A retrospective study of occlusal reconstruction in patients with old jaw fractures and dentition defects.

PURPOSE: This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects. METHODS: Patients with old jaw fractures and dentition defects who underwent occlusal reconstruction at the Third Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2022 were enrolled. Clinical treatment was classified into 3 phases. In phase I, techniques such as orthognathic surgery, microsurgery, and distraction osteogenesis were employed to reconstruct the correct 3-dimensional (3D) jaw position relationship. In phase II, bone augmentation and soft tissue management techniques were utilized to address insufficient alveolar bone mass and poor gingival soft tissue conditions. In phase III, implant-supported overdentures or fixed dentures were used for occlusal reconstruction. A summary of treatment methods, clinical efficacy evaluation, comparative analysis of imageological examinations, and satisfaction questionnaire survey were utilized to evaluate the therapeutic efficacy in patients with traumatic old jaw fractures and dentition defects. All data are summarized using the arithmetic mean ± standard deviation and compared using independent sample t-tests. RESULTS: In 15 patients with old jaw fractures and dentition defects (an average age of 32 years, ranging from 18 to 53 years), there were 7 cases of malocclusion of single maxillary fracture, 6 of malocclusion of single mandible fracture, and 2 of malocclusion of both maxillary and mandible fractures. There were 5 patients with single maxillary dentition defects, 2 with single mandibular dentition defects, and 8 with both maxillary and mandibular dentition defects. To reconstruct the correct 3D jaw positional relationship, 5 patients underwent Le Fort I osteotomy of the maxilla, 3 underwent bilateral sagittal split ramus osteotomy of the mandible, 4 underwent open reduction and internal fixation for old jaw fractures, 3 underwent temporomandibular joint surgery, and 4 underwent distraction osteogenesis. All patients underwent jawbone augmentation, of whom 4 patients underwent a free composite vascularized bone flap (26.66%) and the remaining patients underwent local alveolar bone augmentation. Free gingival graft and connective tissue graft were the main methods for soft tissue augmentation (73.33%). The 15 patients received 81 implants, of whom 11 patients received implant-supported fixed dentures and 4 received implant-supported removable dentures. The survival rate of all implants was 93.82%. The final imageological examination of 15 patients confirmed that the malocclusion was corrected, and the clinical treatment ultimately achieved occlusal function reconstruction. The patient satisfaction questionnaire survey showed that they were satisfied with the efficacy, phonetics, aesthetics, and comfort after treatment. CONCLUSION: Occlusal reconstruction of old jaw fractures and dentition defects requires a phased sequential comprehensive treatment, consisting of 3D spatial jaw correction, alveolar bone augmentation and soft tissue augmentation, and implant-supported occlusal reconstruction, achieving satisfactory clinical therapeutic efficacy.

Dentoalveolar Fractures: New Orthodontic Protocol Proposal and Pilot Study.

The goal of fracture treatment that includes the dentoalveolar process is to obtain the anatomic bone healing and the pre-injury occlusion restoration with functional and aesthetic recovery, avoiding dental or periodontal lesions. Fractures activates, in the damaged tissue, the Regional Acceleratory Phenomenon, a physiological healing process that can also be activated during orthodontic overloads. Orthodontic treatment in the traumatized area could exploit this phenomenon in order to sustain the cellular activity.The aim of this study is to propose a treatment protocol for dentoalveolar fractures based on the use of orthodontics in order to sustain the physiological healing process known as Regional Acceleratory Phenomenon.The authors present 2 cases of an 18 year old woman and 23 year old man affected by dentoalveolar fracture. The operative protocol the authors applied foresaw three steps of treatment: orthodontic brackets application, surgery, orthodontic treatment.The patients showed complete healing at the 3 months follow-up and were treated up to 18 months for further orthodontic treatment.The operative protocol proposed by the Authors appears to be a rational choice since it allows a single orthodontic device to be an "active splinting system", with fast application time, good acceptance by the patient, low complications rate; moreover, it produces any planned dental movements for further orthodontic treatments.

No Need to Routinely Remove Titanium Implants for Maxillofacial Fractures.

PURPOSE: Titanium implants are typically used to fix maxillofacial fractures and their routine removal is a controversial topic in maxillofacial surgery. This study aimed to estimate the removal rate and risk factors associated with removal. MATERIALS AND METHODS: The authors designed and implemented a retrospective study. Adult patients who underwent open reduction and internal fixation with titanium implants for maxillofacial fractures were included and those who returned for implant removal were identified from January 2007 to December 2016. The predictor variables were gender, age, preoperative infection, injury time, trauma cause, and fracture site. The primary outcome variable was removal of titanium implants. Descriptive and bivariate statistics were computed. Kaplan-Meier survival methods were used to estimate rate of removal. Univariate and multivariate Cox proportional hazards models were used to identify risk factors associated with removal. RESULTS: Of 2,325 patients (1,890 men and 435 women; average age, ∼35.49 yr) registered in this study, 163 (7.01%) had their titanium implants removed and 1-, 2-, and 10-year removal rates were 3, 7, and 8%, respectively. The risk factors most closely associated with removal were preoperative infection, injury by a blow from an object, obsolete fracture, and female gender. CONCLUSIONS: Routinely removing titanium implants in patients with maxillofacial fracture is not necessary. When the risk factors listed earlier are present in these patients, follow-up should be scheduled more frequently.

Stress distribution in mandibular donor site after harvesting bone grafts of various sizes from the ascending ramus of a dentate mandible by finite element analysis.

PURPOSE: Harvesting bone from the ascending ramus of the mandible is a common procedure. However, mandibular fracture may occur after grafting bone blocks. This study aimed to investigate the resulting force distribution of stress and strain in the mandibular donor site after harvesting bone grafts of different sizes and various loadings. METHODS: Finite element analysis was performed for virtual harvesting of bone blocks of nine different sizes between 15 × 20 and 25 × 30 mm and three different chewing loads (incisal, ipsilateral and contralateral). von Mises stress and first principal stress distributions were measured. RESULTS: von Mises stress was distributed between 35.01 (10 × 15 mm graft, incisal load) and 333.25 MPa (30 × 20 mm graft ipsilateral load), whereas first principal stress distributions were between 48.27 (10 × 15 mm graft, incisal load) and 414.69 MPa (30 × 20 mm graft ipsilateral load). In general, the least stress was observed with incisal load followed by ipsilateral load and finally contralateral load. The critical value of 133 MPa was found after removing almost all grafts with a width of 20 or 30 mm. CONCLUSIONS: Incisal loading led to less stress compared with contralateral and ipsilateral loads. Increasing graft size led to increasing weakness of the donor site. Graft width exerted a greater influence on stress development than its height. CLINICAL RELEVANCE: Ipsilateral chewing and increasing width of the bone graft result in maximum stress in the mandibular donor side, and critical values regarding to the possibility of fractures are already to expect from a graft size of 20 × 15 mm.

Digital Diagnosis and Treatment Program for Maxillofacial Fractures: A Retrospective Analysis of 626 Cases.

PURPOSE: The purpose of this study was to evaluate the accuracy of the digital diagnosis and treatment program for maxillofacial fractures. MATERIALS AND METHODS: The data of 626 patients with maxillofacial fractures were analyzed retrospectively from January 2010 to August 2016. These patients were divided into 2 groups. In the experimental group, preoperative planning was conducted and transferred to patients with guiding templates and navigation according to the digital diagnosis and treatment program for maxillofacial fractures. In the control group, postsurgical planning was performed instead of preoperative planning. To assess the accuracy of the digital diagnosis and treatment program for maxillofacial fractures, preoperative planning and postoperative computed tomographic models were superimposed and imported to dedicated software (Geomagic Studio 13.0, Geomagic, Inc, Research Triangle Park, NC) to calculate the difference between the 2 models in the 2 groups. RESULTS: Results of the experimental set showed that the mean error between the preoperative planning model and the postoperative model ranged from 0.65 to 0.97 mm (average, 0.89 mm). For the control group, the mean error was 0.78 to 1.45 mm (average, 1.01 mm). Thus, the mean error of the experimental group was statistically lower than that of the control group (P < .0001). Postoperative analysis of the subjective evaluation of occlusion recovery showed that 92.13% of patients achieved good occlusion recovery in the experimental group compared with only 84.91% in the control group. The digital diagnosis and treatment program for maxillofacial fractures was more accurate. CONCLUSION: Aided by the digital diagnosis and treatment program, the accuracy for maxillofacial fractures was notably improved. To facilitate the application and promotion of digital technology, further modification of the complete digital diagnosis and treatment pathway for maxillofacial fractures is highly desired.

Prognosis of teeth in the line of jaw fractures.

BACKGROUND/AIM: The decision as to whether teeth in the line of jaw fractures should be extracted or retained remains a controversial issue. The aim of this study was to assess the prognosis of teeth directly in the line of, and adjacent to, jaw fracture sites. MATERIALS AND METHODS: The study consisted of 50 patients with facial fractures in the dentate region, the diagnosis of which was made on the basis of clinical and radiographic examinations. A total of 124 teeth were present in 69 fracture sites (50 patients), of which 89 teeth were evaluated both, clinically (tooth mobility, pocket depth, pulp sensibility) and with periapical radiographs (degree of fracture displacement, marginal bone loss, root resorption). RESULTS: The results revealed that 61.9% of teeth in directly in the line of fractures showed no response to electric pulp testing compared with 48.9% teeth adjacent to fractures. The maximum frequency of non-responsive teeth was observed in Type I fractures followed by Type II fractures. Response to pulp tests was highly significant at postoperative 3- and 6-month periods (Wilcoxon's test). There was continuous reduction in the measurement for mean pocket depth at both test and control sites of teeth. The measurement of marginal bone levels of teeth in the line of fractures revealed a significant reduction (P < 0.01) from preoperative to postoperative 7-day period only. In teeth adjacent to fracture sites, the mean marginal bone levels of control site and test sites were not significant at any time interval. There was no difference in postoperative complications pertaining to whether the tooth at the fracture site was extracted or retained. CONCLUSIONS: Teeth in line of jaw fractures should not be removed on a prophylactic basis and should be followed up clinically and radiographically to determine any treatment needs.

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.

A Review of Hard Palate Fracture Repair Techniques.

PURPOSE: Hard palate trauma is a relatively infrequent occurrence compared with other craniofacial injuries. Several techniques of hard palate fracture repair have been described. To date, there is no consensus on the optimal management of this type of fracture. The purpose of this study was to compile and analyze studies describing hard palate fracture repair techniques with outcomes data. MATERIALS AND METHODS: A systematic review of the Medline, Scopus, and Web of Science databases was performed for articles describing hard palate fracture repair techniques. RESULTS: Eight articles were ultimately included in the review. Of the collective 310 fractures reported, postoperative malocclusion occurred in 21 of 235 cases (8.9%) and other complications occurred in 13 of 299 cases (4.3%). The most important variability in technique was the method of palatal vault stabilization. Three studies described wiring techniques, 3 described internal fixation techniques, and 2 described external fixation techniques. Studies describing internal fixation techniques reported higher rates of wound complications. Proponents of rigid internal fixation believe that this technique provides better fracture reduction. External fixation techniques appear to impart low rates of wound complications, but their overall effectiveness remains in question. CONCLUSIONS: Hard palate fractures are associated with high rates of malocclusion and wound complications. The most established methods of palatal vault stabilization are closed reduction with wiring and internal plate fixation. Depending on the fracture type, patient comorbidities, and associated injuries, either technique might be preferable in a given circumstance.

Dental Trauma in a Pediatric Emergency Department Referral Center.

OBJECTIVE: The purpose of this study was to describe dental and associated oral injuries in a pediatric population that presents to an emergency department. METHODS: We performed a retrospective study and identified children from January 2007 to September 2011. Charts were reviewed for any subject, age from newborn to younger than 19 years, based on International Classification of Diseases, Ninth Revision codes for any dental or oral injury. Data abstraction included demographics, time of day of presentation, location and identification of tooth (s) injured, management, and disposition. RESULTS: We identified 108 children with dental and if present, associated oral injuries. The median age was 12.3 years, the most common tooth injured were the primary (25.9%) or permanent (62%) upper central incisors, and the majority of subjects presented in the afternoon (mean time was 3:50 PM, SD ±24 minutes). A large proportion of dental injuries occurred in patients with permanent dentation (62%) and half of all children had more than 1 tooth injury. The majority of children (75%) were evaluated by either pediatric dental, oral surgery, or otolaryngology services, whereas 3.7% of the cases required multiple services. Twenty-five percent of children had an associated jaw fracture. Eighty-three percent of children were discharged home, of those, 49.1% were prescribed opioids, and 38.3% oral antibiotics. CONCLUSIONS: Emergency departments are often relied upon to evaluate and treat simple and complex dental and oral injuries. The ability to use a multidisciplinary team to manage pediatric oral and dental trauma is essential for care.

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.

[A Case of Perioperative Hypokalemia and Hypertension due to Concomitant Use of Multiple Herbal Medicines].

A 72-year-old woman underwent surgery for a distal radius fracture with lower jaw fracture under general anesthesia. Preoperative laboratory data showed hypokalemia (3.1 mEq · l(-1)), hypertension, and leg edema. The suspected cause of all of these symptoms was the licorice component of the multiple herbal medicines which she was taking. In addition, the ephedra and aconite tuber components of the Maobushisaishinto were suspected to be contributing to the hypertension. She was therefore taken off all of her herbal medicines. The patient underwent regular blood tests and her potassium levels were replenished perioperatively. Hypokalemia was alleviated within the few days following surgery. Given the identity of the crude contents of the multiple herbal medicines in addition to the postoperative plasma renin activity and aldosterone, pseudoaldosteronism was suspected. When administering multiple herbal medicines, knowledge of the precise contents is critical. Clarification of the doses of licorice and ephedra capable of inducing hypokalemia and hypertension would also be helpful.

Surgical planning, three-dimensional model surgery and preshaped implants in treatment of bilateral craniomaxillofacial post-traumatic deformities.

PURPOSE: The purpose of the present study was to explore the treatment and outcomes of bilateral craniomaxillofacial post-traumatic deformities with surgical planning, 3-dimensional (3D) model surgery, and preshaped implants. MATERIALS AND METHODS: We analyzed the preoperative computed tomography (CT) data and designed preliminary surgical plans for 3 patients with bilateral craniomaxillofacial post-traumatic deformities. 3D resin skull models were produced using rapid prototyping technology, and 3D model surgery was performed to determine the location, reduction direction, and shift distance of the osteotomy and to optimize the surgical plans. Titanium plates or mesh were preshaped on the models and then implanted into the patients. The complications, symmetry of the maxillofacial regions, mouth opening, and occlusion were observed 1 month postoperatively. RESULTS: The patients had good recovery of their facial contour, occlusion, and mouth opening and acceptable symmetry of the bilateral maxillofacial regions. No complications were observed. CONCLUSIONS: The combination of surgical planning, 3D model surgery, and preshaped implants can provide surgical accuracy and efficiency and good therapeutic outcomes in the treatment of bilateral craniomaxillofacial post-traumatic deformities.

The "in situ molding technique: " an accurate and simple way to fix resorbable plates to the facial skeleton.

Bioabsorbable plates developed for use in the facial skeleton have become an integral part of the craniomaxillofacial surgeon's reconstructive armamentarium. They avoid the problems associated with the retention of metal plates and can be easily contoured when heated in a thermobath. The technical process of molding and securing these devices, often through small access incisions, to achieve rigid fixation of facial fractures can be difficult. In this article, we describe a simple, novel technique that we have developed, using hot water suction irrigation, to achieve in situ molding of resorbable plates during facial fracture fixation. We used this technique to fix 123 facial fractures in 110 patients over a 4-year period. No complications secondary to the use of hot water suction irrigation were encountered.

Maxillofacial injuries in infants and preschools: a 2.5-year study.

PURPOSE: This study aims to evaluate the epidemiology of maxillofacial injuries in infants and preschools. PATIENTS AND METHODS: The data from 110 infants and preschools with maxillofacial injuries from October 2010 to March 2013 were analyzed retrospectively. RESULTS: The male-to-female ratio was 1.89:1. The peak age was 1 to 3 years (53.64%). Accident falls (76.36%) were the major cause. A total of 166 soft-tissue injuries were found in 103 patients, 102 dental traumas in 36 patients, and 53 maxillofacial fractures in 33 patients. The most common sites of soft-tissue injuries included the gingiva (17.47%), lower lip (13.86%), upper lip (13.25%), and chin (12.05%), and the majority were lacerations (77.71%). Dental traumas occurred mainly in incisors (81.37%) and the lower arch (60.78%). Of the 53 fractures, the most common sites were the condyle (45.28%), symphysis (22.64%), and mandibular body (16.98%); 28 (52.83%) were treated by operation and 25 (47.17%) by conservative treatment. CONCLUSIONS: Maxillofacial injuries in infants and preschools exhibit specific epidemiological features. These are related to anatomic, physiologic, and psychologic development in infants and preschools.

Pediatric facial fractures from dog bites.

PURPOSE: To report a series of pediatric facial fractures associated with dog bites. METHODS: Retrospective review of all dog bite injuries to the face with facial fractures in children from January 1, 2003, to October 31, 2011, at Children's Hospital Colorado (Aurora, Colorado). Patient demographics, location and number of fractures, clinical course, surgical repair, and complications were recorded and analyzed using Excel statistical software. RESULTS: Seventeen of 1,201 (1.4%) children with dog bite injuries to the face also sustained facial fractures. The average age of patients was 3.9 ± 3.2 years and 53% were female. Thirty-five percent of patients presented with multiple facial fractures. The most common fracture involved the nasal bone (29%), while the remainder sustained fractures of the zygomatic arch, orbital rim, orbital floor, skull, mandible, maxilla, and/or sinuses. Of the 17 patients, 41% also sustained eyelid lacerations, 24% had injuries to the facial nerve, and 18% had canalicular lacerations. Fourteen of the 17 patients required surgical repair under general anesthesia. CONCLUSIONS: Although uncommon, facial fractures associated with dog bites are a significant source of morbidity, often requiring complex surgical repair. Severe injuries to the face from dog bites should be evaluated for possible fractures in addition to soft tissue injuries.

Dental trauma in patients with maxillofacial fractures.

PURPOSE: The purpose of this study was to analyze and evaluate the correlation between dental injuries and the pattern of maxillofacial fractures. The correlation with age, gender, trauma mechanism and type of maxillofacial fracture was also investigated. MATERIALS AND METHODS: From January 2000 to December 2009, 1131 patients with facial fractures were registered. Of these, 473 presented with associated dental trauma. The information and data collected and analyzed included: age, gender, mechanism of injury, type of facial fracture, type of dental injury, and the relationship between dental injury and facial fracture. RESULTS: Dental injury was sustained by 473 patients (41.8%), with a total of 2215 injured teeth. Of the 2215 injured teeth, 1191 (53.8%) were in the maxilla and 1024 (46.2%) in the mandible. Fall from a height had the highest risk of dental injuries (OR = 4.145, P = 0.002). The central incisor was the most injured tooth for both the maxilla (388, 36.2%) and mandible (284, 27.7%). The most common type of dental injury was avulsion (1070, 47.4%). More anterior teeth in the maxilla were of crown fracture, avulsion, and intrusion than that in the mandible, whereas more anterior teeth in the mandible were of subluxation and concussion than that in the maxilla. Dental injuries were more prone to occur in patients who sustained only symphysis fractures (OR = 2.817, P < 0.001), only 0.236-fold risk in patients who sustained only mandible angle fracture (P < 0.001). CONCLUSIONS: The occurrence of dental trauma is significantly related to the pattern and position of the maxillofacial fractures.

Domestic abuse--an underreported problem in general dental practice?

UNLABELLED: 'Child abuse' is a topic about which clinicians will be well informed. There are protocols relating to the management of patients suspected of having sustained non-accidental injuries and clinical staff will be expected, as part of mandatory training, to receive education in this area. Domestic abuse (DA) is an under-reported, but relatively common problem and has many implications in the management of traumatic injuries in adults. The objective of this paper is to discuss the aetiology, history and presentation of patients who have been subjected to domestic abuse, and to help provide a strategy for their management. CLINICAL RELEVANCE: Domestic abuse is a relatively common problem and, as such, dentists should be aware of this important area and how to manage patients they suspect of having been abused, or who inform them that they have' been subjected to DA.

A retrospective evaluation of iatrogenic dental root damage with predrilled vs drill-free bone anchor screws for intermaxillary fixation.

AIMS: The aim of this study was to retrospectively evaluate iatrogenic dental root damage, caused by two different techniques that utilized bone anchor screws, for intermaxillary fixation (IMF) in orofacial trauma. MATERIALS AND METHODS: The techniques used included either predrilled or drill-free bone anchor screws. A total of 123 patients who required IMF were evaluated (97 men and 26 women). Sixty-four patients were treated in the predrilled group, and 59 patients were treated in the drill-free group. The data were collected over an 8-year period and were analyzed using crosstabs and Fisher's exact test. RESULTS: Injuries to dental roots were found only in the predrilled group. Twenty-nine patients (45.3%) were injured at the time of surgery. One year after surgery, 10 patients (15.6%) had permanently injured dental roots. There was a significant difference in injury rates between the predrilled and drill-free groups 1 year after surgery (P < 0.001). CONCLUSION: There is an increased potential risk of iatrogenic injury and permanent damage to the dental roots when a technique that involves predrilled holes for bone anchor screws is used.

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.

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.