Effect of root immaturity and depth of intrusion on spontaneous re-eruption and healing complications: A retrospective analysis.

BACKGROUND/AIMS: Dental trauma resulting in tooth intrusion is a severe injury of permanent dentition, with a prevalence of 0.5%-1.9% among traumatic dental injuries. Currently, treatment guidelines for intruded permanent teeth depend on root development and the degree of intrusion. However, the categorization of tooth maturity as mature or immature simplifies a complex continuum of root development stages. This study aims to investigate the impact of various stages of root development on the success of spontaneous re-eruption (SRE) of intruded teeth. MATERIALS AND METHODS: This retrospective study analysed data from 80 children (125 teeth) aged 6-12 years who experienced dental intrusion between 2018 and 2022. Root maturation was classified based on Cvek's classification, eight were categorized as stage 1, 29 as stage 2, 44 as stage 3, 25 as stage 4, and 19 as stage 5. Intruded teeth with immature roots (Cvek's class 1-4) underwent SRE, while mature teeth (Cvek's class 5) were treated with SRE, orthodontic repositioning, or surgical repositioning based on the degree of intrusion. Primary outcome measures were successful re-eruption and secondary outcomes included observed complications during follow-up. RESULTS: Regression analysis revealed that the patient's age, degree of root maturation, and degree of intrusion significantly affected spontaneous re-eruption (p < .05). SRE was more successful in teeth with Cvek's stages 1 and 2 compared to stages 3 and 4. Complications were associated with the treatment method, degree of root immaturity, and degree of intrusion. CONCLUSION: The study demonstrates that as root maturation progresses, the likelihood of re-eruption decreases, and the risk of pulp necrosis and infection increases. Therefore, teeth in later stages of immaturity (Cvek stage 4) should be repositioned orthodontically or surgically without waiting for spontaneous re-eruption.

Treatment Outcomes of Lip Taping in Patients with Non-syndromic Cleft Lip and/or Palate: A Systematic Review and Meta-analysis.

OBJECTIVE: To conduct a systematic review of the data in peer-reviewed medical literature and evaluate the effectiveness of lip taping as a pre-surgical naso-alveolar molding (NAM) technique in infants with cleft lip and/or palate. DESIGN: An electronic search of various databases for relevant studies, regardless of date, from inception to June 2023 was carried out and evaluated. After completing the electronic search and applying our inclusion/exclusion criteria, 6 studies-2 randomized control trials, 2 non-randomized studies, and 2 case series-were included. Data extraction of relevant articles was done independently by 2 authors. Quality assessment was done using the JBI prevalence critical appraisal tool and certainty of evidence was carried out by GRADE approach. MAIN OUTCOME MEASURES: Nasolabial Aesthetics, Dentoalveolar Relationship. RESULTS: A total of six studies were included in the current review. Meta-analysis was carried out, and forest plots were obtained for a single mean from the lip-taping group. 3 studies had a low risk of bias, while 3 studies displayed a serious risk of bias. Significant improvement in various outcome measures was noted with lip taping when compared with the control group although the certainty of evidence was very low. CONCLUSION: When compared to no therapy, lip taping appears to ameliorate dentoalveolar measurements and nasolabial aesthetics. To increase our knowledge of lip taping, more research will be needed in the future, as there are not many studies to prove lip taping is better than other treatment approaches.

Enhancing Proliferation of Stem Cells from Human Exfoliated Deciduous Teeth (SHED) through hTERT Expression while Preserving Stemness and Multipotency.

BACKGROUND: Stem cells from human exfoliated deciduous teeth (SHED) hold promise in regenerative medicine owing to their multipotent capabilities resembling mesenchymal stem cells (MSCs). Despite their potential, SHED have not been extensively investigated because their limited lifespan and unavailability of cell-lines pose challenges for therapeutic applications. This study investigated the effect of ectopic human telomerase reverse transcriptase (hTERT) expression on SHEDs' proliferation while preserving stemness and genomic integrity. METHODS: Deciduous teeth were collected from children aged 6-10 years. After isolation and characterization, the SHED were transduced with pBabe-puro-hTERT retrovirus to establish SHED cell-line, which was evaluated and compared with pBabe-puro (mock control) for stemness, multipotency and growth attributes through flow cytometry, trilineage differentiation, and growth kinetics. We also estimated hTERT gene expression, genomic integrity, and validated cell-line through STR analysis. RESULTS: Following hTERT transduction, SHED displayed elevated hTERT gene expression while retaining fibroblast-like morphology and mesenchymal stem cell markers. Moreover, after hTERT transduction cellular shape remained same along with increased replicative lifespan and proliferation potential. SHED-hTERT cells exhibited multi-potency and maintained stemness, as evidenced by surface marker expression and multilineage differentiation. Furthermore, genomic integrity was not affected by hTERT integration, as confirmed by STR analysis and CDKN2A gene assessment. CONCLUSION: Ectopic hTERT expression in SHED successfully prolonged their replicative lifespan and improved their ability to proliferate and migrate, while preserving their stemness, multipotency and genomic integrity, suggesting minimal carcinogenic risk. Establishment of SHED cell-line holds potential in regenerative medicine applications, especially in cell-based drugs and tissue engineering experiments.

Schematic Treatment Tree for the Presurgical Nasoalveolar Moulding of Patients with Cleft Lip and Palate.

Background: Cleft lip and palate is the most common and unfortunate congenital defect that is debilitating for both the patients and their parents. Such complex condition demands for a precise and judicious management, as its outcome can drastically influence the quality of life of the child. Aim: To provide a concise treatment algorithm or tree which might guide the clinicians and make it easier for them to opt for a better treatment option when confronting different severities and types of this defect. Material and Methods: The clinical experience at our center alongwith review of current literature is used to propose a decision making treatment tree. Discussion: For the better aesthetics, function and ease of cosmetic surgery, several presurgical procedures have been introduced including the nasoalveolar moulding (NAM) appliance, adhesive tapes with nasal elevators, Figueroa's appliance, Hotz appliance, etc. Conclusion: The schematic decision-making tree may prove beneficial to the healthcare providers specially pedodontists who frequently come across such situations to choose the best treatment option for their patients.

Management of Pediatric Mandibular Fractures Using Orthodontic Archwires and Elastic Traction: An Alternative to Conventional Treatment Methods.

Introduction: Maxillofacial trauma in children consists of >15% of all facial fractures, which is usually associated with sports injuries and falls while playing. Pediatric mandibular fractures are relatively less frequent when compared to adults, and the reason can be attributed to the child's protected anatomic features and infrequent exposure of children to alcohol-related road accidents. Management principles vary in children, and the main concern is about mandibular growth and the development of dentition. Treatment can be done by either closed reduction or open reduction and internal fixation. Case description: A 5-year-old boy reported to the Department of Pediatric and preventive dentistry with the history of falling from a bike. The patient presented with bruise over chin, deviated mouth opening and deranged occlusion. OPG revealed right condylar fracture and left parasymphysis fracture. Treatment with closed reduction was favored over open reduction in order to decrease the risk of any undue trauma to developing tooth buds and to avoid any growth-related injury in children. Hence, a new approach was performed for closed reduction. The patient was kept on follow-up for a period 6 months. Discussion: Earlier treatment options in closed reduction were limited to intraoral cap splints, circummandibular wiring, eyelet wiring, and even bridle wiring. This case report highlights the use of orthodontic archwires and elastic traction in the management of pediatric mandibular fractures, which is something new to conventional treatment methods and can be used as an alternative method. How to cite this article: Kakran A, Singhal R, Namdev R, et al. Management of Pediatric Mandibular Fractures Using Orthodontic Archwires and Elastic Traction: An Alternative to Conventional Treatment Methods. Int J Clin Pediatr Dent 2023;16(6):864-867.