Dental Traumatology最新文献

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.

Sports-related traumatic dental injuries (TDIs) are a significant global concern, particularly in contact sports, where the risk of orofacial injuries is high. Custom-made sports mouthguards (CSMs) are recognized as the most effective means of preventing these injuries, providing both protection and comfort without impairing athletic performance. Despite their proven benefits, there is no globally standardized approach to mouthguard design, fabrication, or usage, primarily due to varying regulations, awareness levels, and cultural attitudes toward sports safety across different countries. This document from the European Association for Sports Dentistry (EA4SD) outlines the latest guidelines for selecting, constructing, clinical use, and maintaining CSMs. It emphasizes the need for mouthguards fabricated from FDA-approved materials, designed to absorb and distribute impact forces effectively, and customized to ensure optimal fit and comfort. The EA4SD also highlights the importance of education for dental professionals and athletes on the benefits of CSMs, advocating for their mandatory use in high-risk sports to reduce the prevalence of TDIs and related complications.

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).

Background/aim: Artificial intelligence (AI) chatbots have become increasingly prevalent in recent years as potential sources of online healthcare information for patients when making medical/dental decisions. This study assessed the readability, quality, and accuracy of responses provided by three AI chatbots to questions related to traumatic dental injuries (TDIs), either retrieved from popular question-answer sites or manually created based on the hypothetical case scenarios.

Materials and methods: A total of 59 traumatic injury queries were directed at ChatGPT 3.5, ChatGPT 4.0, and Google Gemini. Readability was evaluated using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores. To assess response quality and accuracy, the DISCERN tool, Global Quality Score (GQS), and misinformation scores were used. The understandability and actionability of the responses were analyzed using the Patient Education Materials Assessment Tool for Printed Materials (PEMAT-P) tool. Statistical analysis included Kruskal-Wallis with Dunn's post hoc test for non-normal variables, and one-way ANOVA with Tukey's post hoc test for normal variables (p < 0.05).

Results: The mean FKGL and FRE scores for ChatGPT 3.5, ChatGPT 4.0, and Google Gemini were 11.2 and 49.25, 11.8 and 46.42, and 10.1 and 51.91, respectively, indicating that the responses were difficult to read and required a college-level reading ability. ChatGPT 3.5 had the lowest DISCERN and PEMAT-P understandability scores among the chatbots (p < 0.001). ChatGPT 4.0 and Google Gemini were rated higher for quality (GQS score of 5) compared to ChatGPT 3.5 (p < 0.001).

Conclusions: In this study, ChatGPT 3.5, although widely used, provided some misleading and inaccurate responses to questions about TDIs. In contrast, ChatGPT 4.0 and Google Gemini generated more accurate and comprehensive answers, making them more reliable as auxiliary information sources. However, for complex issues like TDIs, no chatbot can replace a dentist for diagnosis, treatment, and follow-up care.

Management of traumatic dental injuries is often challenging due to the complexity in diagnosis, concomitant injuries, and the interdisciplinary treatment planning. As a result, the clinicians are often confused and not confident over important treatment decisions. The guidelines of International Association of Dental Traumatology have improved the standard of dental trauma care globally and provide a roadmap for predictable prognosis. However, there are unique situations that require additional investigations such as the Cone Beam Computed Tomography and customized treatment and follow up protocol. An essential requisite for prevention of adverse late complications of dental injuries is clear understanding of their etiopathogenesis and the changes that occur after an injury. Additionally, it is prudent to understand the basic physiology behind the healing that is expected after a treatment protocol. This review presents the science behind the development of late complications of dental injuries and their management protocols in a simplified and clinical manner. An attempt has been made to highlight the clinical paradigms and decisions that reduce the chances of failures in traumatized teeth.

Background/aim: The optimal storage medium for an avulsed tooth should preserve the viability of periodontal fibroblasts (PDLF) to the highest degree, facilitating the re-attachment of periodontal fibers and improving the prognosis of replantation. This study compared the effect of the PDLF viability in Hank's balanced salt solution (HBSS), supplemented culture medium, that is, Dulbecco's Modified Eagle Medium (DMEM), and four modified HBSS mixtures.

Material and methods: Periodontal tissues were obtained from extracted human teeth and processed for PDLF culture. The cells were then exposed to six experimental media: (i) HBSS, (ii) HBSS and ascorbic acid (HBSS + Vit C), (iii) HBSS and platelet-derived growth factor (HBSS + PDGF), (iv) a mixture of HBSS, PDGF, and Vit C (HBSS + PDGF + Vit C), (v) HBSS and platelet lysate (HBSS + PL), and (vi) DMEM for 3, 6, 12, and 24 h. A MTT assay was performed to determine the cell viability.

Results: Vitamin C-containing media maintained PDLF viability significantly better than HBSS + PDGF and HBSS + PL at 3, 6, 12, and 24 h (p < 0.05). The percentages of viable PDLF at 3, 6, 12, and 24 h were significantly higher than 0 h for HBSS + Vit C, HBSS + PDGF + Vit C, HBSS + PL, and DMEM (p < 0.05).

Conclusion: All experimental media were able to maintain PDLF viability (DMEM>HBSS+Vit C; HBSS+PDGF+Vit C>HBSS+PL>HBSS+PDGF; HBSS). Although DMEM had the highest cell proliferative effect, it is impractical to be used as a transport medium due to its cost, storage, and availability. The supplementation of Vit C yielded significant cell proliferative effects; hence, HBSS + Vit C can be a better alternative as a storage medium than HBSS.

Fragment reattachment in traumatic injuries is notable for its excellent esthetic, morphological, and functional results. The aim of this study was to investigate the scientific history and trends in publications on dental fragment reattachment through a bibliometric and altmetric analysis. The search was conducted in October 2024 using Web of Science. Two researchers selected articles and extracted key study characteristics. Collaborative networks were generated using VOSviewer software. Dimensions was consulted to measure altmetric data. The Spearman correlation was used. A total of 129 articles were included. The most cited article received 160 citations. Studies were published between 1988 and 2024. The leading journal was Dental Traumatology (n = 55). Case reports (n = 63) were the most frequent study design. The majority of studies aimed at clinical case follow-up (n = 71), with coronal fractures being most commonly reported (n = 96). Young patients were most affected in the selected studies (n = 49). Tewari N stood out (n = 8). The All India Institute of Medical Sciences was prominent with seven articles. Brazil was the most prevalent country (n = 29), and Asia was the most frequent continent (n = 57). Vosviewer demonstrated collaborations among authors. According to Dimensions, significant mentions were identified on Mendeley, followed by X users. This bibliometric analysis provides a comprehensive description of the technique of fragments reattachment in traumatized teeth, which has been studied for over 36 years. Studies on this technique primarily rely on case reports describing follow-up in young patients. Intervention studies and systematic reviews are recommended. Additionally, more studies in Africa, Oceania, and North America are encouraged.

Objective: To identify factors associated with the prevalence of traumatic dental injuries (TDI) in children at 4 years of age.

Methods: Participants from the 2015 Pelotas (Brazil) birth cohort were included. Demographic, socioeconomic, behavioral, and environmental data were collected through interviews and physical examinations during cohort follow-up. Dental examination at 4 years of age revealed the presence of TDI. A theoretical model was constructed using a directed acyclic graph (DAG). A descriptive analysis was performed, followed by Poisson regression models relating TDI to each outcome.

Results: Data from 3650 4-year-old children were analyzed; the prevalence of dental trauma was 20.2% (95% confidence interval [CI] 18.9%-21.5%). The prevalence of TDI was lower among girls compared with boys, suggesting a protective effect of female sex (relative risk [RR] 0.80 [95% CI: 0.79-0.91]). Increased height for age (RR 1.55 [95% CI: 1.14-2.09]), increased overjet (RR 1.45 [95% CI: 1.2-1.74]), and anterior open bite (RR 1.26 [95% CI: 1.01-1.56]) demonstrated an association with TDI after testing regression models based on DAGs.

Conclusion: Male sex, increased height, and increased overjet and open bite were factors predisposing to TDI at 4 years of age. Understanding these factors can contribute to the implementation of targeted prevention strategies for reducing TDI and their potential long-term consequences.

Background: Traumatic dental injuries with tracheal intubation during general anesthesia are considered one of the most common complications. It is also the primary reason for malpractice legal claims against anesthesiologists according to insurance companies. There is much information regarding the incidence, consequences, and risk factors of traumatic dental injuries during general anesthesia. This study aimed to assess the awareness (knowledge, practice, and attitude) of anesthetists regarding peri-anesthetic traumatic dental injuries and discuss measures to reduce the risk regarding peri-anesthetic traumatic dental injuries.

Materials and methods: Sixty seven anesthetists participated in this cross-sectional survey between January 2023 and July 2023, which was carried out in the Syrian Arab Republic. The questionnaire was generated using Google Forms and sent individually, as the researcher (MNA) was accompanied by all included anesthesiologists while filling out all the questionnaire paragraphs to answer any questions. The Fisher exact test and Pearson's Chi-squared test were used to analyze the results.

Results: The dental trauma caused by the anesthetists during their professional careers was 38.8%, and none of them were exposed to any legal claim. 77.6% of the anesthetists thought that avulsed permanent teeth could be replanted, 46.2% believed that the procedure must be done in < 30 min, and 84.6% thought they could not do it themselves and would send the patient to a dentist after the procedure. More than half of respondents (63.5%) indicated that the sterile saline solution was the best storage medium for avulsed teeth. Furthermore, 74.6% of anesthetists stated that emergency intubations are related to more traumatic dental injuries in comparison with elective intubation and about 62% were aware of the importance of mouthguard. However, nearly 57% complained about the shortage of knowledge related to the oral cavity and its special structure.

Conclusions: Syrian anesthetists have limited awareness (knowledge, practice, and attitude) of traumatic dental injury classification, prevention, and management. More information and training are still needed about factors used within clinical dentistry.

Tooth fractures are a common consequence of dental trauma in young patients, requiring prompt and effective restorative interventions that ensure both functional integrity and esthetic appeal. Although resin stratification (layering) is the gold standard for achieving life-like restoration of fractured teeth, many clinicians find it technically challenging due to the time and effort required for precise shade matching, concealing the fracture line, and accurate placement of resin composite layers with different levels of opacity. The more recent generation of monoshade composites, with their ability to adapt to various tooth shades, reduce the complexity of multi-layer restorations, and improve chairside efficiency. Additionally, the composite cutback technique has gained attention as an effective method for restoring fractured teeth in young patients. This method combines the benefits of monoshade composites and the precision of simple additional layering to enhance both the esthetic and functional outcomes of the restorations. This mini-review provides a comprehensive analysis of the composite cutback technique, the role of monoshade composites, and their clinical application in the restoration of fractured young teeth.