Dental Traumatology最新文献

Background/aim: Urban violence represents a significant public health issue globally due to its profound impact on daily life and the high prevalence of victims seeking care in health services. This study aims to evaluate sex differences in victimization patterns, using maxillofacial trauma as a marker for urban violence.

Material and methods: This cross-sectional study analyzed data from medical records of patients treated for traumatic injuries at a referral hospital for traumatology in Belo Horizonte, Brazil, between January 2008 and December 2022. Statistical analysis included both descriptive and multivariate methods, with logistic regression used to examine the association between epidemiological variables and sex in cases of urban violence leading to maxillofacial trauma, especially those resulting from interpersonal violence and traffic accidents.

Results: A total of 6447 records were reviewed, with 32.5% of the cases involving female patients. Among female victims, the age group of 30 to 59 years was the most frequently affected. Violence predominantly occurred at night (75.8%) and on weekdays (52.8%), with most cases classified as naked aggression (71.4%). Women were less likely to sustain multiple fractures than men (OR = 0.72, 95% CI 0.57-0.92) when compared to dentoalveolar trauma. Additionally, female patients with facial trauma were more likely to receive conservative treatment compared to male patients (OR = 1.58, 95% CI 1.31-1.91).

Conclusion: Sex differences are an important parameter in understanding victimization patterns associated with maxillofacial injuries resulting from urban violence. Is the findings suggest that men are more frequently victims of severe trauma and are more likely to undergo surgical treatment for maxillofacial fractures than women.

Background/aim: The evidence related to the superiority of the recommended treatment protocols for necrotic immature permanent teeth is unclear. We aimed to compare the clinical, radiographic, and overall success rates of apexification and regenerative endodontic treatment (RET), assess the methodological quality, and assess the strength of evidence for outcomes.

Methods: A search was performed in PubMed, Scopus, LILACS, EMBASE, Web of Science, and the Cochrane Library. The titles, abstracts and full texts of systematic reviews (SRs) comparing RET and apexification were screened. The quality and strength of evidence were analyzed via AMSTAR-2, ROBIS, and modified Kohler's criteria.

Results: Twelve SRs were included, with nine having meta-analytic outcomes. The quality of only one study was high, and the risk of bias was low in two studies. Comparable success and survival rates for RET and apexification, with no superiority of any treatment, were reported. RET was superior in stimulating root thickness and lengthening. Weak evidence was noted for a higher clinical and radiographic success rate of the apical plug technique and for root lengthening and an increase in root thickness in RET.

Conclusion: RET and apexification exhibited comparable success rates of > 85% across all domains. Most comparisons did not reveal significant differences in clinical, radiographic, or overall success. However, the quality of evidence was weak (class IV) for both outcomes, and the majority of systematic reviews exhibited low or critically low quality and high risk of bias.

Calcium hydroxide apexification has been used in the treatment of immature teeth with pulp necrosis and apical periodontitis for more than 50 years. However, the guidelines of the European Academy of Paediatric Dentistry (EAPD) and the American Association of Endodontists (AAE) 'Clinical recommendations for a regenerative procedure' recommend against calcium hydroxide apexification. The American Association of Endodontists "Clinical considerations for a regenerative procedure" do not list calcium hydroxide apexification as a treatment option for immature teeth with pulp necrosis. This review analyses the strength of the science that led to calcium hydroxide no longer being recommended by the EAPD and AAE regenerative guidelines. Many differences in the studies and failure to include adequate controls have resulted in inconsistent outcomes between studies. Furthermore, prior in vitro studies have assessed narrow mechanical properties of teeth without a theoretical fracture mechanics model. Cvek's concerns regarding the thinness of the dentinal walls remain as a primary risk for tooth fracture with Class 3 root development fractured with an incidence of 77% compared to a fracture incidence of just 2% for mature teeth. This review develops a simple fracture mechanics approach to the phenomenon of transverse root fracture that provides a theoretical framework to why fragile roots are more likely to fracture when compared to mature teeth. Furthermore, the effect of the varying size access cavities has not been previously considered. Systematic reviews and clinical studies do attest to the success of all approaches for the treatment of immature teeth with pulp necrosis. Calcium hydroxide apexification is one of the recommended treatments in the International Association of Dental Traumatology guidelines. However, mineral trioxide aggregate (MTA) and hydraulic calcium silicate cements (HCSC's) may provide better outcomes and have the convenience for the patient of a shorter treatment time. Regenerative endodontic treatment (RET) is recommended when the tooth roots are very immature with Cvek Class 1-3 root development. However, the treatment of immature teeth with pulp necrosis remains a clinical challenge as does the risk of tooth fracture.

Background/aim: The aim of this study was to investigate the impact of traumatic dental injury (TDI) on oral health-related quality of life (OHRQoL) of preschool children, and further inform public oral health care policies and strategies for this age group TDI patients.

Materials and methods: This retrospective and cross-sectional study was conducted in the Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China. It included 314 children aged from 2 to 5 years, with 90 children diagnosed with TDIs and 224 without TDIs. Parents or primary caregivers completed questionnaires, and the responses were gathered for statistical analysis to evaluate the impact of TDIs. The OHRQoL was assessed using the Early Childhood Oral Health Impact Scale (ECOHIS).

Results: The total ECOHIS score and the scores for the 13 individual items were significantly higher in children with TDIs compared with those without TDI (p < 0.001). In the child impact section, eating and masticatory function were the most severely affected (40%), while most of parents experienced strong feelings of self-blame in the family impact section (61.1%). A positive correlation was observed between the number of injured teeth and the total ECOHIS score (p = 0.001), while the time elapsed since TDI indicates a negative correlation with the total ECOHIS score (p < 0.001). Additionally, children with severe TDIs had higher ECOHIS scores than those with mild TDIs, indicating a greater impact on OHRQoL (p = 0.006). In contrast, tooth discoloration, the caregiver's relationship to the child, caregiver education level and the position of the affected teeth did not significantly influence the total ECOHIS score (p > 0.05).

Conclusions: TDIs have a significant impact on OHRQoL in preschool children, highlighting the need for greater societal attention. Strengthening preventive and proper treatment measures for TDIs, along with enhancing health education programs, is strongly recommended.

Background/aim: Autotransplantation is a well-documented procedure for replacing missing teeth in the anterior maxilla. This retrospective study aims to evaluate long-term survival rate, success rate as well as esthetics and patient-reported outcome of premolars autotransplanted to the anterior maxilla and secondarily to identify potential prognostic factors for survival, success, esthetic, and biological complications.

Material and methods: One hundred and twenty-two patients with 153 transplants were assessed on survival rate and potential prognostic factors, while 50 patients with 61 autotransplanted premolars underwent clinical, radiographic, and esthetic assessment. Clinical and radiographic parameters were recorded. Esthetic outcomes were evaluated using a comprehensive score system comparing transplanted teeth to neighboring tooth. All patients filled in a questionnaire about the esthetic outcome of the treatment.

Results: The survival rate of transplants after 16-38 years was 76%, with the majority showing no periodontal complications (95%). Radiographically, 46% of transplanted premolars showed no signs of pathosis. Ankylosis and inflammatory resorption were observed in 19% and 16%, respectively. Prognostic factors such as donor tooth type and root stage did not significantly affect transplant survival. Premolars transplanted at an immature stage had a significant lower risk of ankylosis, compared to more mature transplants. Esthetically, 72% of the transplants matched their neighboring teeth, and taking the biological success into consideration an overall success rate was 57.3%. In total, 71% of all patients were esthetically satisfied with their autotransplant, 18% were fairly satisfied, and 11% were dissatisfied.

Conclusions: The transplants demonstrated high survival rate, albeit with biological complications such as ankylosis and inflammatory root resorption. Developmental stage of the root at the time of transplantation had a significant influence on ankylosis of transplanted teeth. Esthetic outcomes were generally satisfactory, although challenges were noted with certain restoration types and donor tooth selections. Overall, the majority of patients expressed satisfaction with their autotransplanted teeth.

Dental trauma is highly prevalent, involving 25% of school-age children and about 12.5% of the general population of the world. Due to the young age of the patients that are usually involved in dental trauma, there are tooth-related complicating factors, such as open apices, thin dentinal walls, and unfavorable crown-to-root ratio, as well as patient-related factors, such as anxiety and cooperation, and other challenges related to the complex diagnosis and treatment. Therefore, it is not surprising that the global status of knowledge for the prevention and emergency management of traumatic dental injuries among dental professionals was often reported as insufficient. Aiming to improve dental trauma education, one should consider that the contemporary educational settings have transitioned to a digital learning ecosystem and that the current students belong to a unique generational cohort. Therefore, this paper examines the challenges educators encounter in contemporary dental school classrooms and the defining characteristics of current generation Y and Z dental student cohorts. Finally, it outlines strategies to optimize dental trauma learning, considering the unique generational characteristics of the current dental students.

Background: This study aimed to analyse the relationships between injury variables, treatment variables and the status of the periodontium or pulp of luxated teeth.

Materials and methods: The electronic medical records and imaging data of patients who underwent treatment for luxation injuries of permanent teeth in the paediatric dentistry and dental emergency departments of the Stomatology Hospital, Zhejiang University School of Medicine between 1 January 2012 and 1 January 2022 were retrospectively analysed. First, the patients' records were reviewed to collect background and follow-up imaging data; then, all early clinical variables were reviewed and used to construct models to predict the periodontal and pulp status of the luxated teeth. The models included the significant factors identified in the univariate analysis, and multivariate analysis was performed to evaluate the relationships between the variables and the final status of the periodontium or dental pulp. The chi-square test and Fisher's exact test were employed to analyse the differences in the frequency of each variable. The variables were systematically screened based on their odds ratios, and significance levels were determined by Pearson's chi-square test.

Results: A total of 188 patients were initially identified and ultimately included. The age range of the patients was 7-56 years. Logistic regression models for periodontal and pulp prognosis of the luxated teeth were established. The models were refined by combining the results of feature selection, parameter testing and goodness-of-fit testing. The final model included four variables and accurately predicted the periodontal outcome in 65.79% of the cases. The prognostic model for the dental pulp included three significant factors and had an overall accuracy of 94.59%.

Conclusion: The prognostic models developed to predict the influence of various factors on the status of the periodontium and dental pulp of luxated teeth demonstrated notable accuracy and practical utility. Therefore, these models are potentially valuable tools for long-term prognostic assessments.

Trial registration: Approval no. ChiCTR2100044897.

Introduction: Maxillofacial injuries are usually associated with ophthalmic injuries that may be mild to severe, and may even result in loss of integrity of the orbital skeleton and impairment of the visual apparatus.

Aim: To evaluate the pattern of ophthalmic injuries associated with maxillofacial fractures in patients who reported to a tertiary care hospital, associated with a medical college in M.P, India.

Material and methods: The records of patients who sustained ophthalmic injuries with maxillofacial trauma from 1st January 2012 to 31st January 2024 and reported to the Department of Dentistry of a tertiary care hospital were evaluated. The data related to demographic characteristics, aetiology of trauma, type of maxillofacial fractures and pattern of ophthalmic injuries were gathered and analysed.

Results: A total of 1575 patients with maxillofacial trauma reported to the institute during the study duration. The study sample comprised 1046 (66.41%) maxillofacial trauma patients who sustained ophthalmic injuries. Males were more commonly involved (85.85%) than females (14.15%). The commonly involved age group was 21-30 years with 34.32% of patients belonging to the age group. The most common aetiology was road traffic accidents, reported in 71.89% of patients. Zygomaticomaxillary complex (ZMC) fractures were evident in 73.52%, mandibular fractures in 50.19%, naso-orbito-ethmoidal (NOE) fractures in 19.41% and frontal bone fractures in 18.74% patients. Subconjunctival haemorrhage was seen in 79.83%, periorbital ecchymosis in 72.94% and periorbital oedema in 60.32% of cases. Retrobulbar haemorrhage was seen in 2.58%, traumatic optic neuropathy in 2.01% and retinal detachment in 0.86% of cases.

Conclusion: Ophthalmic injuries were seen frequently in 66.41% of cases with maxillofacial trauma, particularly in zygomatic complex fractures (73.52%). The findings emphasise that the competency of maxillofacial surgeons plays a vital role in comprehending the severity and management of post-traumatic ophthalmic consequences in maxillofacial injuries. Also, ophthalmological evaluation in maxillofacial trauma, particularly involving the midface should be considered mandatory.

Traumatic dental injuries (TDIs) are a frequent challenge in pediatric dentistry, requiring a coordinated interdisciplinary approach for successful management. These injuries can affect various dental tissues and pose significant diagnostic and therapeutic challenges, particularly in young patients with developing dentition. This review aims to explore the complexities of managing TDIs in young permanent dentition, focusing on the role of orthodontics, endodontics, and other specialties in providing comprehensive care. We highlight the importance of interdisciplinary collaboration in achieving optimal functional and aesthetic outcomes, emphasizing the need for updated diagnostic tools and treatment protocols tailored to the growing child. Specific recommendations are provided for clinicians on integrating orthodontic and endodontic management in trauma cases, focusing on minimizing complications and ensuring long-term prognosis.

Management of traumatic dental injuries (TDI) is very complex, even under ideal circumstances. Children in the primary dentition have unique needs, and it is important that the diagnosis and treatment choices are offered to parents. The prevalence of TDI in the primary dentition is far greater than for any other age group. Education of parents and caregivers in prevention and emergency management of oral injuries is essential. When injuries occur, the dental professionals must also respond appropriately to establish correct diagnosis of the injuries and assist parents in making decisions for management while communicating realistic expectations for the future. Progress has been made in the diagnosis and management of dental injuries in the primary dentition based on the biological healing response of oral tissues following injury over time. Several factors influence critical decisions that must be made based on basic principles and guidelines to improve successful outcomes for the child. Managing co-operation must be balanced with the benefit of anticipated treatment need. The current evidence challenges previous dental interventions. The IADT guidelines updated the approach to management of TDI in children in the primary dentition. Encouraging a positive attitude to the dental setting early in the life course prepares the child to be a motivated dental attendee throughout their lifetime. This manuscript aimed to outline the critical issues and clinical choices for injuries to the primary dentition and to summarise recent guidance from the International Association of Dental Traumatology (IADT).