A retrospective study of isolated fractures of the alveolar process in the permanent dentition.

BACKGROUND/AIM: There is a lack of studies of fractures of the alveolar process (FAP). Only five were published in the last 50 years. The aim of this study was to analyze the risk of pulp necrosis and infection (PN), pulp canal obliteration (PCO), infection-related root resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) as well as to identify the possible risk factors for teeth involved in an isolated alveolar process fracture. In the second part, any late complications of the involved teeth were reported in patients who responded to a follow-up examination. MATERIAL AND METHOD: This study was a retrospective analysis of 126 patients with 329 traumatized permanent teeth treated in a regional dental trauma clinic. Follow-up examination was performed on 31 (24.6%) patients with 75 (22.8%) teeth. The risks of PN, PCO, RR, MBL, and TL were analyzed using the Kaplan-Meier method. Possible risk factors for PN (stage of root development, fracture position in relation to the root apex, concomitant injury, treatment delay, and antibiotics) were analyzed using univariate and multivariate Cox regression and generalized estimating equation. The level of significance was 5%. RESULTS: Pulp necrosis was observed in 43% of the teeth, and it was significantly associated with the presence of a concomitant injury and complete root formation. PCO was recorded in 2.8%, root resorption (RR, IRR, and ARR) in 4%, MBL in 8%, and TL in 0.6% of the teeth. Thirty-four percent of the teeth were assumed to have normal pulps, but they did not respond to pulp sensibility testing. At the follow-up examination, PN was found in 49%, PCO in 28%, RR (IRR and ARR) in 4%, MBL in 17%, and TL in 5%. Estimated risk after a 5-years follow up was as follows: PN: 48.2% (95% confidence interval (CI): 42.0-54.5), IRR: 7.2 (95% CI: 3.5-10.9), ARR: 33.0% (95% CI: 22.4-43.6), BL: 16.7% (95% CI: 9.6-23.8), TL: 4.0% (95% CI: 0.0-8.5). The following factors significantly increased the risk of PN: mature root development (hazard ratio [HR]: 7.50 [95% CI: 1.84-30.64], P=.005) and concomitant injury (HR: 2.68 [95% CI: 1.76-4.09], P<.001). In a logistic regression model, teeth with mature roots had a threefold risk of becoming non-responsive to pulp testing. CONCLUSION: Teeth involved in an isolated alveolar process fracture and managed with a conservative treatment approach appear to have a good prognosis. The most common complication was PN which did not negatively affect the survival of the teeth after root canal treatment.

Alveolar process fractures in the permanent dentition. Part 1. Etiology and clinical characteristics. A retrospective analysis of 299 cases involving 815 teeth.

AIM: To describe the etiology and clinical characteristics of alveolar process fractures treated in a regional trauma clinic. MATERIAL AND METHOD: The study is a retrospective descriptive analysis of 299 patients (180 males, 119 females; 815 permanent teeth) diagnosed with fractures of the alveolar process. RESULTS: Violence was the overall most frequent cause of injury in men (44%), whereas the three most common causes of this type of injury in women were violence (33%), falls (32%), or traffic injuries (26%). Fracture of the alveolar process occurred most frequently in the maxilla (74%) and less frequently in the mandible (26%). The majority of the fractures involved only two teeth (57%) but occasionally involved up to seven teeth. The age at fracture ranged from 5 to 90 years; alveolar process fractures occurred most frequently between 15 and 25 years of age (43%). Concomitant soft tissue injuries were present in 73%. The most frequent location of the mandibular fracture line was along the periodontal ligament of the canine and in the sagittal suture between the two central maxillary incisors. This pattern appears to correlate with weak zones in the jaws. CONCLUSION: In conclusion, alveolar process fractures are rare. They occur most frequently in young males and are often associated with violence. Concomitant soft tissue injuries are frequent. This type of injury accordingly appears to result from a frontal impact transmitted through a soft tissue shield (the lips) where the zone of least resistance gives in, namely the periodontal ligament and areas where the alveolar bone is thin.

The dental trauma internet calculator.

BACKGROUND/AIM: Prediction tools are increasingly used to inform patients about the future dental health outcome. Advanced statistical methods are required to arrive at unbiased predictions based on follow-up studies. MATERIALS AND METHODS: The Internet risk calculator at the Dental Trauma Guide provides prognoses for teeth with traumatic injuries based on the Copenhagen trauma database: http://www.dentaltraumaguide.org The database includes 2191 traumatized permanent teeth from 1282 patients that were treated at the dental trauma unit at the University Hospital in Copenhagen (Denmark) in the period between 1972 and 1991. Subgroup analyses and estimates of event probabilities were based on the Kaplan-Meier and the Aalen-Johansen method. RESULTS: The Internet risk calculator shows individualized prognoses for the short- and long-term healing outcome of traumatized teeth with the following injuries: concussion, subluxation, extrusion, lateral luxation, intrusion, avulsion, crown fractures without luxation, root fractures and alveolar fractures. The prognoses for pulp necrosis, pulp canal obliteration, infection-related root resorption, ankylosis, surface resorption, marginal bone loss, and tooth loss were based on the tooth's root development stage and other risk factors at the time of the injury. CONCLUSIONS: This article explains the database, the functionality and the statistical approach of the Internet risk calculator.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth.

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

[Penetrating injuries in the face and neck region. Diagnosis and treatment]. / Penetrierende Gesichts- und Halsverletzungen. Diagnostik und Therapie.

Penetrating head and neck injuries often present with vascular lesions and airway compromise and may be life-threatening. Thus controlling bleeding and airway stabilisation take priority in emergency treatment. High-velocity projectiles, fragmentations from improvised explosive devices (IEDs) and shrapnel can cause severe tissue injury, representing a challenge for the head and neck surgeon. Since several organ structures, such as the eyes, midface, pharynx, larynx, trachea, esophagus, nerves, vessels and vertebral spine can be injured at the same time, patients should be referred to a specialized trauma center for interdisciplinary treatment following emergency treatment. High-speed ballistic injuries were once confined to the battle field and have been uncommon in Europe since World War II. For this reason, experience among civilian head and neck surgeons is at present limited. With the increased incidence of terrorism and the use of IEDs as the preferred weapon in terrorism it has become important for civilian head and neck surgeons to understand the role of ballistic injuries in mass casualty events. The present paper discusses current viewpoints in the diagnosis and treatment of penetrating head and neck injuries.

Treatment cost of patients with maxillofacial fractures at the University Hospital in Mostar 2002-2006.

The aim of this study was to establish the costs structure of medical treatment for the patients with maxillofacial fractures, to perform a treatment cost evaluation, describe the factors which considerably influence the costs and discover the ways of achieving financial savings in treated patients. The study group consisted of patients with maxillofacial fractures who were admitted and treated at the Department of Maxillofacial Surgery of the University Hospital Mostar in the period from January 2002 until December 2006. Data for the study were collected from the patients' databases, case histories and data obtained on the basis of individual payments for the treatment that was collected by Finance Department of the University Hospital of Mostar Most patients in this study were men (83%), of average age 34 +/- 19 years. Zygomatic bone fracture was the commonest injury. Open surgical procedure was performed in 84.7% of treated cases. The costs for the open procedure were considerably higher than conservative treatment. Medication cost made up a total of 37.9% and cost of hospital accommodation 27.3% out of total hospital charge. Cost reduction in treated patients with maxillofacial fractures should be achieved through protocols of urgent treatment of maxillofacial trauma patients immediately after sustaining an injury and with earlier discharge of the patients when postoperative complications are not expected.

The initial management of dento-alveolar trauma in general dental practice.

UNLABELLED: Dento-alveolar trauma presents commonly in general dental practice, but may prove difficult to manage for those unfamiliar with it. Timely and well-informed intervention can significantly improve the clinical outcome for the patient. This article aims to inform the clinician on best current practice for the assessment and initial management of dental traumatic injuries, incorporating current international guidelines and practical arrangements for follow-up care. CLINICAL RELEVANCE: The dental trauma patient often presents to the general dental practitioner and the appropriate emergency management plays a vital role in relieving pain, protecting the dentino-pulpal complex, reducing displaced teeth and improving prognosis.

Polylactide/polyglycolide copolymer in bone defect healing in humans.

This pilot study aims to evaluate the healing of a large defects in the human jawbone filled with a Poly-Lactide-co-Glycolide (PLG) polymer (Fisiograft) by means of clinical, radiological and histological methods and to compare the results with those of platelet-rich plasma (PRP) clot or autologous bone (AB) fillings. Bone cysts, where previous non-surgical treatments failed to promote healing, underwent surgery. Nineteen consenting male patients were randomly split into three groups, packed with PRP, AB or PLG. A core biopsy was performed 4 and 6 months after surgery. All treated defects showed clinical, radiological and histological progresses over time. AB provided the best clinical and histological performance and PLG had overlapping outcomes; PRP filling was statistically different. Six months after surgery, bone activities were enhanced in sites treated with PLG and fairly good with PRP. Additionally, PLG showed some new lamellar formations. In conclusion, outcomes were best with AB graft, but suitable results were achieved using PLG to promote healing of severe bone defects. PLG shows only a delayed regenerative capability but does not require a secondary donor site.

The treatment of condylar fractures: to open or not to open? A critical review of this controversy.

The treatment of condylar process fractures has generated a great deal of discussion and controversy in oral and maxillofacial trauma and there are many different methods to treat this injury. For each type of condylar fracture, the techniques must be chosen taking into consideration the presence of teeth, fracture height, patient's adaptation, patient's masticatory system, disturbance of occlusal function, deviation of the mandible, internal derangements of the temporomandibular Joint (TMJ) and ankylosis of the joint with resultant inability to move the jaw, all of which are sequelae of this injury. Many surgeons seem to favor closed treatment with maxillomandibular fixation (MMF), but in recent years, open treatment of condylar fractures with rigid internal fixation (RIF) has become more common. The objective of this review was to evaluate the main variables that determine the choice of method for treatment of condylar fractures: open or closed, pointing out their indications, contra-indications, advantages and disadvantages.

Bone fractures: assessment and management.

Severe dental traumatic injuries often involve the supporting bone and soft tissues. This article outlines the current concepts in the management of dentoalveolar fractures for the general dental practitioner with case reports to illustrate management principles and techniques.

Orofacial injuries from sport: preventive measures for sports medicine.

Individuals worldwide are participating in an expanding arena of vigorous physical activities as well as competitive sports at all levels. The healthful benefits of such activities are unfortunately associated with injury risks that include orofacial soft- and hard-tissue trauma. This article describes the scope and emergency management of sports-related orofacial traumatic injuries that may be encountered by physicians in the field of sports medicine. Since most of these injuries are preventable with the use of protective equipment, specific recommendations are provided for the use of properly fitted mouthguards.

The Göttingen quick arch-bar. A new technique of arch-bar fixation without ligature wires.

A simple and easy fixation technique is described in which a newly designed quick arch-bar is used which can be attached easily and quickly and provides consistently firm fixation even in difficult situations. No anaesthesia or sophisticated appliances are required.

Fractures of the maxillofacial region in children.

83 children with maxillofacial fractures have been analyzed according to, aetiology, age, sex, type, and site of fractures. The results showed a high male to female ratio. Mandibular fractures were the commonest, in the condylar region in particular. The commonest causes in descending order were falls, bicycle accidents and at play.

Embolization for traumatic epistaxis. Adjuvant therapy in severe maxillofacial fracture.

In a case of persistent traumatic epistaxis successful treatment by embolization therapy is reported. The method is described in detail and the advantages of the use of Digital Subtraction Angiography (DSA) are stressed.

Maxillofacial fractures related to work accidents.

Work-related maxillofacial fractures were studied retrospectively over a six-year period. There were 98 cases accounting for 4.5% of all facial bone fractures treated in our hospital between 1981 and 1986. Of the patients, 89.8% were male. The mean age of the injured was 36.4 years. The incidence of work-related maxillofacial fractures was 0.37 per 1000 workers. Most of the injuries (66%) occurred in factories and construction work. Such work was associated with an to 15 times higher risk of maxillofacial fracture than service and office work. Of the fractures, 20.4% were sustained on the way to or coming from work. At the place of work, the commonest causes of injury were blows from objects or falls from a height (70%). On the way to or coming from work, the aetiological factor was most often a traffic accident. Assault and battery had caused facial bone fractures in 11.2% of cases. Fifty-five patients with midface and 45 patients with mandibular fractures were found, of these, 8 patients had bimaxillary fractures. In 6 cases, only dentoalveolar fractures were found. Of the patients, 55.1% were treated operatively. Sixty-six patients were hospitalized, the mean length of hospital stay being 3.2 days (range 1-12 days).

New device for interdental immobilization.

The immobilization of a simple fractured jaw with arch bars is a time-consuming, laborious procedure. The alternative method of immobilization described here uses a precisely threaded, 22-gauge, malleable stainless steel wire and a threaded nylon nut. It affords the surgeon relative safety from accidental puncture trauma and makes the interdental immobilization a precise and speedy procedure.

Effect of intermaxillary fixation on pulmonary function.

A study to measure the pulmonary effects of intermaxillary fixation (IMF) demonstrated that this technique produces a significant degree of airway obstruction. This may be dangerous to patients with limited respiratory reserve due to chronic obstructive airways disease. The impairment of pulmonary function can be assessed pre-operatively and should be estimated in high risk patients. Alternative management of stabilization of jaw fractures that avoid IMF should be considered in such patients.

Modified acrylic cap splint for dento-alveolar fractures.

A modified method of constructing an acrylic cap splint is introduced. The splint is made from wax and is then replaced by acrylic. The splint has a uniform thickness and is therefore suited for maintenance of a proper occlusion.

Cranio-maxillary fixation using supra-orbital pins.

This paper compares the forces which external frames, used for cranio-maxillary fixation, can resist. Clinically, several frames using supra-orbital pins have been proven satisfactory. By quantifying the resistance forces, a more objective assessment of their effectiveness is made. The resistance to backward displacement of the maxilla is measured and compared for 3 frames. Two frames are used for comparison of resistance to occlusal forces.