Dental Traumatology最新文献

Background

Traumatic dental injuries represent a substantial concern in dental public health, often leading to functional, aesthetic, and psychological complications. Timely and appropriate management is essential to ensure favorable outcomes. This study aimed to assess the knowledge and attitudes of youth soccer team coaches regarding the management and prevention of traumatic dental injuries, as well as their awareness and promotion of protective mouthguard use.

Materials and Methods

A standardized three-part survey was distributed to youth soccer team coaches from all 14 professional football clubs in Kuwait. The survey instrument, adapted from validated tools in previous studies, gathered demographic data and assessed coaches' knowledge through hypothetical case scenarios and multiple-choice questions. Statistical analysis included descriptive methods and linear regression to assess factors influencing coaches' knowledge. Multicollinearity (VIF) and model fit (ANOVA) were evaluated.

Results

A total of 56 coaches completed the survey. Although 64% reported first aid training, only 9% had specific training in dental injury management. Case scenario analysis revealed significant knowledge gaps: only 29% correctly identified an injured tooth, and 9% recommended dental referral. In the avulsion scenario, 72% were unwilling to replant the tooth, and 90% were unaware of appropriate transport media. Although 59% acknowledged mouthguard importance, only 23% advised their use. Linear regression showed no significant predictors of knowledge score (mean = 1, SD = 0.88). The model explained only 9% of variance (R² = 0.09), with no significant predictors (p > 0.05) or model fit (F = 0.446, p = 0.84).

Conclusion

There is a substantial gap in the recognition and management of traumatic dental injuries among Kuwaiti youth soccer coaches. The study highlights the importance of targeted educational programs to improve coaches' ability to recognize dental injuries, emergency response, and advocacy for the use of protective mouthguards.

Background

When patients accidentally lose or miss one or more teeth due to agenesis, the dentoalveolar complex is either destroyed or not formed. Replacing these teeth typically presents significant challenges This case report offers proof of principle that the periodontal ligament (PDL) of an endodontically treated tooth can form new alveolar bone in a previously non-existent location, offering a potential breakthrough in treating such cases.

Case Description

A 15-year-old healthy Caucasian male presented for orthodontic treatment with lower right lateral incisor and canine transposition. To enable optimal canine positioning, extraction of the incisor was required. A decision was made to temporarily store the endodontically treated incisor in a subperiosteal pocket to preserve the viability of the PDL while the orthodontic repositioning of the canine was completed.

The incisor was thoroughly debrided, extracted, and placed in a subperiosteal pocket created via a small incision and tunnel preparation in the buccal corridor.

After 14 months, retrieval of the incisor revealed the formation of a nearly complete alveolus housing the incisor. The incisor was immediately transplanted into its final position. Favorable healing allowed functional loading with orthodontic extrusive force 3 weeks post-transplantation. Follow-up assessments were conducted at 3, 6, and 12 months, with annual evaluations extending up to 5 years.

Practical Implications

The regenerative potential of PDL to reconstruct the dentoalveolar complex, including alveolar bone, provides an optimal pathway for tooth replacement. This approach, employed within an interdisciplinary treatment framework, broadens the range of techniques available to dental specialists for managing complex clinical cases involving substantial alveolar bone loss.

Background/Aim

Artificial intelligence (AI) chatbots, also known as large language models (LLMs), have become increasingly common educational tools in healthcare. Although the use of LLMs for emergency dental trauma is gaining popularity, it is crucial to assess their reliability. This study aimed to compare the reliabilities of different LLMs in response to multiple questions related to dental trauma.

Materials and Methods

In a cross-sectional observational study conducted in October 2024, 30 questions (10 multiple-choice, 10 fill-in-the-blank, and 10 dichotomous) based on the International Association of Dental Traumatology guidelines were posed to five LLMs: ChatGPT 4, ChatGPT 3.5, Copilot Free version (Copilot F), Copilot Pro (Copilot P), and Google Gemini over nine consecutive days. Responses of each model (1350 in total) were recorded in binary format and analyzed using Pearson's chi-square and Fisher's exact tests to assess correctness and consistency (p < 0.05).

Results

The answers provided by the LLMs to repeated questions on consecutive days showed a high degree of repeatability. Although there was no statistically significant difference in the success rate of providing correct answers among the LLMs (p > 0.05), the rankings based on the rate of successful answers were as follows: ChatGPT 3.5 (76.7%) > Copilot P (73.3%) > Copilot F (70%) > ChatGPT 4 (63.3%) > Gemini (46.7%). ChatGPT 3.5, ChatGPT 4, and Gemini showed a significantly higher correct response rate for multiple choice and fill in the blank questions compared to their performance on dichotomous (true/false) questions (p < 0.05). Conversely, The Copilot models did not exhibit significant differences across question types. Notably, the explanations provided by Copilot and Gemini were often inaccurate, and Copilot's cited references had low evidential value.

Conclusions

While LLMs show potential as adjunct educational tools in dental traumatology, their variable accuracy and inclusion of unreliable references call for careful integration strategies.

Aim

To assess the effect of a dental traumatology educational intervention on general dentists' knowledge. The study was conducted at Vestland County's Public Dental Service (PDS) in Western Norway.

Materials and Methods

All PDS dental clinics of Vestland County (n = 52) were purposively assigned to a control group receiving no intervention (CC, n = 19), a webinar group (IC1, n = 17), and a combined webinar and in-person physical course group (IC2, n = 16). To examine the effect of the intervention, participants received a post-intervention online questionnaire (Q2) with clinical cases. A generalized linear mixed-effects model (GLMM) was used to compare the individual proportion of correct answers in Q2 between the three groups of educational intervention, where the clinic was set as a random effect factor. Additionally, a GLMM with a binary response variable was used to analyze the answers to individual cases. p < 0.05 was considered statistically significant.

Results

The response rate was 57% (n = 94). The overall proportion of correct answers was 67.7%, 71.0%, and 75.0% for the CC, IC1, and IC2 groups, respectively. There was no statistically significant difference in the overall proportion of correct answers between the groups when accounting for the dependency structure caused by clinics. However, for the individual cases, the IC2 group had a statistically significantly higher proportion of correct answers in complicated crown fracture of the immature tooth (p = 0.02) and first aid after avulsion (p = 0.02) compared to the CC group. Furthermore, the IC2 group had a trend of difference in complicated crown fracture of the mature tooth (p = 0.09) compared to the CC group and in emergency treatment of root fracture (p = 0.08) compared with IC1.

Conclusion

This study demonstrates that an educational intervention combining webinars with in-person interactive courses has a positive effect on general dentists' knowledge of dental trauma.

Background/Aim

This study evaluated the dentoalveolar responses of central incisors to anterior maxillary trauma in vitro and in silico using mouthguards (MGs) reinforced with polyamide mesh at three distinct positions.

Material and Methods

Forty 4-mm thick MGs were categorized based on mesh location: Group MG1 + 3 (reinforcement 1 mm from the vestibular limit), Group MG2 + 2 (2 mm), Group MG3 + 1 (3 mm), and a control group without reinforcement. A 3D-printed skull model (Spin Red Resin, Quanton 3D) simulated the dentoalveolar complex, with Resilab Clear resin (Wilcos) for teeth and addition-cured silicone for the periodontal ligament. This setup was connected to a custom impact device to ensure forces remained within the materials' elastic limits. Microstrains were measured using four strain gauges placed on the vestibular surfaces of the central incisors and the alveolar process of the maxilla. The impact was applied at Ep = 0.5496 J, parallel to the ground, using a 35-mm diameter steel sphere. For the in silico test, the setup was modeled in CAD software (Rhinoceros 7.0) and analyzed in CAE software (Ansys 2021 R1) through explicit dynamic simulation. All materials were assumed homogeneous, isotropic and linearly elastic. A 1 m/s impact was simulated using a 7.8 g/cm³ steel sphere. Physical contact conditions were defined as frictional and glued, with tetrahedral mesh elements applied after a 10% convergence test to ensure accuracy.

Results

The maximum principal strains and stresses in teeth and maxilla were presented through colorimetric graphs. Statistical analysis (Shapiro–Wilk, Kruskal–Wallis, and Dunn's tests, 5% significance) revealed significant differences for the non-reinforced group (p = 6.8 × 10⁻⁵) but none between impact zones (p = 0.879), confirming uniform stress distribution.

Conclusions

Reinforcement systems significantly improved impact absorption in oral tissues, enhancing protection. However, the reinforcement location did not significantly affect absorption. Finite element analysis validated the in vitro results supporting both theoretical and practical models for further study and future improvements.

Introduction

Regenerative endodontic treatment (RET) aims to promote root maturation in necrotic immature teeth, where effective microbial disinfection is crucial for treatment success. This study evaluated the effect of calcium hydroxide (CH) and 2% chlorhexidine gluconate (CHD) as intracanal medicaments and their impact on bacterial loads and RET outcomes.

Methods

The material consisted of bacterial samples from 41 patients who participated in a previously conducted randomized controlled clinical trial comparing CH and CHD during RET. A total of 123 microbial samples were analyzed using real-time quantitative polymerase chain reaction (qPCR). Bacterial loads were assessed at three time points: before root canal disinfection (S1), after root canal disinfection (S2), and after intracanal dressing (S3). The microbial composition was evaluated at the kingdom (Eubacteria), phylum (Actinomycetota), and species (Enterococcus faecalis) levels.

Results

Significant reductions in bacterial loads were observed after root canal disinfection (S2) in both CH and CHD subgroups, regardless of treatment outcome. Further reductions after intracanal dressing (S3) occurred exclusively in the successful cases. Actinomycetota loads significantly decreased after root canal disinfection in the successful cases but remained unchanged after intracanal medication. The presence of E. faecalis after intracanal dressing was associated with failed RET (OR = 9.778; p = 0.0432), although no significant differences in the effectiveness of the intracanal medicaments were found.

Conclusion

Both CH and CHD effectively reduced bacterial loads, with greater reductions linked to successful outcomes. The association between E. faecalis and failed RET suggests that this species may play a role in treatment outcomes. Further research, including microbiome profiling, is desirable to identify potential prognostic markers for failed RET.

Aim

This is the quantitative part of a study that aimed to evaluate the knowledge and experience of orthodontists in managing the orthodontic treatments of traumatized teeth.

Material and Method

The study was divided into 4 stages: first, a structured interview; second, face validity; third, test–retest; and fourth, administering the questionnaire. The first three stages aimed at developing the questionnaire, while the fourth consisted of the application of the instrument in a sample of 395 orthodontists properly licensed with the Regional Councils of Dentistry of Brazil. The questionnaire was sent to these orthodontists through the social media platform Instagram.

Results

It was found that the majority of participants had encountered this type of emergency in their offices, had moderate knowledge of the subject, and were successful in their orthodontic treatments. Furthermore, almost all professionals recognized the importance of additional training, and only a small portion of them were familiar with any care protocols for these cases.

Conclusion

It can be concluded that the orthodontists had limited experience and a moderate knowledge about the orthodontic management of traumatized teeth.