Dental Traumatology最新文献

Objective: To assess the influence of conservative or invasive treatments on the appearance of sequelae in permanent successor teeth (SPT) after injuries in the support tissues of anterior deciduous teeth (ISTDT).

Methods: This cohort study accompanied 52 children with ISTDT up to the complete eruption of the permanent successor to investigate the presence or not of SPT. Trauma was clinically evaluated according to the International Association for Dental Traumatology. Sex, age at the time of trauma (ATT), type and severity of trauma, sequelae in anterior deciduous teeth (SDT), treatment type (conservative-without exodontia/ invasive-with exodontia), seeking care (immediate/late), and the caregiver's education level (CEL) were collected. Regression models were performed (p = 0.05).

Results: Of the children (ATT = 3.6 ± 1.5 years), boys (52/57.1%) were the majority. The teeth (n = 91) injuries were lateral luxation (26/28.6%), intrusion (22/24.1%), concussion (20/22.0%), subluxation (19/20.9%), and extrusion (4/4.4%), that affected only incisors. Most teeth (63/69.2%) received late care, presented SDT (62/68.1%) and were treated conservatively (73/80.2%). There was no association of sex (p = 0.611), SDT (p = 0.705) and seeking care (p = 0.800) with SPT. The treatment type did not influence the SPT occurrence (p = 0.923), independent of the ATT, trauma severity and the educational level of the caregiver. The lower the ATT (p = 0.026) and the more severe the trauma (p = 0.009), the higher the number of SPT.

Conclusion: The treatment type of anterior deciduous teeth, mainly considering incisors, did not influence the appearance of SPT, which leads us to always choose the most conservative treatment, independent of the child's age, the injury severity, and the caregiver's educational level.

Background/aim: Sports mouthguard should be designed and fabricated adequately. The purpose was to propose a criterion for fabricating sports laminate mouthguard with adequate thickness for protect orofacial structures.

Materials and methods: Ethylene vinyl acetate sheet (Sports Mouthguard) was fabricated using a pressure former. Sports laminate mouthguard was designed as the first layer covered the labial, buccal, and occlusal sides, and the second layer covered the first layer. Four conditions were investigated; the combination of the sheets forming the first and second layers was 2 mm and 3 mm sheets (2 mm + 3 mm), 3 mm and 2 mm sheets (3 mm + 2 mm), 2 mm and 4 mm sheets (2 mm + 4 mm), and 4 mm and 2 mm sheets (4 mm + 2 mm). Laminate mouthguard thickness was measured at the labial, buccal, and occlusal sides. Statistical analyses were performed by two-way ANOVA and Bonferroni method for the measurement areas and laminate conditions.

Results: Laminate mouthguard thickness was significantly differed among the measurement areas (p < 0.01). The average thickness at the labial side was 2.83 mm (2 mm + 3 mm), 2.89 mm (3 mm + 2 mm), 3.51 mm (2 mm + 4 mm), and 3.53 mm (4 mm + 2 mm). Mouthguard thickness on the conditions of 2 mm + 4 mm and 4 mm + 2 mm became significantly larger compared to 2 mm + 3 mm and 3 mm + 2 mm at the labial, buccal, and occlusal sides (p < 0.01). Adequate thickness could be obtained on the conditions of 2 mm + 4 mm and 4 mm + 2 mm.

Conclusions: Sports laminate mouthguard fabricated using 2 mm sheet with 4 mm sheet could offer adequate thickness at the labial, buccal, and occlusal sides. This finding would be one of the criteria for fabricating sports laminate mouthguard.

Background/aim: Avulsion injuries have an uncertain prognosis. This study aims to evaluate periodontal ligament healing patterns and factors affecting the survival of replanted avulsed teeth.

Materials and methods: In this retrospective study, data from 204 avulsed teeth in 143 children (mean age: 9.6 ± 2 years) who sustained avulsion injuries were reviewed. Primary teeth, non-replanted permanent teeth, and cases with follow-up shorter than 60 days were excluded. Data analysis included 60 replanted permanent teeth from 41 patients (18 girls and 23 boys), with a follow-up period ranging from 2 to 147 months. Collected data covered age, gender, extra-alveolar storage time, root development stage, and periodontal ligament healing patterns. Statistical analysis was performed on the data.

Results: Avulsion injuries predominantly occurred during outdoor activities (n = 22, 59.5%), followed by school (n = 10, 27%) and home (n = 5, 13.5%). The main causes were falls (n = 20, 50%), bicycle accidents (n = 6, 15%), sports injuries (n = 5, 12.5%), traffic accidents (n = 2, 5%), and violence (n = 1, 2.5%). Among replanted teeth, 51.7% were immature. Treatments included root canal therapy (n = 30, 50%), apexification (n = 12, 20%), and regeneration (n = 2, 3.3%), while 16 teeth received no treatment. Inflammatory resorption was not observed in teeth replanted within 1 h of injury (8.4%). Functional healing/ankylosis was observed in 14 (23.3%) of the replanted teeth, replacement resorption in 40 (66.7%), and inflammatory resorption in 6 (10%). Replacement resorption affected 66.7% of the replanted teeth, with 62.5% lost over time. Functional healing/ankylosis was more common in mature teeth, while inflammatory resorption was higher in immature teeth. According to Kaplan-Meier estimated survival curves, the survival rate during the 5-year observation period was 47.5%. Survival times were longer in boys and in mature teeth (p < 0.05).

Conclusions: Gender and root development stages were observed to significantly impact the prognosis of replanted avulsed teeth.

Background/aim: Traumatic Dental Injuries (TDIs) are an emerging public health problem and a realm of research for oral health enthusiasts. Certain populations can be more vulnerable to injuries such as those with a sensory deficit. Nevertheless, literature is scarce, especially for those with hearing impairment. Therefore, the aim of the study was to compare the prevalence and patterns of TDI in children and adolescents with severe-to profound hearing impairments and children without hearing impairments.

Material and methods: Three hundred and ninety participants (195 severe to profound hearing impaired and 195 age and sex-matched controls) between 4 and 18 years were recruited from a tertiary care setting. A single calibrated examiner evaluated TDI for both groups. Among those with TDI, a vestibular function test (VFT) was also performed to assess postural balance. A single examiner from the Department of Otorhinolaryngology evaluated the VFT results.

Results: The overall prevalence of TDI was found to be 12.82% among the severe to profound hearing-impaired individuals, and 11.79% in controls. The majority of participants were aged between 7 and 13 years, in the mixed dentition stage, and were males. Among the cases, the majority had profound hearing loss (≥ 91 dB HL) and bilateral ear involvement. The most common type of TDI was uncomplicated crown fractures. Falls were identified as the most common cause of TDI in both groups. Vestibular dysfunction and loss of postural control were identified in 12 out of 14 patients tested with VFT. A significant association was found between TDI and the dentition type, that is, primary dentition was more affected among the severe to profound hearing impaired as compared to controls (p < 0.05).

Conclusion: There was no significant association between the severity of hearing impairment and the prevalence of dental trauma in children and adolescents with severe to profound hearing impairment. However, hearing-impaired individuals were susceptible to trauma at an early age compared to their healthy counterparts.

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.