ankylosis of these replanted teeth.

Decoronation of an ankylosed tooth for preservation of alveolar bone prior to implant placement

A 12-year-old patient sustained avulsions of both permanent maxillary central incisors. Subsequently, both teeth developed replacement resorption. The left incisor was extracted alio loco. The right incisor was treated by decoronation (removal of crown and pulp, but preservation of the root substance). Comparison of both sites demonstrated complete preservation of the height and width of the alveolar bone at the decoronation site, whereas the tooth extraction site showed considerable bone loss. In addition, some vertical bone apposition was found on top of the decoronated root. Decoronation is a simple and safe surgical procedure for preservation of alveolar bone prior to implant placement. It must be considered as a treatment option for teeth affected by replacement resorption if tooth transplantation is not feasible.

A retrospective classification of tooth injuries using a new scoring system

The WHO classification presently in use categories dental trauma only according to the main injury. A new scoring system will now enable more precise and complete diagnosis of tooth injuries. In an initial retrospective investigation, 100 traumatised teeth were classified according to the WHO and the new scoring systems. Clinical and radiological examinations and another evaluations using the new scoring system were made at the time of follow-up examination. Avulsion, intrusion, and root fractures (score < 30) showed the most unfavourable findings at the time of the accident. In comparison, the most favourable findings were shown by concussion and first degree crown fracture (score > 70). A comparison to the WHO classification occasionally revealed noticeable score variations within a single WHO type of injury. Generally, a strong interdependence was observed between the evaluations at the time of the accident and at the time of the follow-up examination (P < 0.001). If the score at the time of the accident was equal to or larger than 57, a successful therapy was usually ensured (P < 0.001). The new scoring system enables more complete diagnosis as well as permitting statements to be made concerning prognosis.

Periodontal healing after intentional auto-alloplastic reimplantation of injured immature upper front teeth

BACKGROUND/AIMS

Conventional endodontic treatment results in high complication quota when performed in immature teeth. Intentional reimplantation with extraoral insertion of an endodontic implant (auto-alloplastic reimplantation) is an alternative.

METHOD

In a retrospective study, the healing of 40 teeth reimplanted intentionally according to this method in patients aged 7 to 15 years was evaluated. Clinical tests (palpation, percussion sound, periotest values) and radiographical examinations were used to determine the type of periodontal healing (inflammatory resorption/periodontitis apicalis; replacement resorption/ankylosis; normal healing).

RESULTS

Mean lifetime of the replanted teeth was 59.2+/-42.5 months, estimated survival time on the basis of the Kaplan-Meier analysis was 99.5 months. 17 teeth (42.5%) were classified as failures, mostly due to inflammatory resorption or periodontitis apicalis. Further investigations demonstrated that success rate and retention period of intentionally replanted teeth depend on the preoperative condition of the pulp. Teeth with preoperative infection suffered frequently from inflammatory resorption or periodontitis apicalis after being replanted (14 of 28 teeth). Estimated survival time according to Kaplan-Meier was 75.5 months. In contrast, inflammations or progressive resorptions were not observed in teeth without preoperative infection of the pulp. All these 12 teeth showed normal periodontal healing and regular tooth mobility. In the absence of any pathology in clinical or radiological findings after an average functional period of 72.3 months, the prognosis can be presumed excellent. Estimated survival time of 148.3 months according to Kaplan-Meier differs significantly from survival time of teeth infected preoperatively.

CONCLUSIONS

From the results of this investigation, it may be concluded that an infection of the pulp - due to delay of treatment or attempts at endodontic therapy - should be avoided before intentional replantation of immature front teeth with pulp necrosis. Periodontal healing of the autologous root is not impaired by the insertion of posts made of Al2O3-ceramics or titanium. The inserted posts do not ankylose. Orthodontic movement of auto-alloplastically replanted teeth is possible.

Investigations on a cell culture medium for storage and transportation of avulsed teeth

Non-physiologic storage of avulsed teeth leads to a high incidence of root resorption, resulting in poor prognosis. This study investigated the suitability of specially composed cell culture media for storage of extracted teeth for up to 48 hours. Autoradiographic investigations revealed that the proliferative activity of periodontal ligament (PDL) cells of teeth stored in cell culture medium for up to 48 hours increased with storage time. Studies on proliferation of PDL cells after storage of teeth in different media for up to 24 hours demonstrated that the proliferative activity is dependent on the composition of the medium. Immunohistochemical investigations with markers for cell proliferation revealed that pulp cells of extracted immature teeth show numerous proliferations after storage for up to 24 hours in a special cell culture medium but few proliferations after storage in Hanks Balanced Salt Solution (HBSS). The investigations indicate that a special cell culture medium can preserve cell viability of PDL cells adhering to extracted teeth for at least 48 hours. The in vitro results are confirmed by a case presented: After storage of two upper central incisors for 36 hours in the cell culture medium the teeth could be successfully reimplanted after extraoral insertion of titanium posts into the root canal (auto-alloplastic reimplantation). Clinical and radiological follow-up examinations for 12 months revealed normal periodontal healing.

Sensory disorders after separation of the nasopalatine nerve during removal of palatal displaced canines: prospective investigation

During a prospective study after separation of the nasopalatine nerve at the foramen incisivum during exposure or removal of impacted and palatal displaced maxillary canines, 59 patients were examined neurologically for 4 weeks postoperatively over an investigation period of 18 months. During the first week after the operation, subjective as well as objective sensory disorders were found in all of the patients, but after 4 weeks at the most no neurological deficit could be detected in any patient.

Transplantation of displaced and dilacerated anterior teeth

The therapy of dilacerated permanent anterior teeth usually involves surgically removing the tooth. Subsequently, orthodontic methods for closing the space or keeping it open are preferred until the patient reaches an age when definitive implantological or prosthetic treatments may be used. Anterior tooth transplantation should be considered as an alternative to surgically extracting the tooth. This study describes a period of investigation covering 3 years during which neither replacement resorption nor inflammatory resorption was diagnosed in the five transplanted teeth. The clinical tooth mobility was similar to that of the adjacent teeth. In spite of the vertical loss of bone shown radiographically no pathologically enlarged pockets or recessions have been found. It is not yet possible to make any comments on the prognosis for the long term.

Sequestration of the alveolar bone by invasive aspergillosis in acute myeloid leukemia

Compared to non-invasive aspergillosis, invasive aspergillosis in the region of the mouth, jaw and face has rarely been reported. It occurs particularly often in the presence of haematological oncological illness. The case of a patient suffering from acute myeloid leukemia is described; he contracted invasive aspergillosis of the lungs and the alveolar processes in the course of chemotherapeutic treatment. All the alveolar processes in the region of the premolars and molars were demarcated and had to be removed by sequestrectomy. The therapy of invasive aspergillosis should be carried out within the framework of intensive interdisciplinary treatment. In addition to systemic and local antimycotic therapy, the debridement of necrotic hard and soft tissue was necessary.

Replantation of avulsed primary anterior teeth: treatment and limitations

In addition to the successful replantation of avulsed permanent teeth, the replantation of primary anterior teeth may also be indicated. The decision is based on age and stage of tooth development, development of dentition, storage of the avulsed tooth and the way it is transported to the treatment site, the appropriate in vitro treatment of the tooth before reinsertion, and the willingness of the child to cooperate. A method involving retrograde filling of the primary tooth root with calcium hydroxide after resecting the root apex has proved successful. Other commercially available root filling materials and pins are not indicated. Calcium hydroxide allows the tooth to heal in place without reaction and prevents the development of apical periodontitis. As regards any surgical intervention, the attending dentist in this case has to weigh the benefits against the risks.

Dental treatment of handicapped patients using endotracheal anesthesia

Dental treatment using endotracheal anesthesia is indicated where acute odontogenic infections, accidental injuries, or multiple caries and periodontitis marginalis require surgical and/or restorative treatment. It is also indicated where it is not possible to use psychological support during local anesthesia or during premedication or analgosedation. Dental treatment of handicapped patients using endotracheal anesthesia is described, along with indication and frequency of such treatment. The state of the dentition is illustrated, along with its relationship to the oral hygiene the handicapped patients receive. The main points of the intraoperative dental procedures and the follow-up of patient care are reported. Postoperative dental or general medical complications have not occurred within the patient population under study.