Fragment rehydration, splinting, and autotransplantation: A journey to better treatment for traumatized teeth

Abstract

Uncomplicated crown fractures make up 18%–22% of all traumatic dental injuries (TDIs).¹ The recommended treatment is rehydration and reattachment of the tooth fragment.^{1, 2} Humidification is an alternative method for rehydration that has previously been shown to increase the force required for tooth fracture.^2-4 In this issue, Jhunjhunwala et al. compared and evaluated three materials for bonding after the rehydration of bovine teeth with reattached uncomplicated crown fractures in a humidification chamber.⁵ The materials used for fragment reattachment after rehydration were light-cured glass ionomer cement, nano-hybrid composite, and micro-hybrid composite, with the control group being the non-rehydrated reattachments. The results have shown the possibilities of reducing the cost of fragment reattachment procedures and using different bonding materials for reattachment.

Severe TDIs can lead to tooth loss, but timely and appropriate treatment provided to traumatized teeth can significantly impact their prognosis.^6-8 The limited number of referral centers for TDIs, as well as their distance to other facilities may cause a delay in treating TDIs.⁹ In this issue, an 8-year retrospective study was conducted at the Department of Pediatric Dentistry at the University Dental Clinic in Zagreb, Croatia. Šimunović et al. assessed the arrival time of TDIs according to the urgency of treatment, as well as place of residence.¹⁰ The results of this study offer valuable insight that may help establish educational and preventive programs for TDIs in children and adolescents.

Early tooth loss in the anterior maxilla leads to the collapse of the alveolar bone along with changes in craniofacial growth.^{11, 12} The replacement of the missing tooth is difficult and costly once the patient is fully grown, due to the extent of the defect.¹³ Autotransplantation of premolars to the anterior maxilla might be a suitable solution especially when orthodontic indication for extraction exists.^{11, 14-17} An observational retrospective analysis of 910 cases with autotransplanted premolars was carried out in a Periodontology Clinic in Rotterdam, Netherlands. In this issue, Louropoulou et al. evaluated the survival, success, and possible complications of transplanted premolars to the anterior region, depending on the development stage and the patient's age.¹⁸ This article highlights the predictability of premolar autotransplantation to the anterior region over a 10-year follow-up period.

Interpersonal violence (IPV) is a public health concern, and the number of reported injuries is increasing.^19-22 Patient analysis in a hospital environment is crucial to help aid victims of violence, as well as devising violence prevention strategies to decrease the number of cases of maxillofacial injuries.²³ A retrospective study was conducted at a maxillofacial and oral surgery clinic at a trauma center hospital in Sao Paolo, Brazil. In this issue, Benassi et al. assessed the profile of patients with maxillofacial trauma due to IPV.²⁴ The findings of this study can help dental professionals be more cognizant of the possibility of IPV cases. In the next few months, a special issue dedicated to domestic violence will be published in Dental Traumatology.

Luxation injuries compose 18%–33% of TDIs and usually require dental splinting.²⁵ The IADT recommends a 2-week regime of flexible or semi-rigid splinting for luxation injuries, to allow for functional movement and promote periodontal regeneration.^{1, 26} A randomized controlled trial was carried out to investigate splinting in luxation injuries. In this issue, Raza et al. compared conventional composite-wire splints to bulk-fill composite-wire splints in adults.²⁷ Factors evaluated included retention, adhesive point dimension, splint application and removal time, and tooth mobility reduction. The results of this research may help clinicians choose materials for composite-wire splinting of tooth luxation.

Intrusion is an uncommon yet serious TDI, accounting for 0.3%–1.9% of all TDIs in the permanent dentition.^28-30 The current IADT guidelines recommend spontaneous eruption, orthodontic extrusion, and surgical repositioning as three treatment options for repositioning intruded teeth.^{1, 26} Orthodontic repositioning of traumatically intruded teeth might result in clinical complications such as root resorption and pulp necrosis.³¹ In this issue, a retrospective study of the effects of extrusion of traumatically intruded teeth was conducted. Shalish et al. compared adverse effects after orthodontic extrusion of traumatically intruded teeth to the treatment of non-traumatized teeth.³² Determining the appropriate timing and duration of eruptive force requires careful consideration of possible complications of traumatized teeth. Orthodontic treatment should be carried out with caution and mild force to prevent complications, especially keeping in mind the patients' dental trauma history.

Traditionally, treatment options following TDIs aimed to create a hard tissue bridge at the open apex, through apexification with mineral trioxide aggregate application.^{33, 34} More biologically based techniques are used to try and restore lost pulp tissues with regenerative endodontic procedures using platelet concentrates.³⁵ A randomized clinical trial compared the regenerative potential of injectable platelet-rich fibrin (i-PRF) and platelet-rich plasma (PRP) scaffolds in traumatized immature maxillary anterior teeth. In this issue, Abo-Heikal et al. compared the completion of root formation and the restoration of pulp sensitivity in traumatized necrotic immature maxillary anterior teeth following i-PRF versus PRP regenerative scaffolds.³⁶ Maintaining pulp vitality is highly important for the long-term survival of teeth following TDIs.

Stand-up scooters have gained popularity as electrically operated personal mobility devices.³⁷ With the increase in the use of stand-up scooters, accidents caused by them, including the prevalence of maxillofacial trauma, have increased as well.^{38, 39} In this issue, Lee et al. investigated the trauma pattern associated with the use of stand-up electric scooters compared with that related to the use of bicycles.⁴⁰ Medical records were collected at the Wonju Christian Hospital over a 5-year period. Maxillofacial trauma caused by stand-up scooters and bicycles were analyzed. The findings of this study emphasize the necessity of safety regulations with the development of personal transportation.

Restrictions during the recent COVID-19 pandemic led to the closure of playgrounds, schools, and sports centers, and decreased vehicle traffic affecting the incidence of orofacial injuries and hospitalizations.^{37, 41} In this issue, Aminian et al. investigated the effect of Covid-19 lockdowns on the rates of orofacial trauma hospitalizations in children in Australia and the United Kingdom.⁴² As the lockdowns limited physical activities and travel, dental trauma rates during that time helped explore the effect of physical activity as a factor in orofacial injuries in children.

The etiology of TDI in the general population has been linked to a variety of factors, including oral, environmental, and human behaviors.⁴³ Conditions affecting neural and/or muscular coordination such as epilepsy, cerebral palsy (CP), autism, and attention deficit hyperactivity disorders (ADHD) are known to increase the susceptibility to injuries. Individuals with special healthcare needs (SHCN), especially ADHD and CP, have a higher chance of TDI than the general population.^44-48 The prevalence of TDI in individuals with SHCN has been reported, but the associated risk factors are less understood than in the general population. In this issue, Devi et al. assessed various risk factors associated with TDIs in individuals with SHCN.⁴⁹ This systematic review highlighted a large number of facets of TDIs in SHCN patients, including open bite, the extent of CP, seizures, bruxism, non-nutritive sucking habits, severe malocclusion, disabling conditions, and previous TDI history.

CP reduces defensive reflexes, which makes individuals with CP more susceptible to orofacial injuries.^{50, 51} The greater the brain damage, the greater the risk of trauma.⁴⁴ In this issue, Heiden et al. evaluated the prevalence of orofacial injuries resulting from trauma in patients with CP.⁵² Interdisciplinary collaboration with other healthcare professionals is essential for providing integrated and holistic care for patients with CP. This systematic review emphasizes the implementation of preventive measures by adapting guidance and instructions according to the patient's communication needs and abilities, as well as those of their caregivers.

Intentional replantation of a tooth is a technique that involves atraumatic tooth extraction, extraoral repair, and tooth reinsertion into the extraction socket.⁵³ It is a treatment option for inaccessible endodontic or resorptive lesions, and might allow minimally invasive treatment with the retention of natural teeth.^{54, 55} In this issue, Huang et al. performed a bibliometric analysis of articles related to intentional replantation.⁵⁶ The analysis evaluated the global annual publication trends, geographical distribution of publications, institutions and authors. This bibliometric analysis provides comprehensive and valuable insight into the vast body of literature related to the developments of the intentional replantation technique.