Dental Traumatology最新文献

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.

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.

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.