Bones heal, teeth don't! The involvement of dentists in the acute and long-term management of patients injured in the Manchester Arena Bomb.

This paper outlines the involvement of dentists in the treatment of patients following the terror attack at Manchester Arena on 22 May 2017. It predominantly describes the role of the authors - a paediatric dental consultant and maxillofacial surgery dental core trainee (DCT). As a result of the incident a number of patients suffered oro-facial injuries, with many treated at Central Manchester Foundation Trust Hospitals' Manchester Royal Infirmary and Royal Manchester Children's Hospital. The major incident response of the trust is discussed, as are the presentation of blast injuries and corresponding NHS guidance. Two paediatric cases present the role of the paediatric dental consultant in the acute, intermediate and long-term management of these patients. The presentation of unique dento-alveolar injuries in the context of other trauma and their subsequent treatment demanded true multidisciplinary management. The importance of teeth and oral health to physical and psycho-social wellbeing and recovery was clear and recognised by other teams involved in the patients' management. The experience reinforced the overall impact dental health has on physical and psycho-social health, and how a holistic approach is integral to treatment of major trauma.

Classification and Epidemiology of Traumatic Dentoalveolar Injuries in Dogs and Cats: 959 Injuries in 660 Patient Visits (2004-2012).

The objective of this study was to determine the epidemiology of traumatic dentoalveolar injuries (TDI) in dogs and cats and to evaluate the applicability of a human classification system for TDI in dogs and cats. All patients diagnosed with a TDI were identified from the University of Wisconsin-Madison School of Veterinary Medicine Dentistry and Oral Surgery Service case log and the hospital patient processing software. The study population consisted of 621 dogs and cats, in a total of 660 patient visits from 2004 to 2012, admitted for oral treatment and subsequently diagnosed with at least one TDI Medical records including diagnostic imaging studies were reviewed to group the injury according to a classification system used in humans for TDI. Patient signalment, tooth injured, and number of injuries per patient were recorded and tabulated. The overall prevalence of TDI was 26.2%. The mean +/- SD number of TDI per patient was 1.45 +/- 0.85. All 14 classes of TDI recognized by the classification system utilized in humans were identified, and all (100%) TDI identified in this study were classifiable using this system. Enamel-dentin-pulp fracture was the most common TDI (49.6%). The most commonly injured teeth were the mandibular or maxillary canine teeth (35.5%). The most common age for dogs and cats with TDI were 3-6 years (33.0%) and 7-10 years (31.3%). With a frequency of 1 in 4 animals, TDI are common and represent a significant pet health concern. Most TDI are considered severe and require timely, and sometimes immediate, treatment. The adoption and utilization of a complete classification system, such as the one used in this study, is recommended in order to improve future epidemiological study of TDI in animals.

Update on the management of dentoalveolar trauma.

PURPOSE OF REVIEW: Dentoalveolar injuries are the most common type of facial injury and are often associated with concomitant facial fractures. These injuries may initially be seen by surgeons who do not have formal dental training. This article reviews the assessment and management of dentoalveolar fractures. RECENT FINDINGS: Semi-flexible splinting of traumatized teeth for shorter periods of time than previously suggested is associated with better long-term outcomes. The use of dental implants to replace teeth lost to trauma is a predictable restorative option. SUMMARY: Surgeons need to be aware that dentoalveolar injuries may be a marker for other injuries. Prompt relocation and splinting of displaced teeth is associated with better outcomes.

Multidisciplinary approach for the treatment of a complicated crown-root fracture in a young patient: a case report.

Crown-root fractures in permanent teeth cause esthetic and functional problems. This paper reports the case of a complicated crown-root fracture in the maxillary right central incisor of a young patient who was treated with a multidisciplinary approach in two phases. A modified Widman flap, root canal therapy, glass fiber post cementation, and adhesive tooth fragment reattachment were performed shortly after an accident. Satisfactory esthetic and functional outcomes were obtained. However, the patient did not attend follow-up visits and returned after 7 years. During this second phase, the clinical and radiographic examination showed stability and adaptation of the fragment and good periodontal health conditions, but crown darkening and a radiolucent image associated with the root apex of the fractured tooth were also observed. The periapical lesion was surgically removed by apicoectomy, and the esthetics were recovered with a direct composite resin veneer on the traumatized tooth.

Detection of vertical root fractures by using cone-beam computed tomography: a clinical study.

INTRODUCTION: Vertical root fractures of teeth (VRFs) often pose a diagnostic dilemma because of the difficulty in detection of these in intraoral radiographs except in certain cases with very distinct clinical findings. This often leads to unwarranted extraction of the tooth. Cone-beam computed tomography (CBCT) produces three-dimensional images and allows precise visualization and evaluation of VRFs or cracks in extracted teeth, as reported previously. This clinical pilot study was designed to determine the diagnostic accuracy of noninvasive CBCT for detection of suspected VRFs in endodontically treated teeth by using exploratory surgery to confirm the presence or absence of a fracture. METHODS: Thirty-two teeth in 29 patients with clinical signs and symptoms suggestive of VRF were included in the study after informed consent was obtained. They underwent a limited area CBCT evaluation. All CBCT studies were blinded, and 2 board-certified oral and maxillofacial radiologists assessed the presence or absence of VRF through sequential evaluation of the three-dimensional volume. Subjects underwent surgical exploration as part of treatment, which helped establish the presence or absence of VRF. RESULTS: Pearson correlation coefficient by using surgical finding to confirm presence/absence of fracture was 0.602, positive predictive value was 91%, and negative predictive value was 67%. The sensitivity was 88%, and specificity was 75%. CONCLUSIONS: This study revealed the superior diagnostic accuracy of CBCT for detection of VRF.

Effect of post type and restorative techniques on the strain and fracture resistance of flared incisor roots

Restoring flared endodontically treated teeth continues to be a challenge for clinicians. This study evaluated the effect of post types and restorative techniques on the strain, fracture resistance, and fracture mode of incisors with weakened roots. One hundred five endodontically treated bovine incisors roots (15 mm) were divided into 7 groups (n=15). The two control groups were (C) intact roots restored with Cpc (cast posts and core) or Gfp (glass fiber posts). The five experimental groups were (F) flared roots restored with GfpAp (Gfp associated with accessory glass fiber posts), GfpRc (anatomic Gfp, relined with composite resin), and GfpRcAp (anatomized Gfp with resin and accessory glass fiber posts). All teeth were restored with metal crowns. Mechanical fatigue was performed with 3x10(5)/50 N. Specimens were loaded at 45º, and the strain values (μS) were obtained on root buccal and proximal surfaces. Following that, the fracture resistance (N) was measured. One-way ANOVA and Tukey's HSD tests (α=0.05) were applied, and failure mode was checked. No significant difference in strain values among the groups was found. Cpc presented lower fracture resistance and more catastrophic failures in flared roots. Gfp associated with composite resin or accessory glass fiber posts seems to be an effective method to improve the biomechanical behavior of flared roots.

Restaurar dentes tratados endodonticamente continua sendo desafio para clínicos. Este estudo avaliou o efeito de pinos e técnicas na deformação, resistência à fratura e padrão de fratura de incisivos com canal radicular alargado. Cento e cinco raízes bovinas, tratadas endodonticamente (15 mm) foram divididas em 7 grupos (n=15). Os grupos controle (C), constituídos de raízes não alargadas, foram restauradas com Cpc (núcleo metálico fundido) ou Gfp (pino de fibra de vidro). Nos grupos experimentais os canais foram alargados (F) e restaurados com: GfpAp (Gfp associado com pinos de fibra de vidro acessórios); GfpRc (pino anatômico, reembasado com resina composta) e GfpRcAp (pino anatomizado com resina composta e pinos acessórios). Os dentes foram restaurados com coroas metálicas. Fadiga mecânica foi simulada com 3x10(5)/50 N ciclos. O teste foi realizado a 45º e a deformação (μS) obtida nas superfícies vestibular e proximal. Em seguida, a resistência à fratura (N) e o padrão de fratura foram verificados. Aplicou-se ANOVA e Teste de Tukey (α=0,05). Não houve diferença na deformação. Cpc resultou em menor resistência à fratura e com mais fraturas catastróficas em raízes fragilizadas. As técnicas de reembasamento do pino com resina composta ou o uso de pinos acessórios parecem ser efetivos para melhorar o comportamento biomecânico de raízes fragilizadas.

[Injuries to permanent teeth--Part 4: Therapy of crown fractures]. / Verletzungen der bleibenden Zähne. Teil 4: Therapie der Kronenfrakturen.

Diagnostic and therapeutic interventions following dental injuries are not part of the routine practice in the dental office. Quite often, these patients are emergency cases who seek treatment after normal office hours. The objective of this and the future papers is to present the current treatment concepts in dental traumatology at the School of Dental Medicine, University of Berne. The fruitful cooperation in the field of dental traumatology between the Department of Oral Surgery and Stomatology, and the Department of Conservative Dentistry (including pediatric dentistry and endodontology) is based on the interdisciplinary approach that has been established five years ago. Following discussion and evaluation of such treated cases, and considering current clinical and experimental references, the said concepts have been worked out. The present paper describes the therapeutic concepts of crown fractures.

Fratura radicular horizontal: relato de caso / Dental trauma with root fracture: a case report

O presente estudo teve como objetivo apresentar um caso clínico de traumatismo dentário com fratura radicular horizontal apresentando mau prognóstico devido à qualidade do atendimento inicial. O tratamento proposto constitui-se a terapia endodôntica ortógrada com medidas para o controle da infecção presente no sistema de canais radiculares e realização da obturação endodôntica por compartimentos, sendo a porção apical selada com guta-percha e o segmento coronário com MTA. Após cinco anos de acompanhamento, há sinais significativos de sucesso na terapia proposta.

The effect of a blast on the mandible and teeth: transverse fractures and their management.

Transverse mandibular fractures caused by blast waves have given us a better understanding of the physical and pathophysiological effects on this anatomical region. The external contour of the mandible, being rounded in parts (en face) and flat in others (lateral) will experience different effects of the blast. Impact of a spherical blast wave will inflict transverse lines of fractures on the mandibular body, and may be associated with transverse shearing of teeth at the cementoenamel junction. Fractures of the mandible caused by blast are different from those in the same region caused by any type of civilian trauma; these are the vertical to the longitudinal axis unlike comminuted fractures caused by shrapnel or bullet injuries. Fractures of the mandibular body by blasts are single or multiple parallel fractures in the lower border, between the apices of the roots and the mandibular lower border. Fractures are broken off by acceleration or deceleration of the blast wave.

[Sequelae of dental trauma: forensic medical aspects]. / Séquelles des traumatismes dentaires: aspects médico-légaux.

Dental trauma is a frequent condition which may occur alone or in combination with craniofacial trauma and/or other injuries. Many factors influence the gravity of the trauma and subsequent prognosis including age, anterior state, trauma etiology, treatment and follow up. In order to establish a prudent provisional or definitive expertise, the medical expert must have a panoramic view of the trauma. Time should be taken to consolidate facts and estimate prejudices on sound evidence. In certain cases outcome can be predicted. The medical expert should provide advice and counselling both for the patient and the mandating authority. In this article, iatrogenic dental accidents occurring during anesthesia or extraction will not be discussed.

Vertical root fracture in endodontically treated teeth: a review of 25 cases.

OBJECTIVE: We sought to examine the clinical conditions under which 25 endodontically treated teeth underwent vertical root fracture (VRF) and to relate this condition to the time elapsed from endodontic treatment to fracture. STUDY DESIGN: This was a retrospective study in which we reviewed 25 case histories of patients with postendodontic VRF and studied the effect of various pretreatment and posttreatment factors as they related to VRF. RESULTS AND CONCLUSIONS: The mean time to VRF was 54 months; this was not significantly influenced by the presence or absence of prior restoration or by the presence or absence of a crown fitting. The use of a prefabricated, cylindrical, cemented intraradicular retainer increased the time between endodontics and VRF. Teeth restored with conventional amalgam took significantly longer to undergo VRF than those restored with composite or bonded amalgam. In contrast, amalgam-restored teeth suffered more coronal fractures before VRF than did teeth in the other 2 groups.

The role of the microscope in 21st century endodontics: visions of a new frontier.

In endodontics, the microscope is indispensable. Clinicians are discovering that every facet of endodontics is better, safer, and easier. Microscopic endodontics is a new technology that emphasizes visual information, rather than tactile information. The learning curve can be fairly steep, but it is one worth climbing. Future controlled studies should document an improvement of endodontic outcomes. This is becoming more true as dentistry becomes more extensive and expensive, and needs to last longer and longer. The days of "easy cases" are much fewer, even for the general practitioner. Lastly, there is a groundswell conversation, at least in the endodontic community, that the benefits of the microscope are beyond biology. Clinicians experience a greater sense of personal and professional fulfillment because they are not achieving what is "good enough," but aspiring to "what is possible."

Interpretaçäo radiográfica das fraturas dentárias / Radiografphic interpretation of dental fractures

As fraturas dentárias säo abordadas sobre vários aspectos. É dada enfase às imagens radiográficas que estas injurias apresentam e ás técnicas para obtê-las

Reposición del fragmento dentario fracturado en una clase II y clase III de Elli's / Reposition of the fractured segment in Elli's class II and III

Se reportan dos casos de reposición del fragmento fracturado en un paciente de 11 años de edad, sexo femenino, con exposición dentinaria y otro en un paciente de sexo masculino, de 9 años con exposición pulpar. Los fragmentos fracturados fueron reposicionados empleando la técnica de grabado de esmalte y colocación de un adhesivo dentinario Scothbond II y resina fotopolimerizable. Se muestran resultados favorables tanto clínicos como radiográficos un año después