Clinical photography and documentation after traumatic dental injuries.

Clinical photographic documentation is recommended as part of the standardized clinical evaluation of traumatized patients according to the most current International Association of Dental Traumatology guidelines for the management of traumatic dental injuries (TDIs), published in 2020. The use of current technology such as mobile smartphones and the emergence of teledentistry for direct communication between dentists and with patients have increased the need to improve the knowledge and skills for contemporary clinical photographic documentation procedures at the dental office as well as at the accident site. The purpose of this review is to include findings from the available literature and discuss modern techniques, contemporary equipment, accessories and developments that can be used by both patients and dental professionals for proper clinical documentation after TDIs. Emphasis is given on the positioning and patient management based on the type and severity of the injury, and the selection of the appropriate technique. Moreover, the number and type of clinical photographs for each dental trauma scenario, the suggested timeline for optimal photographic documentation as well as legal considerations involved are also discussed.

Evaluating the knowledge level, attitudes, and therapeutic approaches of Greek dentists for traumatic dental injuries.

BACKGROUND/AIM: Greek dentists are facing a new era of a globally continuous effort to improve the first-aid management and long-term treatment outcome of traumatic dental injuries (TDI). In Greece, where the basic and clinical research in the field of dental trauma has been limited until recently, assessing the attitudes and therapeutic strategies of Greek dentists for dental trauma is of great importance. The aim of this study was to evaluate the knowledge attitudes and therapeutic approaches of Greek dentists in different clinical scenarios of TDI. MATERIALS AND METHODS: A cross-sectional study was conducted among 448 dentists. A questionnaire-based survey of demographic characteristics, attitudes, and a scenario-based knowledge test, of TDI, which was used to formulate a "Dental Trauma Knowledge Score" with a 0-8 score range, was administered. Mann-Whitney U tests (for two categories variables) and Kruskal-Wallis tests (for more than two categories variables) were performed. RESULTS: The median knowledge score was 5.0 (IQR: 4-7), a level considered as "Acceptable." Knowledge scores were found to significantly differ by age group, with the younger dentists presenting the highest scores. Dentists with a self-evaluation as "Acceptable" had significantly higher scores. Most of the dentists would refer for CBCT in severe trauma cases. A significant association was found between younger ages and on awareness of the mobile application ToothSOS. Female dentists had significantly higher scores compared to males when asked about avulsion management. CONCLUSION: An acceptable level of knowledge on TDI management was revealed among dentists in Greece. Higher knowledge scores were observed among younger dentists.

A questionnaire-based survey for the evaluation of the knowledge level of primary school teachers on first-aid management of traumatic dental injuries in Athens, Greece.

BACKGROUND/AIM: School teachers can play an important role in improving the prognosis of traumatized teeth of school children through immediate onsite management or on time referral to healthcare providers. In Greece where the research in the field of dental traumatology is very limited, this issue is of utmost importance. The aim of this study was to evaluate the knowledge level of Greek primary school teachers and their attitude with regard to emergency first-aid management of traumatic dental injuries (TDI) occurring in schools. MATERIAL AND METHODS: A cross-sectional descriptive study among 276 school teachers was undertaken in Athens, Greece. This was done through a two-part questionnaire-based survey including demographic characteristics, attitude, and knowledge of first-aid management of TDI. Data were analyzed using non-parametric tests for differences. Log Poisson regression analysis was used to estimate relative risks of low or high knowledge of first-aid management. RESULTS: The risk of lower knowledge score was almost double in teachers with <10 years of teaching experience and almost threefold higher in those reporting that they are not interested in being informed about dental trauma. In the case of luxation injury, 69.9% of the participants would not take any immediate action and would refer the child to a dentist. In case of permanent tooth avulsion, 52.2% knew that the tooth can be replanted in the socket, whereas only 17% believed that this should be performed within 30 minutes. Most of the participants would send the child to their own/family dentist, whereas only 4.7% would refer to an Endodontist. CONCLUSION: The knowledge of primary school teachers in Greece about first-aid management of TDI is limited. However, a clear positive association was found between knowledge of first-aid management and teaching experience. Reliable information about dental trauma may result in improving the knowledge level of Greek primary school teachers.

Uncontrolled Removal of Dentin during In Vitro Ultrasonic Irrigant Activation in Curved Root Canals.

INTRODUCTION: The aim of this study was to examine the effect of file type and activation time on the uncontrolled removal of dentin during in vitro ultrasonic irrigant activation in prepared curved root canals. METHODS: Seventy-two curved mesial root canals of human mandibular molars were prepared to size 35/.04 taper. The specimens were randomly allocated to 4 groups (n = 18). Two milliliters of 2% sodium hypochlorite were delivered 3 times to each root canal, and the irrigant was ultrasonically activated every time for 10 seconds at 35% power either by a ultrasonic K-file (group A), an Irrisafe file (Acteon Satelec, Merignac, France) (group B), or a smooth wire (group C). The same specimens also received further activation continuously for another 30 seconds. No activation took place in group D. Specimens were scanned by micro-computed tomographic imaging before and after preparation and after the first and second activation period. Scans were coregistered and segmented, and the amount of dentin removed during activation was quantified by morphological operations. Results were analyzed by nonparametric statistical tests (α = 0.05). RESULTS: Defects with a maximum depth of 0.18 mm were identified. Both the type of file and activation time affected the removal of dentin (P ≤ .002 and P ≤ .031, respectively). K-files removed more dentin than Irrisafe files and smooth wires in the coronal and middle third. All files removed comparable amounts in the apical third. CONCLUSIONS: All 3 types of files may result in uncontrolled removal of dentin. A longer activation time may increase this effect.

Uncontrolled Removal of Dentin during In Vitro Ultrasonic Irrigant Activation.

INTRODUCTION: The aim of this study was to evaluate uncontrolled removal of dentin during in vitro ultrasonic irrigant activation in prepared root canals using 2 different files. METHODS: Fifty-four human single-rooted teeth with straight root canals were prepared to size 35/.06 taper. The specimens were randomly allocated to 3 groups (n = 18). Two milliliters of 2% sodium hypochlorite was delivered 3 times to each root canal by a syringe and an open-ended needle. After each delivery, the irrigant was ultrasonically activated for 10 seconds at 35% power either by a size 15 ultrasonic K-file (group A) or a size 20 Irrisafe file (Acteon Satelec, Merignac, France) (group B) placed at 2 mm short of the working length. The irrigant in the control specimens (group C) was not activated. Specimens were scanned by micro-computed tomographic imaging at 10-µm voxel size before preparation, after preparation, and after the final irrigation/activation sequence. Scans were coregistered and segmented, and the amount of dentin removed during the final step was quantified by morphologic operations. Results were analyzed by nonparametric statistical tests. The level of significance was set to P < .05. RESULTS: Defects with a maximum depth of 0.09 mm and 0.07 mm were identified in groups A and B, respectively. Both ultrasonic files removed significantly more dentin than irrigant delivery in the control group (P ≤ .005). K-files removed significantly more dentin than Irrisafe files in the apical third (P = .001). CONCLUSIONS: Ultrasonic irrigant activation may result in uncontrolled removal of dentin in straight root canals and at manufacturer-recommended power settings.

Comparative evaluation of sealing ability and microstructure of MTA and Biodentine after exposure to different environments.

OBJECTIVES: The aim of this study was to evaluate the sealing ability and morphological microstructure of Biodentine in comparison to ProRoot mineral trioxide aggregate (MTA) after storage in an acidic environment. MATERIALS AND METHODS: Biodentine and ProRoot MTA were prepared and packed into the canal lumen of dentin disks. Twenty specimens of each material were further randomly divided into two groups according to the storage media: group A: materials with saline as storage medium; group B: materials with citric acid buffered at pH 5.4 as storage medium. The sealing ability was evaluated at 1, 3, 6, and 24 h and 1 or 3 months, using a fluid transport model for quantitative analysis of endodontic microleakage. The morphological microstructures of the materials were also evaluated using scanning electron microscopy. RESULTS: During the first 24 h, MTA showed greater fluid transport values than Biodentine in both environments. At the 3-month measurement, when the materials were stored in saline, MTA showed greater ability to prevent fluid movement than Biodentine (p < 0.0001). However, when the materials were stored in an acidic environment, no statistical significant difference was found after 3 months. After storage in saline, both materials showed an uneven crystalline surface with similar hexagonal crystals. The microstructure of Biodentine changed after exposure to citric acid, showing a relatively smooth surface with more spheroidal crystals. CONCLUSIONS: The exposure to an acidic environment, within the limits of this study, seems to result in morphological changes of Biodentine in a different manner than MTA. MTA shows good ability to prevent fluid movement over time, in both environments. The ability of Biodentine to prevent fluid movement over time was enhanced in the acidic environment. CLINICAL RELEVANCE: The findings of the present study could imply that both materials are indicated for use in an acidic environment.