Dental Traumatology最新文献

Aim: External cervical resorption is a clinically challenging destructive process, with its etiology poorly understood. This study aimed to evaluate the survival of external cervical resorption treatments performed by a single operator over 20 years.

Materials and methods: A dataset of recalled external cervical resorption cases treated from 1996 to 2023 was created. The measured metrics included Heithersay classification, tooth type, historical treatment period, treatment modality, and pre-treatment pulp status. Adverse sequelae such as extractions, revisions, and surgeries were analyzed. A multivariable Cox regression analysis was performed for independent predictors of tooth extraction. The analysis included Heithersay classification, tooth type, time period, and treatment modality.

Results: The 5-year censored survival rate was 83.6%. The most commonly treated resorption was Heithersay class 2, yielding a 5-year survival rate of 89.5%. Anterior teeth exhibited the lowest survival rate (76.6%), and molars possessed the highest survival rate (95.2%) at 5 years. Combined non-surgical endodontic treatment with surgery resulted in the highest five-year survival rate (91.0%). A non-surgical internal root approach yielded a survival rate of 82.2% at 5 years. No statistical survival difference was observed between the teeth initially presenting with root canal filling, as necrotic, or with vital pulps. The treatment period from 2014 to 2018 exhibited the highest survival rate at 93.3%. The hazard ratio was highest for anterior teeth at 6.225. Adverse sequelae were noted in 29.7% (n = 47) of the cases. These included root fracture, progressive resorption, endodontic pathosis, periodontal pockets, and percussion sensitivity; root fracture led to extraction, and other sequelae could be managed.

Conclusions: The clinical management of external cervical resorption has previously been regarded as unpredictable, with outcomes often considered short-to-medium term and frequently leading to eventual extraction. This study suggests that most teeth with external cervical resorption can be treated successfully and saved.

Background/aim: Fragment reattachment is a conservative option for anterior crown fractures, yet failure after the initial procedure creates a clinical dilemma. Evidence on effective retreatment strategies is lacking. This study investigated how surface preparation and chamfer design influence fracture resistance and failure patterns in failed fragment reattachments.

Materials and methods: Sixty bovine mandibular incisors were sectioned 3 mm below the incisal edge and reattached using a standardized protocol with adhesive and flowable composite. After thermocycling (5000 cycles, 5°C-55°C), baseline fracture resistance was measured. Specimens were stratified by baseline values and randomly assigned to four groups (n = 15): Group A-bur cleaning + simple reattachment, Group B-sandblasting + simple reattachment, Group C-bur cleaning + external chamfer, and Group D-sandblasting + external chamfer. Re-reattachment used the same adhesive protocol; in Groups C and D, a 1 mm external chamfer was prepared and restored with nanohybrid composite. post-treatment fracture resistance was tested with a universal testing machine, and percentage improvement was calculated. The specimens were examined with a stereomicroscope, and failures were categorized as adhesive, cohesive, or mixed. data were analyzed with two-way repeated measures ANOVA, Bonferroni post hoc, and Chi-square tests (p < 0.05).

Results: All groups showed significant increases in fracture resistance after re-reattachment (p < 0.05). ANOVA revealed significant effects of time, group, and time × group interaction (All p < 0.001). Group D achieved the highest post-treatment resistance, significantly greater than all others (p < 0.01). Group C ranked second, while Groups A and B did not differ (p = 0.111). Failure mode distribution differed significantly (p < 0.001); chamfer groups (C and D) showed more cohesive/mixed failures.

Conclusion: External chamfer, especially combined with sandblasting, enhanced fracture resistance and shifted failure patterns, indicating a clinically promising strategy for failed fragment reattachments.

Aim: There are several challenges encountered in the traumatic dental emergencies including their documentation. The aim of this 2-stage study is to perform a quantitative and qualitative analysis of the current state on traumatic dental emergencies, and the end-user experience on the "Add Dental Trauma" dialog box in a Patient Management Software (PMS).

Materials and methods: Stage 1 study involved an online questionnaire (24 questions) where correlates were evaluated using the chi-square test or Fisher's exact test. One-to-one interviews were conducted to assess the registration, treatment, and referral processes in cases with dental trauma (n = 10). In stage 2 the experiences of clinicians using the "Add Dental Trauma" dialog box in PMS were analyzed qualitatively using the "think-aloud" technique, and quantitatively with 28 statements corresponding to "DeLone and McLean Information System Success Model" rated on a 5-point Likert scale.

Results: A total of 126 dentists participated in the survey. The most reported challenges encountered during emergency shifts were the lack of staff (57.1%), materials and equipment (55.6%). Besides, 82.5% of them indicated that they felt responsible for treating dental trauma, and 59.5% of them reported the use of PMS. Dentists working in the university hospitals were significantly more capable of treating luxation injuries (excluding avulsions) (p < 0.001), while the ability to treat avulsion injuries did not differ significantly among dentists (p = 0.072). The feasibility of treating complicated cases was significantly higher at university hospitals and among pediatric dentists. One-to-one interviews emphasized the need for training in recording cases of dental trauma. The "think-aloud" analysis revealed that dentists were not fully aware of the features of the dialog box in PMS. Evaluation using the DeLone and McLean model indicated net benefits in its use and further improvements regarding its application were suggested.

Conclusions: The findings revealed that the management of traumatic dental emergencies remains challenging across settings, underscoring the need for standardized documentation. "Add Dental Trauma" dialog box in PMS may be a promising tool for recording and targeted training could promote adoption, improve data interoperability, and support better care and research.

Background: Child maltreatment (CM) has been associated with adverse oral health outcomes during childhood. However, few studies have investigated the relationship between CM and dental trauma (DT) in the primary dentition.

Aim: To evaluate the association between CM and DT at 4 years of age.

Design: The sample comprised 4275 children from the 2015 Pelotas Birth Cohort Study, southern Brazil. Overall CM from birth to age 4, as well as specific types of maltreatment ("physical abuse," "sexual abuse," "emotional abuse," "neglect," and "custodial interference"), were assessed using the Juvenile Victimization Questionnaire, completed by mothers when the children were 4 years old. DT was assessed at age 4 using the criteria of the UK Child Health Survey (1993). Bivariate analyses were conducted using the chi-square test, and crude and adjusted analyses were performed using Poisson regression models. Confounding variables with p < 0.250 in the crude analysis were included in the adjusted models.

Results: Of the 3645 children evaluated, 11.4% had been exposed to some form of CM, and 20.2% presented with DT. In the adjusted analysis, no statistically significant association was found between DT and overall or specific types of CM.

Conclusions: In this large-sample study, no association was found between DT in the primary dentition and CM.

Background: Traumatic dental injuries (TDIs) are highly prevalent worldwide and require immediate and appropriate management to ensure favorable outcomes. The aim of the study was to develop and validate SOS Dental Trauma, an interactive artificial intelligence-based chatbot integrated with WhatsApp. SOS Dental Trauma was designed to provide first-aid guidance based on the International Association of Dental Traumatology (IADT) recommendations until professional care is available.

Methods: The chatbot was developed using natural language generation techniques, programmed with a structured clinical script strictly limited to dental trauma management in primary and permanent dentitions. The chatbot was implemented with the FastAPI framework in Python, hosted on a cloud server, and integrated into WhatsApp through Twilio. Validation was performed in two stages: (1) assessment by six independent experts in the field of dental traumatology (three general dentists and three endodontists) who evaluated clarity, appropriateness, and coherence of the interaction flow; and (2) performance testing with simulated clinical cases corresponding to trauma types included in the IADT ToothSOS application. Outcomes were defined as accuracy (correspondence to IADT guidelines) and completeness (including all clinically relevant steps). A minimum sample of 384 interactions was calculated, and a performance threshold of 90% accuracy was established. Cases not reaching this threshold were revised and retested.

Results: Experts highlighted the need for more explicit question formulation and adjustments to interaction flow, which were incorporated into the final version. In the initial tests, the chatbot achieved 100% accuracy and completeness for permanent dentition. Nevertheless, it fell below the threshold in cases of primary dentition, particularly luxation and displacement, due to oversimplification of management options. After prompt revisions, the system achieved 100% accuracy and completeness for all trauma types. The chatbot provided structured, accessible, and user-friendly instructions in alignment with IADT recommendations, demonstrating consistency and reliability.

Conclusion: The SOS Dental Trauma chatbot showed high accuracy and completeness in simulated scenarios, offering immediate, evidence-based guidance for TDIs in both primary and permanent dentitions. Delivering structured recommendations through a widely used platform such as WhatsApp expands access to reliable first-aid information, supports patients and caregivers in dental trauma management, and has potential as a complementary tool in dental emergencies and health education.

Introduction: According to Dutch dental trauma guidelines (DTG), optimal outcomes for avulsed permanent teeth are achieved when replantation or professional treatment occurs within 30 to 60 min following trauma. However, studies suggest that patients in the Netherlands often seek care well beyond the critical window for effective intervention, reducing the chances of successful reimplantation. This delay may be partly due to limited public awareness of appropriate first-aid measures for dental avulsion.

Objective: This study assesses awareness and perceived urgency in managing dental avulsion among Dutch students, focusing on knowledge gaps and their variation across different educational levels. Participants included secondary school students and individuals in higher education with both medical and non-medical backgrounds.

Methods: A 16-item questionnaire, incorporating a case-based scenario, was designed to evaluate general awareness and urgency perception. The questionnaire was distributed in educational settings between December 2024 and February 2025 and completed by students.

Results: A total of 348 responses were included. Only 49% of participants correctly identified the recommended treatment timeframe of 30 min or less. Those with a dental background scored highest overall (p < 0.001), while secondary school students scored lowest. Medical students showed significantly greater general knowledge of avulsion management ("awareness") than secondary school students (p < 0.05); however, they did not differ considerably in recognizing the urgency of treatment or in taking correct immediate actions ("sense of urgency"). Notably, only 17% of participants answered all six key management questions correctly according to national guidelines, highlighting substantial knowledge gaps, even among higher-education groups.

Conclusion: The findings of this study indicate significant knowledge deficits regarding the emergency management of dental avulsion across all educational levels. These results highlight the urgent need for targeted educational strategies to enhance first-aid awareness, particularly among adolescents and medical students, with an emphasis on timely and appropriate response.

Background/objective: 3D printed materials have been evaluated for fabricating mouthguards; however, little is known about their biomechanical performance in preventing dental trauma. This study aimed to compare two 3D printed polymers and three ethylene vinyl acetate (EVA) sheets used for mouthguard fabrication regarding their mechanical properties and stress-strain behavior during impact, analyzed through finite element analysis (FEA).

Materials and methods: Two 3D printed polymers, KeyGuard (Keystone) and DimaPrint (Kulzer), and three EVA sheets, Bio-art, Essence Dental, and Proform, were used to create the specimens following ISO 37-II (n = 10). Shore A hardness was measured on the surface. The breaking force (F, N), elongation (EL, %), ultimate tensile strength (UTS, MPa), and elastic modulus (E, MPa) were measured using a universal testing machine (EMIC). Density (ρ, g/cm³) was determined using the test method following ASTM D792. Poisson's ratio was calculated by using axial tensile tests following ASTM D638. Scanning electron microscopy was used to examine the surfaces of EVAs and 3D printed polymers. A two-dimensional finite element model of the maxillary structure and upper incisor was evaluated with and without a 4.0 mm mouthguard made from each material. An impact simulation was performed by striking the upper incisor with a rigid surface at 1 m/s (3.6 km/h). Strain and modified von Mises stress distributions were evaluated, and mouthguard displacement relative to the tooth was calculated.

Results: One-way ANOVA revealed significant differences among the tested mouthguards for all evaluated parameters (p < 0.01). Essence Dental showed the highest and DimaPrint the lowest values of F and UTS values (p < 0.01). Proform was the highest, and DimaPrint had the lowest EL values (p < 0.01). DimaPrint and KeyGuard had the highest, and Proform had the lowest E values (p < 0.01). KeyGuard, Essence Dental, and Bio-art had higher Shore A values than Proform and DimaPrint (p < 0.01). The 3D printed polymer group had significantly higher Poisson's ratio values than EVAs. The density values were similar for all tested materials (p = 0.055). The absence of a mouthguard led to greater stress and strain on the impacted tooth. All mouthguards significantly reduced these values, showing comparable shock-absorbing capacity. Displacement was generally lower in the buccal region and increased toward the palatal side.

Conclusion: Although the 3D-printed polymers exhibited mechanical properties different from EVA materials, all mouthguards demonstrated similar effectiveness for reducing stress and strain on the impacted tooth, indicating comparable protection against dental trauma.

Background/aim: This study tests materials by additive manufacturing methods that will demonstrate impact resistance and structural stability comparable to conventional EVA.

Material and methods: Researchers tested ethylene-vinyl acetate copolymers, thermoplastic polyurethane via fused deposition modeling, and flexible photopolymer resins from liquid crystal display-based three-dimensional printing. Analyses included tensile strength, hardness, and impact resistance.

Results: Thermoplastic Polyurethane via fused deposition modeling showed the best combination of elasticity, energy dissipation, and durability. Ethylene-vinyl acetate exhibited lower resilience, and the resins failed prematurely. Increased thickness and structural reinforcement improved protection.

Conclusions: The material manufacturing method and design significantly influence a mouthguard's effectiveness. Thermoplastic Polyurethane made with additive manufacturing, especially with reinforced designs, offers superior resilience for high-impact sports, providing a path for customizable, effective, and accessible preventive dentistry.

Background/aim: Facial trauma is a major public health challenge due to its aesthetic, functional, psychological, and socioeconomic impacts. In Northern Brazil, particularly in the Amazon region, subsistence activities such as plant extraction, animal handling, and river transportation are essential to daily life and may contribute to an increased risk of facial injuries. These environmental and cultural factors are often underrepresented in the literature. This study aimed to investigate the epidemiological profile of facial fractures associated with etiologies specific to the Amazon region.

Materials and methods: This was a retrospective study conducted over an 8-year period (2013-2020) at a trauma referral center in Northern Brazil. Medical records of patients with facial fractures resulting from boat accidents, animal-related incidents, plant extraction, and hunting and fishing accidents were reviewed.

Results: A total of 97 patients met the inclusion criteria, with males accounting for 88.7% of cases and adults (20-64 years) being the most affected age group. Boat accidents were the most frequent cause of trauma (40.2%) and were associated with a higher median number of surgical fractures compared to animal-related trauma (p = 0.041) and hunting and fishing accidents (p < 0.001). The middle third of the face was most commonly affected (78%), and the mean FISS score was 4.4. The average length of hospital stay was 11 days, with a significant correlation between FISS and hospital stay (p = 0.0078). Hunting and fishing accidents were the leading cause of long-term sequelae.

Conclusion: Facial fractures related to the Amazon region are associated with distinct occupational and environmental risks, imposing not only a burden on public health but also resulting in specific morbidities within traditional populations. Although these injuries do not necessarily reflect the characteristics of the broader population, they highlight the need for public policies tailored to the regional context.

Background and aim: Physical strain is a potential contributing factor for bruxism, particularly among athletes, but limited research exists among weightlifters. The aim of this study was to assess the prevalence of awake bruxism among weightlifters in Chennai City and evaluate their knowledge and attitudes toward preventive measures.

Materials and methods: A cross-sectional study was conducted among 272 professional weightlifters aged 25-40 years using purposive sampling. Participants were evaluated using the Standardized Tool for the Assessment of Bruxism (STAB), which included self-reported behavior and clinical examination for signs such as linea alba, lip/tongue impressions, and tooth wear using the Tooth Wear Evaluation System. A validated 7-item questionnaire assessed knowledge and attitudes. Descriptive measures and Chi-square tests were used to analyze the data.

Results: Self-reported bruxism was observed in 68.01% of participants, while clinical signs included linea alba (61.02%), lip impression (48.16%), and tooth wear (63.97%). Though 66.9% had adequate knowledge of bruxism, only 29.04% exhibited a positive preventive attitude. Poor knowledge was significantly associated with the presence of all clinical signs (p < 0.001), while poor attitude correlated with a higher prevalence of self-reported bruxism and tooth wear (p < 0.001).

Conclusions: Awake bruxism is highly prevalent among weightlifters, with limited preventive attitudes despite moderate knowledge. These findings indicate the need for targeted education and screening strategies in fitness populations to reduce the prevalence of oral health disorders.