Dental Traumatology最新文献

Background/aim: To evaluate the efficacy of the combined cone-beam (CBCT)/3D-replicas protocol on the clinical and radiographic outcomes of autotransplanted molars.

Material and methods: Controlled clinical trial registered ISRCTN13563091 from August 2019 to September 2022. Patients aged 13-22 years requiring permanent premolar extraction and having at least one non-erupted third molar were enrolled at the Institute of Stomatology, Stradins University, Riga, Latvia. Patients in the 3D-replicas (n = 30) underwent maxillary CBCT scans and had 3D-printed replicas of the third molar fabricated, while the control group (n = 28) did not. The clinical outcomes included tooth mobility, bleeding on probing, and periodontal pocket depth assessed at 3, 6, and 12 months. The radiographic outcomes included root development, obliteration, periapical status, and crown changes at 12 months.

Results: Of the 55 patients assigned to interventions, 46 completed the study. No significant differences in survival and radiographic outcomes were found between the control (n = 22) and 3D-replica group (n = 24): root development (p = 0.3), root resorption (p = 0.057), periapical status (p = 0.7), and crown/root ratio change (p = 0.4). Logistic regression showed no significant associations between radiologic predictors (root resorption: p = 0.4; periapical status: p > 0.9; root development: p = 0.8). Significant clinical outcome predictors included total operative time (β = 0.0043, p = 0.049), Moorrees' stage (stage 4: β = -0.31, p < 0.001; stage 5: β = -0.39, p < 0.001), and four donor placement times (β = 0.93, p < 0.001), but group assignment was not a significant predictor.

Conclusions: The CBCT/3D-replica protocol showed no significant differences in the clinical or radiological outcomes. The high success rates in both groups suggest that the protocol is valuable primarily for optimizing surgical efficiency and as a training tool for clinicians.

Background/aim: The fiber splint represents an advanced treatment for traumatized dental injuries. The complete understanding of the localization of a splint on traumatized teeth remains elusive. The aim of this study was to assess the impact of the incisal/cervical positions of the fiber splint on the stress distribution of traumatized dental roots in various occlusal relationships.

Materials and methods: Three-dimensional finite element models were generated based on a cone beam computer tomogram of a patient. The incisal and cervical splints were simulated by strips that were bonded close to the incisal/cervical labial surface of traumatic teeth. Force was loaded on the incisal ridge, incisal and cervical positions on the palatal surface of each tooth to simulate the conditions of traumatized teeth during mastication. The equivalent stress (von Mises) on the traumatic teeth and abutment teeth was calculated by Ansys software (version 2021, R1).

Results: The incisal splint effectively transferred the stress from the traumatized tooth roots to the abutment teeth when force was loaded on the incisal ridge and incisal and cervical positions on the palatal surface. Nevertheless, the reduction effect was notably diminished when the cervical splint was used. Notably, in cases of cervical splints, with a loading force on the incisal ridge, there is an increase in stress on the roots of traumatized teeth, which poses a disadvantage in the management of traumatic dental injuries.

Conclusion: The incisal splint demonstrated a more effective transfer of stress from the roots of the traumatic teeth to the abutment teeth than the cervical splint and the raw.

Introduction: The aim of this study was to evaluate root development in autotransplanted teeth using cone-beam computed tomography (CBCT) images.

Methods: Twelve premolars with incomplete root formation, which were selected to replace prematurely lost upper central incisors, were analyzed by CBCT on two different occasions. The first CBCT examination (T1) was conducted before tooth autotransplantation. The second CBCT examination (T2) was performed over a follow-up period of at least 12 months and < 5 years. Three previously calibrated evaluators assessed root development. The positions of the tomographic planes were standardized. The mean root length in sagittal and coronal tomographic sections was used to validate the root length at T1 and T2. Longitudinal root development of the transplanted tooth was determined by calculating the difference in root length between T2 and T1. The intraclass correlation coefficient (ICC), paired t-test, and Pearson test were applied, with significance set at 5%.

Results: The mean time elapsed between T1 and T2 was 962 days/2.6 years. The ICC was > 0.75. The measurements obtained at T2 were significantly greater than at T1 (p = 0.001). The mean increase in root length was 2.83 mm. There was no significant correlation (p = 0.413; r = 0.261) between root length increase and the time elapsed between T1 and T2.

Conclusion: Premolar teeth with incompletely formed roots transplanted to the upper central incisor region showed continued root development during postoperative follow-up.

Background: The prognosis of an avulsed permanent tooth depends on the time elapsed from injury to replantation in the injured socket. Wide variability exists in the terminologies used to describe this period. Hence, the aim of this study was to identify and categorize the terminologies related to this aspect of tooth avulsion, grade the explanations provided by the authors, and develop a consensus about the most appropriate terminology through a Delphi approach.

Methods: This study involved a scoping review to identify and analyze the terminologies. It was performed according to PRISMA-ScR with a systematic search performed in PubMed, Scopus, EMBASE, LILACS, and Web of Science. The terminologies were extracted, categorized, and evaluated for correctness. On the basis of the results of the review and expert group discussion, an ideal terminology was proposed. A Delphi study with 20 global experts in dental traumatology was conducted to develop a consensus for the proposed terminology and its description.

Results: A total of 92 studies were included. They were distributed into five categories according to the terminology used: (a) dry period alone, (b) total period with dry and/or wet times, (c) extra-alveolar period, (d) extraoral period, and (e) miscellaneous. The explanations provided were correct in 37.5% of the studies that used an extraoral period. In the Delphi study, the lowest scores were given to the term dry period. There was an agreement of 95% for the proposed terminology.

Conclusion: A wide variation in terminologies was observed that could be distributed into five categories. The correctness of explanations was highest in the studies that described total periods with dry and wet times. The Delphi study revealed excellent agreement for the proposed term "total extra-alveolar period," with precise and clear recordings of both nonphysiologic (dry) periods and physiologic (wet) periods.

Traumatic dental injuries of permanent teeth result in multiple immediate and long-term consequences depending upon the severity of trauma, age of the patient, the status of root maturity, and the emergency care provided. The healing responses may get disturbed due to severe damage, loss of vascularity of the supporting structures, and infections. As a result, the prohealing mediators and pathways are overpowered by the destructive stimuli often manifested by an increased osteoclastic activity. Among the various late complications, the apical periodontitis or the periapical lesions are most worrisome for the patients and create clinical dilemma for the dentists. In the past, many such lesions were classified as cysts and subjected to surgical management. However, better understanding of lesion pathophysiology, three-dimensional imaging, and molecular pathways have established their inflammatory nature. The advancements in materials such as calcium silicates, and regenerative techniques have propelled the research related to non-surgical endodontic management as its clinical acceptability. The treatment largely follows the recommendations of regenerative medicine and is based on four principles: (a) establishing the drainage or an endodontic access to the area, (b) removal of most of the triggering agents such as necrosed pulp, toxins, and inflammatory mediators, (c) disinfection of the area, controlling inflammation and reversal of the acidic pH, and (d) maintenance of this infection/inflammation-free state for a long time through adequate sealing. This review aims to highlight the rationale of the approach, case selection, pathophysiology of the causation and healing, clinical protocols, and the limitations of non-surgical endodontic management of large periapical lesions secondary to traumatic dental injuries.

Background: In this study, the accuracy and comprehensiveness of the answers given to questions about dental avulsion by two artificial intelligence-based language models, ChatGPT and Gemini, were comparatively evaluated.

Materials and methods: Based on the guidelines of the International Society of Dental Traumatology, a total of 33 questions were prepared, including multiple-choice questions, binary questions, and open-ended questions as technical questions and patient questions about dental avulsion. They were directed to ChatGPT and Gemini. Responses were recorded and scored by four pediatric dentists. Statistical analyses, including ICC analysis, were performed to determine the agreement and accuracy of the responses. The significance level was set as p < 0.050.

Results: The mean score of the Gemini model was statistically significantly higher than the ChatGPT (p = 0.001). ChatGPT gave more correct answers to open-ended questions and T/F questions on dental avulsion; it showed the lowest accuracy in the MCQ section. There was no significant difference between the responses of the Gemini model to different types of questions on dental avulsion and the median scores (p = 0.088). ChatGPT and Gemini were analyzed with the Mann-Whitney U test without making a distinction between question types, and Gemini answers were found to be statistically significantly more accurate (p = 0.004).

Conclusions: The Gemini and ChatGPT language models based on the IADT guideline for dental avulsion undoubtedly show promise. To guarantee the successful incorporation of LLMs into practice, it is imperative to conduct additional research, clinical validation, and improvements to the models.

Background: The aim of this cross-sectional observational analytical study was to assess the accuracy and consistency of responses provided by Google Gemini (GG), a free-access high-performance multimodal large language model, to questions related to the European Society of Endodontology position statement on the management of traumatized permanent teeth (MTPT).

Materials and methods: Three academic endodontists developed a set of 99 yes/no questions covering all areas of the MTPT. Nine general dentists and 22 endodontic specialists evaluated these questions for clarity and comprehension through an iterative process. Two academic dental trauma experts categorized the knowledge required to answer each question into three levels. The three academic endodontists submitted the 99 questions to the GG, resulting in 297 responses, which were then assessed for accuracy and consistency. Accuracy was evaluated using the Wald binomial method, while the consistency of GG responses was assessed using the kappa-Fleiss coefficient with a confidence interval of 95%. A 5% significance level chi-squared test was used to evaluate the influence of question level of knowledge on accuracy and consistency.

Results: The responses generated by Gemini showed an overall moderate accuracy of 80.81%, with no significant differences found between the responses of the academic endodontists. Overall, high consistency (95.96%) was demonstrated, with no significant differences between GG responses across the three accounts. The analysis also revealed no correlation between question level of knowledge and accuracy or consistency, with no significant differences.

Conclusions: The results of this study could significantly impact the potential use of Gemini as a free-access source of information for clinicians in the MTPT.

Background/aim: This study aims to evaluate and compare the impact absorption capacities of thermoformed ethylene vinyl acetate (EVA) mouthguards and 3D-printed polyolefin mouthguards used in sports dentistry applications. The objective is to determine whether 3D-printed polyolefin mouthguards offer superior impact toughness compared to traditional EVA mouthguards commonly used in sports settings.

Materials and methods: Six material samples were assessed: five pressure-formed EVA mouthguards (PolyShok, Buffalo Dental, Erkoflex, Proform, and Drufosoft) and one 3D-printed synthetic polymer (polyolefin). The materials were evaluated using a modified American Society for Testing and Materials (ASTM) D256 Test Method A for Izod pendulum impact resistance of plastics. Polyolefin samples were 3D-printed using fused filament fabrication (FFF) technology. Notably, the FFF process included samples printed with notches placed either parallel or perpendicular to the build direction. This orientation served as a study factor, allowing for comparison of material behavior under different printing conditions. Impact testing was conducted using an Izod impact tester to assess the materials' performance under controlled impact conditions.

Results: The study achieved a high power (1.0) in power analysis, indicating strong sensitivity to detect significant differences. Among molded materials, PolyShok showed significantly lower impact toughness compared to others (p = 0.06). The mean impact absorption of EVA materials was 5.4 ± 0.3 kJ/m², significantly lower than polyolefin materials, which demonstrated 12.9 ± 0.7 kJ/m² and superior performance (p = 0.0). Horizontal-notched polyolefin samples exhibited higher impact strength compared to vertical-notched samples (p = 0.009).

Conclusions: 3D-printed polyolefin mouthguards exhibited significantly higher impact toughness than thermoformed EVA mouthguards. While EVA materials demonstrated structural robustness, their lower impact resistance and observed tearing in other test specimens suggest the need for alternative testing standards to better reflect real-world conditions. 3D-printed mouthguards fabricated with build orientations perpendicular to the direction of impact demonstrate significantly enhanced impact absorption. Further research into manufacturing methods and testing protocols is recommended to optimize mouthguard performance under impact scenarios.

Aim: The thickness of the mouthguard is a crucial factor in its protective ability for athletes. This study aimed to investigate the final thickness of double-layered sports mouthguards, which were fabricated using different methods before pressing the second layer.

Materials and methods: Seven upper working models (n = 7 per group) were prepared for mouthguard fabrication. The first 3-mm mouthguard sheet underwent heating, pressing, and vacuuming onto the model, followed by various protocols before the second 3-mm sheet was pressed. Group 1: The second sheet was pressed immediately. Group 2: The first sheet underwent a 1-h cooldown period before pressing the second sheet. Group 3: The interproximal areas of the first sheet were punctured followed by immediate pressing of the second sheet. Group 4: The first sheet was punctured followed by a 1-h cooldown before pressing the second sheet. After 24 h, the mouthguard thickness was measured at various points on the left and right central incisors and first molars using a digital caliper. The thickness analysis was performed using SPSS 29.0 with one-way ANOVA and Tukey post hoc analysis.

Results: At the labial surface of the central incisors, Group 4 exhibited the highest thickness, while Group 3 had the lowest (p < 0.001). Groups 1 and 2 did not show significant differences in thickness. At the incisal edges, Group 3 again had the lowest thickness (p < 0.05), with no significant differences observed among the other groups. There were no significant differences in thickness across all areas at the first molars, including cusp tips, pits, and buccal surfaces (p > 0.05). Group 4 demonstrated greater uniformity at the central incisors in thickness compared with the other groups.

Conclusions: Using the puncturing method at interproximal areas combined with a cooldown period could enhance mouthguard thickness at the labial surfaces of the central incisors and improve its thickness uniformity.

Background/aims: Transient apical breakdown (TAB) is a phenomenon that indicates temporary apical periodontal destruction and root resorption after tooth luxation injuries, followed by the healing process of the dental pulp. Andreasen in 1986, reported that TAB was seen in approximately 4.2% of all luxation injuries. However, there have been no reports thereafter on the types and frequency of the luxation traumatic injuries in which TAB occurs. Therefore, this retrospective study was aimed to assess the incidence and pathogenesis of dental trauma-induced TAB and to suggest a possible mechanism of subsequent healing based on a series of cases.

Methods: Data analysis included mature teeth (n = 56) of 49 patients aged 9-30 years who presented in a private dental office over a period of 10 years (2012-2022) to investigate the incidence and healing sequala of TAB.

Results: TAB was observed in 43.8% of subluxation, 62.5% of extrusive luxation, and 75% of lateral luxation injuries. The average age of patients who developed TAB was 14.5 years, ranging from 9 to 28 years old.

Conclusions: TAB can be expected in many cases of luxation injuries with minimal dislocation. Therefore, mild injuries (subluxation, extrusion, and lateral luxation), may exhibit spontaneous healing, recovery of dark discoloration of the crown, disappearance of a periapical radiolucent lesion and return to normal response to EPT as long as 12 months after the traumatic injury. Thus, a decision to perform endodontic treatment in these cases might be postponed until clear evidence for an infection exists.