Dental Traumatology最新文献

Background/aim: Traumatic dental injuries (TDIs) require accurate documentation for diagnosis, treatment planning, and medico-legal purposes. International guidelines strongly recommend the use of clinical photography, yet its use among pediatric dentists has not been consistently evaluated across countries. This study aimed to assess pediatric dentists' knowledge, attitudes, and practices regarding the photographic documentation of TDIs.

Materials and methods: A multinational, mixed-method cross-sectional survey was conducted between April and June 2025. Quantitative data were analyzed, while qualitative insights from open-ended responses were analyzed thematically and integrated with quantitative results. A non-probability convenience sampling method was used to recruit participants through professional networks, academic societies, and social media platforms.

Results: A total of 404 participants from 14 countries responded, predominantly pediatric dentists (66.6%) with 5-20 years of experience. Most respondents (95.3%) considered photography important for documenting TDIs, but only 23.5% reported always using it. Smartphones were the most common tool (65.1%), while fewer used DSLR cameras (26.7%). Major barriers included uncooperative children (40.2%) and time constraints (27.4%). Formal training in photography was reported by 41.6% of participants. Multivariate regression showed that awareness of international guidelines (OR = 2.94; CI: 1.71-5.18, p < 0.001) and high perceived importance (OR = 4.63; CI: 1.56-18.21, p = 0.005) significantly predicted frequent use. Participants who were aware of IADT guidelines were almost three times more likely to use photography routinely, and those who perceived it as highly important were over four times more likely to do so. Thematic analysis highlighted ethical concerns, including uncertainty regarding parental consent and data storage, as well as training gaps and calls for standardized protocols.

Conclusions: Photography is essential for recording pediatric dental trauma, but is inconsistently used. Knowledge of guidelines and training influences implementation. Standardizing consent, training, and routine photography can bridge the gap between recommendations and practice.

Background/aim: The prognosis of traumatized teeth might be influenced by the type and quality of the dental splint. This prospective observational study was aimed to evaluate the indications and quality of dental splints performed in a comprehensive public oral health service in the city of Uberlândia, Brazil.

Materials and methods: Between January 2024 and January 2025, 51 dental splints involving 320 teeth were evaluated. Data of the dental splint types (semi-rigid or rigid), splint characteristics, polishing of resin composite, plaque retention, oral hygiene orientation, patient satisfaction, duration of the splint, and adherence to IADT protocol were recorded. Data were analyzed descriptively.

Results: Most dental splints were semi-rigid using fishing nylon line (58.8%); 49% showed improper alignment. Visible plaque was presented in 73.4% and gingival inflammation in 66.9% of the dental splints. Only 32.6% of treated patients received oral hygiene instructions. Diagnostic errors were found in 19.6% of cases, and 31.4% did not follow the recommended protocols regarding the correct dental splint rigidity.

Conclusion: Gaps related to splint indication, application, and follow-up were observed within the public healthcare services evaluated in this study. Reinforcing the necessity of training and continuing education, protocol standardization and better recording documentation are essential to enhance trauma care outcomes follow-up.

Trial registration: Brazilian Clinical Trials Registry (ReBEC) under the UTN code: U1111-1309-8338.

Background/aims: A dental splint is a stabilization device designed to support an injured tooth by allowing physiological tooth mobility and redistributing stresses to adjacent healthy teeth. Dental splints incorporating auxetic structures with a negative Poisson's ratio can offer improved biomechanical performance. The aim of the present work is to optimize dimensions and evaluate the biomechanical performance of a superelastic NiTi alloy-based double U-arrowhead (DUA) auxetic dental splint for reducing the stress and tooth mobility of an avulsed tooth.

Materials and methods: The DUA splint was optimized by varying dimensions of arm-width (0.5, 0.6, 0.7, 0.8 mm) that influence overall dimensions of motif. Finite element analysis under tensile and bending conditions was conducted to evaluate the effect of arm-width on Poisson's ratio, effective modulus, and effective bending stiffness. The biomechanical performance of the DUA splint was assessed using a 3D maxillary avulsed tooth model under masticatory loading (100 N) applied to the lingual surface of the crown.

Results: On increasing arm-width leads to a gradual increase in effective modulus (36.7-43.6 GPa), bending stiffness (3.1-5.44 N/mm), and reduction in negative Poisson's ratio (-0.21 to -0.01). The avulsed tooth model shows a reasonable reduction in maximum principal stress (11.14%), minimum principal stress (23.89%), and tooth mobility (24.77%) of avulsed tooth and PDL von-Mises stress (26.47%) when splinted with DUA splint of 0.7 mm arm-width. Further comparison with a commercial Titanium trauma splint showed better performance of DUA splint (0.7 mm).

Conclusions: The proposed superelastic NiTi alloy-based DUA auxetic splint with 0.7-mm arm-width reduces tooth mobility and stresses without exceeding biological limits. This will facilitate the reimplantation of the avulsed tooth, ensuring healing of the PDL and allowing physiological tooth mobility for ossification of the alveolar bone around the tooth socket. This will inhibit further complication of the affected tooth such as hyalinization of PDL, root resorption, or tooth ankylosis.

Background/aim: In clinical practice, fragment reattachment and direct composite restoration are commonly used to restore fractured anterior teeth. However, the comparative studies about these two treatments in children and adolescents remain limited. This study aims to evaluate their clinical longevity in pediatric patients and identify risk factors associated with failure.

Materials and methods: This study analyzed the clinical records of patients with anterior crown fractures treated by fragment reattachment or direct composite restoration from January 2021 to December 2022. Experienced pediatric dentists performed diagnoses and treatments in strict accordance with the latest International Association of Dental Traumatology guidelines. Restorative and biological survival rates were evaluated using Kaplan-Meier survival analysis, and potential prognostic factors were identified by Cox proportional hazards regression modeling.

Results: Overall, 439 patients (mean age, 8.8 ± 1.5 years; range, 6-14 years) with 500 teeth were included, with a mean follow-up period of 31.1 ± 5.8 months. Fragment reattachment was performed on 63 teeth, while 437 teeth received direct composite restoration. The cumulative survival rates at 1 and 2 years were 76.2% and 71.4% for fragment reattachment, and 87.4% and 81.0% for direct composite restoration, respectively. The Log-rank test revealed no statistically significant difference in survival rates between the two groups for either restorative or biological failure. The stratified multivariate analysis revealed that age (HR = 0.77, 95% CI: 0.66-0.90, p = 0.001) and fracture pattern (Class C: HR = 4.45, 95% CI: 1.87-10.58, p < 0.001 and Class c1: HR = 7.28, 95% CI: 1.79-29.53, p = 0.005) significantly influenced the survival rates of teeth treated by direct composite restoration. The rates of restorative and biological failure did not differ significantly between these two treatments for either uncomplicated or complicated crown fractures. A considerable proportion of failures occurred within the first 12 months after the initial treatment.

Conclusion: Both fragment reattachment and direct composite restoration demonstrated favorable clinical effects on the treatment of permanent anterior crown fractures in children and adolescents. Fragment reattachment was recommended as the primary treatment option for pediatric patients due to its clinical advantages in procedural simplicity, time efficiency, and aesthetic preservation. It can be concluded that younger age and teeth with Classes C and c1 fracture patterns significantly increase failure risks in direct composite restorations. Close follow-up is highly recommended during the first 12 months post-treatment.

Backgroung/aim: New resins for the additive manufacturing of mouthguards for contact sports are now available on the market. However, no study has evaluated the impact performance of these resins. The aim of this in vitro study was to compare the shock absorption capacities of custom-made mouthguards produced by additive manufacturing with those of thermoformed mouthguards.

Materials and methods: Three types of custom-made mouthguards were fabricated: 3D-printed Keyguard and Dima resin mouthguards and thermoformed triple-layer mouthguards. For each type of mouthguard, eight samples were produced. Each mouthguard was subjected to an impact performance test defined by the NF S72-427 standard for industrial mouthguards. Mean transmitted deceleration must not exceed 230 g (g = 9.81 m/s²) and no individual impact should exceed 250 g. Mechanical performance was evaluated by a series of five consecutive impacts with a drop-mass impact test on the inter-incisal area. Peak force transmission and deceleration were measured. Thickness decrease was assessed by 3D scanning.

Results: None of the mouthguards met the impact absorption standard. Thermoformed mouthguards exhibited major structural failure after the first impact. For 3D-printed mouthguards, average peak deceleration ranged from 255 to 278 g for Dima and 292 to 299 g for Keyguard. Corresponding transmitted forces ranged from 2753 to 3106 N (Dima) and 3192 to 3292 N (Keyguard), with no significant difference between the two 3D-printed mouthguards (p > 0.05). Mean thickness decrease at the impact site was 0.2 mm for Dima mouthguards, 0.1 mm for Keyguard mouthguards, and 0.3 mm for thermoformed mouthguards.

Conclusion: Although none of the tested mouthguards met the NF S72-427 standard, 3D-printed custom devices demonstrated promising shock absorption performance after repeated impacts. These results highlight the potential of additive manufacturing as a cost-effective alternative to conventional thermoformed mouthguards, particularly for younger athletes requiring frequent replacements.

Introduction: Traumatic dental injuries (TDIs) are common but understudied consequences of combat-related craniofacial trauma. The Swords of Iron (SOI) War exposed Israel Defense Forces (IDF) personnel to high-velocity injuries in extreme battlefield conditions. This study aims to characterize the prevalence, anatomical distribution, and associated complications of TDIs among IDF soldiers during the SOI war, and to explore their operational and clinical implications.

Methods: A retrospective cohort study using the IDF Trauma Registry (IDF-TR) from October 2023 to February 2025 was conducted. Soldiers with head and neck trauma who underwent dental evaluations were included. Dental injuries were categorized by type (fracture, avulsion, periodontal ligament [PDL] injury), tooth location, and associated comorbidities, including temporomandibular disorders (TMDs) and sensory deficits.

Results: Of 1542 soldiers with head and neck trauma, 259 underwent dental evaluation, and 67 (25.9%) sustained at least one TDI. Tooth fractures (n = 73, 28.2%) and avulsions (n = 68, 26.2%) were the most common, predominantly affecting the maxillary central incisors. Penetrating trauma and endotracheal intubation were associated with higher avulsion rates, although the difference was not statistically significant. TMDs were diagnosed in 27 (10.4%) of the patients and were significantly associated with avulsed teeth (mean 1.41 vs. 0.15; p = 0.013). Soldiers with sensory deficits also trended toward higher avulsion rates.

Discussion: Combat-related TDIs during the SOI war showed a high incidence of anterior tooth trauma, especially avulsions and fractures, with strong associations with TMDs. These findings underscore the need for targeted prevention strategies, early dental and TMJ assessments, and long-term rehabilitation planning to preserve the functional and operational readiness of military personnel.

Background/aim: Healing of the periodontal ligament (PDL) and pulp vitality is critical for successful management of traumatic dental injuries (TDI), which could be compromised due to adverse stress distributions caused by occlusal forces. As a common treatment to stabilize traumatized teeth, the impact of fiber splinting locations on the masticatory stress distribution in the PDL and dental pulp has not reached a consensus. The biomechanical effects of incisal and cervical fiber splinting on stress distribution in traumatized teeth were investigated in this study.

Material and methods: A cone-beam computed tomography (CBCT) scan of the patient's maxilla was processed using Mimics 22.0, Geomagic Wrap 2017, and SolidWorks 2018 to rebuild three-dimensional finite element models. The fiber splints were modeled by bonding strips near the labial surfaces at the incisal and cervical regions of the anterior teeth. Three locations on the palatal surface: the incisal ridge, incisal third, and cervical third regions were loaded with force to simulate mastication. The ultimate stress distributions were analyzed by ANSYS 2021 R1.

Results: Comparative analysis of stress distribution caused by simulated occlusal forces revealed that incisal splinting consistently reduced stress concentration more effectively than cervical splinting on the PDL and apical foramen of traumatized teeth. The mean stress values in the PDL of traumatized teeth were 183,972 Pa (without splinting), 132,216 Pa (cervical splinting), and 75,294 Pa (incisal splinting). Compared to the CS group, the mean value of the four traumatized incisors' PDL in the IC group was decreased by 43%. The mean stress values around the apical foramen of traumatized teeth were 1,010,861 Pa (without splinting), 670,261 Pa (cervical splinting), and 415,661 Pa (incisal splinting). Compared to the CS group, the mean value around the apical foramen of the four traumatized teeth in the IC group was decreased by 37%.

Clinical relevance: This study demonstrates that incisal splinting provides superior biomechanical advantages over cervical splinting by mitigating harmful stress concentrations on the PDL and dental pulp (apical foramen), potentially accelerating the PDL healing process and preserving pulp vitality in TDI.

Conclusion: Compared to cervical splinting, the biomechanical advantages of incisal splinting reduce stress concentration more effectively to improve prognosis in TDI.

Background: Dental avulsion is among the most common traumatic dental injuries in children, with prognosis heavily reliant on the prompt response of parents or caregivers. While such injuries can have significant and lasting physical, emotional and social impacts on children and their families, the specific nature and extent of these effects remain understudied in New Zealand.

Aims: To explore the lived experiences of New Zealand children, adolescents, and their families following dental avulsion of permanent maxillary central incisors, and to identify barriers to accessing timely emergency dental care.

Methods: Exploratory qualitative research design involving the use of semi-structured interviews (n = 11). The data were analysed using thematic analysis. Participants were recruited via social media and advertisements.

Results: Interviews were conducted with 11 children and adolescents, along with their parents. Thematic analysis revealed five major themes: the injury itself, challenges in accessing emergency dental care, emotional and psychological impact (identified as a key finding), treatment experience and outcomes, and the role of barriers and enablers. The degree of impact varied depending on parental, caregiver, or teacher awareness, access to timely care and treatment success. Parents with prior knowledge of dental trauma were more likely to seek immediate care, leading to more favourable treatment outcomes and reduced emotional distress. In contrast, lack of awareness, limited access to emergency services, and poor treatment outcomes were associated with heightened negative emotional and psychological effects.

Conclusion: This is the first study in New Zealand to explore the lived experiences of children and their families following a dental avulsion injury. It highlights the emotional, practical and clinical impacts on both children/adolescents and their caregivers. The findings reveal persistent barriers to accessing timely emergency dental care. There is a critical need for improved education and awareness about dental avulsions and appropriate immediate care to support better outcomes.

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.