Multidisciplinary Management of Intrusive Luxation: Four-year Clinical Follow-up.

This article aims to describe the multidisciplinary clinical management of an intrusive luxation case. The clinical case reports the management of crown fracture and intrusive luxation of permanent maxillary incisors. The clinical results and subjective outcomes four years after the trauma and after two years of post-treatment follow-up are presented. An 11-year-old female patient sought dental care at the local University after experiencing dental trauma. Crown fracture of tooth 8 and the intrusion and crown fracture of teeth 9 and 10 were clinically diagnosed. The multidisciplinary treatment performed involved: periodontal surgical procedures; orthodontic traction; endodontic treatment; dental bleaching; and esthetic resin composite restorations. After two years of follow-up, the clinical parameters of the restorations were satisfactory, as well as the periodontal and periapical status. Oral health-related quality of life was assessed before and after treatment using the OHIP-Aes instrument, with a significant improvement in quality of life after treatment. The multidisciplinary approach was an effective treatment for this case of intrusive luxation. The dentofacial function and esthetics were recovered and the patient's quality of life was improved.

Cell-Based Therapy for Tooth Replantation Following Avulsion: A Systematic Review.

The management of avulsed teeth undergoing delayed replantation remains a clinical challenge as there are currently no effective interventions that can improve periodontal healing and prevent replacement root resorption. While several preclinical studies have reported varied success using cell-based tissue engineering to improve periodontal healing, a consensus is required before further clinical translation. Therefore, this systematic review seeks to evaluate the efficacy of cell-based therapy in promoting periodontal healing following delayed replantation in animal models. MEDLINE (PubMed) and Embase were searched on September 27, 2020. Ten studies involving rodent and dog models met the inclusion criteria. Cell sources included gingiva, periodontal ligament (PDL), bone marrow, and adipose tissues. Generally, cell-based therapy had increased the proportion of root surfaces displaying periodontal healing and concomitantly reduced the proportion presenting with replacement root resorption and ankylosis. The best outcomes were observed following treatment with PDL-derived cells of various potency. Future preclinical studies will benefit from adopting measures to minimize bias during the conduct of animal experiments and the standardization of the outcome measures reporting. This will facilitate future reviews with possible pooling of results in the form of meta-analyses, allowing a consensus to be obtained from the literature. In addition, further research will be required to shed light on the implications of using allogeneic cells as well as the optimization of cell delivery protocols. The findings of this systematic review demonstrated the therapeutic potential of certain cell-based therapies in promoting periodontal healing following delayed replantation, thus highlighting their prospective clinical benefits and translational value. Impact statement Current therapies cannot predictably promote periodontal healing following delayed replantation of an avulsed tooth, especially when there is already significant root surface damage. This review systematically assessed the literature for preclinical studies employing cell-based therapies to promote periodontal healing following delayed replantation. The results showed that certain cell-based therapies significantly increased the formation of new periodontal ligament and reduced adverse healing outcomes of replacement root resorption and ankylosis. This highlights the potential clinical benefits and translational value of cell-based therapy for the replantation of avulsed teeth.

Avulsión dental y mantenedor de espacio estético-funcional y correctivo en Odontopediatría / Dental avulsion and esthetic-functional and corrective retainers use in Pediatric Dentistry / Avulsão dentária e mantenedor do espaço estético-funcional e corretivo em Odontopediatria

RESUMEN Se presentó el caso de un niño de 8 años que acudió al Servicio de Estomatología del Policlínico Universitario "Chiqui Gómez Lubián", de Santa Clara, provincia Villa Clara. En el mismo se observó avulsión del incisivo central superior derecho, fractura no complicada de la corona en incisivo central superior izquierdo y una marcada vestibuloversión. Se confeccionó un aparato placa Hawley de acuerdo a las características y necesidades del paciente, con el fin de lograr la recuperación estética, mantener la longitud del arco y corregir la vestibuloversión en el mismo. El aparato permitió obtener un resultado satisfactorio, que ha influido psicológicamente en el paciente al elevar su autoestima y salud bucal.

ABSTRACT A boy of 8 years old was seen in the dental service at the Policlínico Universitario "Chiqui Gómez Lubián", in Santa Clara, Villa Clara. Examination revealed avulsion in the right upper central incisor, uncomplicated crown fracture in left upper central incisor and an improper alignment of the teeth. Taking into account patients´ characteristics and requirements, it was fabricated a Hawley´s retainer in order to achieve a better aesthetic outcome, maintain the length of the dental arch and correct the improper alignment of the teeth. The appliance has achieved a satisfactory outcome, which has had a psychological influence on the patient by improving his self-esteem and oral health.

RESUMO Foi apresentado o caso de um menino de 8 anos que veio ao Serviço de Estomatologia do Policlínico Universitario "Chiqui Gómez Lubián", em Santa Clara, província de Villa Clara. Neste, observou-se avulsão do incisivo central superior direito, fratura não complicada da coroa em incisivo central superior esquerdo e vestibuloversão acentuada. Um dispositivo de placa de Hawley foi confeccionado de acordo com as características e necessidades do paciente, a fim de se obter recuperação estética, manter o comprimento do arco e corrigir a vestibuloversão nele. O dispositivo permitiu obter um resultado satisfatório, o que influenciou psicologicamente o paciente, elevando sua autoestima e saúde bucal.

Population Knowledge and Attitude Toward Emergency Management of Avulsed Permanent Teeth

Abstract Objective: To evaluate the knowledge of patients treated in a public University concerning dental avulsion and its emergency first-aid management. Material and Methods: Three hundred patients were invited to answer a questionnaire about demographic characteristics, attitude and knowledge of first-aid management of dental avulsion. Chi-square test was used to assess the association between knowledge about dental replantation and education level. Results: Female gender (66.7%) aged from 31 to 40 years (31.3%) with high school education (50.3%) predominated among all the participants. It was not found a difference between education level and management of avulsed permanent teeth (p=0.076), and 66% of the respondents were not able to do the replantation. In relation to the management of avulsed tooth, 42.7% of the respondents would brush the tooth and if the replantation was not possible, most of them would choose inappropriate media for storage. The association between the storage medium and educational level showed to be statistically significant (p=0.043). Conclusion: It was possible to notice the lack of knowledge about this subject, and it could result in the worst prognosis. In avulsion cases, the subsequent root resorptions may lead to the loss of the child's tooth. It is important to implement educational campaigns to spread knowledge and improve success rates of permanent avulsed teeth

Risk of ankylosis of 400 avulsed and replanted human teeth in relation to length of dry storage: A re-evaluation of a long-term clinical study.

BACKGROUND/AIMS: Ankylosis and subsequent tooth loss is a serious complication following tooth avulsion and replantation. The aim of the study was to evaluate the risk of ankylosis of human teeth replanted after various periods of dry storage prior to replantation. The material originates from a previously reported clinical study of 400 replanted teeth. METHODS: Initial treatment, clinical and radiological examination and follow-up were conducted according to a standardized protocol. PDL was not removed. Follow-up periods ranged from 0.2 to 20 years (mean 5.1 years). The risk of ankylosis was analysed using the Cox regression model including stage of root development, length of dry time and age > 20 years. RESULTS: The risk of ankylosis significantly increased with increasing length of dry time (hazard ratio: 1.22, P = .002) and was significantly higher for teeth with mature root development than for teeth with immature root development (hazard ratio: 2.1 P < .0001). The estimated risks of ankylosis after 900 days for teeth with immature root development were: dry time < 20 minutes: 33.9% (95% confidence interval (CI): 25.4-42.7), dry time 20-40 minutes: 49.6% (95% CI: 37.5-64.8), dry time 40-60 minutes: 54.4% (95% CI: 37.1-71.3) and dry time > 60 minutes: 60.0% (95% CI: 45.0-75.8). The risks for teeth with mature root development were: dry time < 20 minutes: 59.4% (95% CI: 51.6-66.5), dry time 20-40 minutes: 78.3% (95% CI: 69.5-86.2), dry time 40-60 minutes: 81.9% (95% CI: 67.2-92.4) and dry time > 60 minutes: 86.4% (95% CI: 79.7; 92.9). CONCLUSION: The risk of ankylosis rose with increasing length of dry time. However, some teeth may heal without ankylosis even after 60 minutes of dry time. Immature teeth have a lower risk of developing ankylosis. Replantation should therefore always be considered for avulsed teeth.

How does orofacial trauma in children affect the developing dentition? Long-term treatment and associated complications.

Each year, millions of children are injured and live with the consequences of those injuries. Through infancy and childhood, orofacial trauma caused by falls or being struck by or against objects occurs in children. The long-term implications on the developing permanent teeth are little known, even when the oral region is the second most frequently injured body area in children under 6 years of age. During this period, the developing permanent teeth may be directly involved after trauma, causing mild to severe hypoplasia, displacement, damage to the tooth germ, or an extended range of morphofunctional disturbances. In some cases, the effects of oral and dental injuries caused by trauma appear later with the eruption of the permanent incisors when ectopic eruption, malalignments, and other developmental disturbances become visible. Therefore, long-term follow up of the patient in order to diagnose and treat associated complications becomes essential. Critical points for facing the consequences of orofacial trauma on the developing dentition are to recognize the impact of orofacial trauma in young children and the dentist's role in providing anticipatory guidance to parents and health care professionals, differentiate between mild and severe disturbances affecting the developing permanent teeth after oral injuries in early childhood, recognize the importance of follow-up controls, and recognize the importance of early referral to a pediatric dentist and orthodontist for diagnosis and treatment planning.

Changes in the aetiological factors of dental trauma in children over time: An 18-year retrospective study.

BACKGROUND/AIM: Dental trauma causes significant aesthetic, functional and psychosocial problems that often require emergency attention in children. The aim of this retrospective study was to assess the factors related to dental injuries in children. A secondary aim was to better understand how to improve the education given to children, parents and teachers in schools regarding dental trauma. MATERIALS AND METHODS: Records of children who were referred to the Department of Pedodontics at Suleyman Demirel University were reviewed. A total of 1971 patients with a history of dental trauma who attended the clinic from 1999 to 2017 were evaluated. The following information was recorded: age, gender, year, aetiology, location, season and time elapsed after trauma. Results were evaluated using the Pearson chi-square test. RESULTS: The patients' average age was 8.56 ± 0.08. Dental injuries were frequent in the 7- to 12-year age group (55.9%). Children in the 0- to 6-year age group attended the clinic more frequently during the years 2013 and 2017 compared to previous years. Boys had a higher frequency of trauma than girls (P < 0.05). The most frequent cause of trauma was falls (46%). The accidents occurred predominantly in the street (41.8%). Trauma that took place at home increased in the later years of the study period, whereas the percentage of injuries occurring in schools decreased. The ratio of patients who attended the clinic within the first two days after trauma was 33.4% between 1999 and 2007, and this increased to 59.8% between 2013 and 2017. The majority of the injuries occurred during the summer. CONCLUSIONS: The aetiological factors related to trauma in children, and the number of patients who attended the clinic, have not changed over the 18-year period but the elapsed time to attend the clinic has changed. Education will increase the awareness regarding the importance of emergency intervention immediately following dental trauma.

Evaluation of knowledge regarding emergency management of avulsed traumatic dental injuries in children among general dental practitioners in India.

CONTEXT: Traumatic dental injuries (TDIs) leading to dental avulsion occur very frequently in society. Management of avulsion is critical for the dentist, as it requires appropriate knowledge. AIM: The study was conducted to evaluate the knowledge of the general dental practitioners (GDPs) regarding the emergency management of TDI leading to avulsion in children. SETTING AND DESIGN: Questionnaire-based cross-sectional survey design was utilized to assess the knowledge. SUBJECTS AND METHODS: Data for this cross-sectional survey were collected through questionnaires from July to September 2014. A total of 278 GDP were contacted and requested to fill a pretested questionnaire to assess the knowledge regarding tooth avulsion. The GDPs were grouped on the basis of their educational qualification and years of clinical experience. STATISTICAL ANALYSIS USED: Chi-square test was used for intra- and inter-group comparison. RESULTS: A total of 224 (80.57%) GDPs consented to participate in the survey. Markedly low knowledge levels were noted in the sample irrespective of educational qualification and years of experience with respect to replantation of the avulsed primary tooth, holding the root instead of the crown, choice of appropriate storage medium for transportation of avulsed teeth, use of medications, and splinting type and time. Clinical experience and higher educational qualification of GDPs revealed statistical significant difference in the methods of management for TDI leading to avulsion. CONCLUSION: Higher professional education and added clinical experience were associated with better knowledge in the management of TDI leading to avulsion. The finding warrants the need for informative educational programs to update and boost the knowledge of practicing dentists regarding emergency management of avulsed teeth.

Traumatic displacement of teeth into maxillary sinus and the retrieval assisted by computer-assisted navigation: A case report.

RATIONALE: Traumatic displacement of teeth into the maxillary sinus is rare. This report described a case of 2 molars accidentally displaced into the maxillary sinus and the retrieval of teeth assisted by computer-assisted navigation. PATIENT CONCERN: A 16-year-old male patient suffered from maxillofacial trauma with the first and second molars in the left maxilla were missing, and an orificium fistula to the maxillary sinus appeared in the dentition region of molars. DIAGNOSE: The tomography revealed 2 tooth-like hyperdensity images in the left maxillary sinus. INTERVENTION: Computer-assisted navigation surgery was scheduled for the retrieval surgery, and the displaced teeth were removed from the maxillary sinus smoothly. OUTCOMES: The patient displayed uneventful wound healing without postoperative complications in the maxillary sinus. LESSONS: Surgeons should be alert to the presence of missing teeth in maxillofacial trauma and avoid missed diagnosis, and computer-assisted navigation is recommended for the retrieval of teeth displaced into the maxillary sinus.

Comparison of the Contact Force Exerted on Teeth by Conventional Macintosh Laryngoscope Versus Video Laryngoscopes.

During laryngoscopy, the laryngoscope blade sometimes comes in contact with the teeth, fracturing or dislocating them. However, no studies have compared the effects of newly marketed video laryngoscopes and the Macintosh laryngoscope (Mac) on teeth. In this study, we measured and compared the force exerted on the teeth of an intubating manikin by the Mac, the Airway Scope (Pentax), and the McGrath MAC (Covidien). The mean force exerted was 141.1 ± 15.7 kg by the Mac, 39.2 ± 10.3 kg by the Airway Scope, and 48.7 ± 6.7 kg by the McGrath MAC. No significant difference was observed between the Airway Scope and the McGrath MAC. When the Mac is inserted, the glottis has to be visually located from outside the oral cavity. However, a significant force is not necessary when inserting video laryngoscopes because a camera is mounted on the blade tip. In this laboratory model, the lower force exerted by the video laryngoscopes should contribute to a reduction in their impact on fracture or dislocation of teeth.

Glandular odontogenic cyst: An updated analysis of 169 cases reported in the literature.

OBJECTIVE: To integrate the available data published on glandular odontogenic cyst (GOC) into a comprehensive analysis of its clinical/radiological and histopathological features. METHODS: An electronic search was undertaken in May/2017. Eligibility criteria included publications having enough clinical/radiological/histological information to confirm the diagnosis. RESULTS: Fifty-eight publications (169 GOCs) were included. The lesion was slightly more prevalent in men than in women. There was a high prevalence in the fifty/sixth decades of life, in the anterior regions, and in mandibles. Lesions were commonly associated with bone expansion (73%) and unilocular radiological appearance (61.5%). GOC was found to be associated with tooth displacement or an unerupted tooth (30.9%), cortical bone perforation (26%), presence of clinical symptoms (24.3%), root resorption (13.9%). Microscopic parameters most commonly were observed in GOCs-in at least 95% of the lesions: presence of hobnail cells, intraepithelial microcysts, epithelial lining with variable thickness. The presence of apocrine snouting was the microscopic parameter less often found (40.4%). CONCLUSION: Although the recurrence rate of GOCs is not as high as previously believed, it is a relevant phenomenon (21.6%). Adjunctive procedures after enucleation should be considered. None of the clinical/radiological and histopathological features evaluated had a statistically significant effect on the recurrence rate.

Langerhans Cell Histiocytosis Involving Both Jaws in an Adult.

Langerhans cell histiocytosis (LCH) is the latest terminology for a disorder of reticulo-endothelial system, previously known as histiocytosis X, and marked by aberrant proliferation of bone marrow derived Langerhans cells with variable inflammatory infiltrate including neutrophils, lymphocytes, plasma cells, eosinophils, and multinucleated giant cells. Although rare, the disorder frequently inflicts children with peak incidence recorded in 2-4 years age group. LCH is rare in adults. A22-year adult male presented with the complaint of teeth mobility. Orthopantomogram (OPG) revealed multiple extensive osteolytic lesions destroying both jaws. Giant cell granuloma, Paget's disease and LCH, along with other vanishing bone disorders (Gorham Stout disease and Winchester syndrome) were suspected differentials. Multiple incisional biopsies were performed and a diagnosis of LCH was confirmed by routine histopathological analysis followed by immunohistochemical staining for S-100 and CD1a.

Management of upper and lower molars that are displaced into the neighbouring spaces.

Our aim was to describe our experience of retrieval of accidental displacements of upper and lower molars into neighbouring anatomical spaces. Thirteen patients were evaluated retrospectively in terms of age, sex, affected side, jaw (mandible or maxilla), surgeon's experience, whether the extracted teeth had erupted, which portion of the tooth or teeth was displaced, the anatomical space into which the fragment was displaced, postoperative complaints, timing of the retrieval, type of anaesthesia, and surgical approach. There were no significant differences in sex, affected side, which part of the tooth was displaced, whether the extracted teeth had erupted, type of anaesthesia, or timing of retrieval. We conclude that this condition should be treated, although follow-up alone may be an option. The intraoral lingual pouch approach for complications of mandibular third molars and the intraoral Caldwell-Luc operation for those in the maxilla could be successful options for retrieval.

Tooth autotransplantation as a pillar for 3D regeneration of the alveolar process after severe traumatic injury: A case report.

In dental traumatology, the loss of teeth and the supporting alveolar bone in children compromise the proper development of maxillofacial structures and also limit the solutions that can be offered. In this case report, multidisciplinary management is described of a child with a significant loss of alveolar bone and associated teeth due to a traffic accident at 8 years of age. The management involved staged teeth autotransplantation into surgically prepared sites with bone expanders, orthodontic treatment and dental implants. The 3D regeneration of the alveolar process was successfully stimulated by teeth autotransplantation. At the 4-year follow-up visit, evaluation of the autotransplanted teeth and the implants indicated a successful outcome for the patient.

Oral Trauma and Tooth Avulsion Following Explosion of E-Cigarette.

Electronic cigarettes (E-cigarettes), or personal vaporizers, were introduced in 2003 and have been available in the United States since 2007. In addition to the health and safety concerns of the aerosol delivery of nicotine through E-cigarettes, during the past 8 years, reports of explosions and fires caused by the E-cigarette devices have led the US Fire Administration to evaluate the safety of these devices. These explosions have been observed frequently enough that the US Department of Transportation has recently banned E-cigarette devices in checked baggage aboard airplanes. This report contributes to existing knowledge about the hazards related to E-cigarettes by describing oral hard and soft tissue injuries from an E-cigarette explosion.

Unusual Spontaneous Mandibular Regeneration of a Large Defect Followed by Orthodontics, Alveolar Distraction, and Dental Implant Rehabilitation: A 10-Year Follow-Up.

This report describes an atypical case of spontaneous mandibular regeneration of a large size bony defect after resection of an aseptic osteonecrotic area near the symphysis and parasymphyseal area. The patient underwent orthodontic therapy, vertical osteogenic distraction of the alveolar bone, and oral rehabilitation with an implant borne prosthesis. This case study also describes the 10-year follow-up of comprehensive multidisciplinary treatment and successful recovery of a patient's esthetic and functional aspects.

Long-term complications after facial, pharyngeal, laryngeal and tracheal traumas.

Long-term complications after facial, pharyngeal, laryngeal and tracheal traumas. OBJECTIVE: To review and summarize the existing evidence for long-term anatomical and functional complications after pharyngeal, laryngeal and tracheal traumas. DATA SOURCES: The MEDLINE database and the bibliographies of relevant studies were selected, analysed and appraised prior to December 2015. METHODS: With regard to the search strategy, the selected items were: ((long-term complications) AND pharyngeal) AND laryngeal) AND tracheal) AND traumas. Abstracts and titles were screened for relevance, while full articles of the se- lected records were evaluated and critically appraised after inclusion. Data concerning life-threatening situations, as well as long-term severe adverse effects were collected.

Adult Dental Trauma: What Should the Dental Practitioner Know?

The management of adult dental trauma can be a daunting challenge for practitioners at any level. Like medical emergencies, initial management can have a large influence on prognosis. It is important that practitioners understand the basic principles of managing the acute presentations of dental trauma. This article aims to illustrate a step-by-step approach in order to improve the management within general dental practice for better outcomes for patients.