Traumatic dental injuries over an 8-year period at a German dental center: a retrospective overview and cross-sectional analysis.

BACKGROUND/AIM: The aim of this study was to analyze a population of patients who had suffered from traumatic dental injuries (TDIs) by using different patient-, trauma- and treatment-related parameters. MATERIAL AND METHODS: All dental records of patients ≥ 3 years old who had presented at the dental emergency service between Jan 1, 2009 and Dec 31, 2016 for the treatment of dental trauma were analyzed. A total of 2758 patients were invited for a recall examination at the Department for Dental Surgery and Implantology, ZZMK Carolinum, Goethe University Frankfurt, Germany; of these, 269 patients attended their recall appointments. RESULTS: The enrolled patient population consisted of 1718 males and 1040 females, with a mean age of 19.63 years (median 12.00 ± 17.354 years). A total of 4909 injured teeth were assessed, with a mean of 1.78 injured teeth per patient (median 2.00 ± 1.279). Males were found to be more frequently affected by TDIs compared to females (1.65:1). The majority of these injuries occurred in the first two decades of life (66.1%; n = 1824). The majority of the patients presented for initial treatment within 24 h of their accident (95.7%). The most frequent TDIs were isolated luxation injuries 49.4% (n = 2426) and isolated crown fractures 30% (n = 1472). Combination injuries were diagnosed in 20.6% of the cases (n = 1011). CONCLUSIONS: Based on the findings of the present analysis, it can be concluded that males were more frequently affected by TDIs than females. Most patients had suffered from TDI before they had turned 10 years of age. Overall, the enamel-dentin fracture was found to be the most frequent injury, followed by concussions and lateral luxations.

Dental and Dentoalveolar Injuries in the Pediatric Patient.

Dental and dentoalveolar injuries are common in the pediatric population. Management is predicated on the type of tooth injured (primary or permanent), extent of injury, the dental and behavioral age of the patient, and ability of the patient to tolerate treatment. Although many dental injuries occur in isolation, a systematic evaluation of the patient is mandatory to confirm the absence of basal bone fractures of the maxilla or mandible, traumatic brain injury, cervical spine injury, and/or facial soft tissue injury. Long-term follow-up is paramount to achieving a functional occlusion and optimal dental health following injury.

Knowledge and skills of emergency physicians in managing traumatic dental injuries.

PURPOSE: Emergency departments are frequently confronted with traumatic dental injuries (TDIs). The prognosis of the injured tooth is related to early dental trauma management. For this reason, physicians must be familiar with the appropriate management of TDI. This study aimed to investigate the knowledge and skills of German emergency physicians regarding TDI. METHODS: An electronic questionnaire was sent to 438 emergency departments throughout Germany. Four hundred and twenty seven questionnaires were evaluated and included in the analysis. The survey contained questions about physician characteristics and assessed their knowledge and skills of managing dental trauma. For statistical analysis, the Kruskal-Wallis, Mann-Whitney U test or ANOVA test was used as appropriate. Rank correlations were performed with the Spearman's rank correlation. RESULTS: Out of 427 participants, 256 (59.95%) stated they had no or insufficient knowledge, and 266 (71.12%) stated they had no skills in dental trauma management. Almost 76% of the participants had no previous knowledge of dentistry. Only 7.28% knew the right procedure for replanting an avulsed tooth. Just 26.06% would choose the right medium for temporary tooth storage. Having a dentist in the family (p = 0.0074) or clinical exposure to patients with dental trauma (p = 0.0384) influenced the results of the knowledge score. CONCLUSION: The knowledge and skills in dental trauma management among German emergency physicians are generally inadequate. Targeted training courses are necessary to ensure early and adequate TDI treatment to reduce the resulting medical and societal costs as much as possible.

Intrusive luxation of permanent upper central incisor into the nasal cavity: A case report.

This case report outlines a rare complete intrusion of a permanent, maxillary central incisor (tooth 11) into the nasal cavity, with a late diagnosis and treatment. An eight-year-old boy was referred to an oral and maxillofacial surgery service with absence of tooth 11 after an episode of a fall from his own height. Approximately 50 days after the trauma, the patient presented with a complaint of obstruction of the right nostril. The clinical examination and tomographic evaluation showed that the tooth had been intruded into the nasal cavity on the right side. The tooth in question was removed under general anesthesia by direct approach through the right nostril. The patient was followed up for approximately one year without complications. This case demonstrates the importance of a detailed evaluation during the first examination after intrusive luxation, so the correct diagnosis is made and the correct treatment is performed to avoid greater morbidity and complications for the patient.

O YouTube® pode ser considerado uma fonte de informação imediata segura para o manejo correto de uma situação de avulsão dentária evidente? / Is YouTube® a reliable source of immediate information for the correct management of an evident tooth avulsion setting?

O objetivo deste estudo foi avaliar se o YouTube® pode ser considerado uma fonte de informação imediata segura para o manejo correto de uma situação de avulsão dentária evidente. Para isso, o YouTube® foi utilizado para pesquisa a partir da utilização dos termos "como tratar um dente avulsionado", "reimplante de dente avulsionado" e "avulsão dentária". Os vídeos obtidos foram submetidos a critérios de inclusão e exclusão. Os vídeos inclusos foram analisados a partir de oito tópicos variáveis que condizem com as informações adequadas sobre a sequência do manejo da avulsão dentária que independente da atuação do cirurgião dentista, baseadas nos guidelines da Associação Internacional de Traumatologia Dentária (IADT). O engajamento do vídeo e o ano de publicação também foram avaliados. Foi realizada análise descritiva a partir da frequência de repetição dos dados. Ao total, 71 vídeos sobre avulsão foram obtidos na plataforma, sendo que 39 (54,92%) apresentam os critérios de inclusão. A maioria foi publicada por profissionais (74,35%) e em 2021 (23,07%). Três vídeos (7,7%) apresentam todos os tópicos considerados indispensáveis no manejo correto da avulsão, correspondendo ao padrão ouro desejado a ser obtido durante a busca no YouTube®. "Encaminhar imediatamente ao cirurgião dentista" apresenta-se como recomendação em todos os vídeos. Todos os vídeos apresentaram informações verídicas, mesmo na incompletude dos 8 tópicos. A plataforma apresenta poucos vídeos sobre a sequência completa do manejo da avulsão. Mesmo havendo veracidade em todos os vídeos, a ausência de sequer um tópico compromete o prognóstico. O predomínio de conteúdos com ausência de tópicos infere que o YouTube® é insuficiente em vídeos referentes às condutas a serem seguidas em um caso de avulsão dentária evidente que estão de acordo com os tópicos baseados no guideline da IADT, mesmo com a ausência de informações falsas sobre o manejo da avulsão dentária(AU)

The aim of this study was to evaluate whether YouTubeTM can be considered a reliable source of immediate information for the correct management of an evident tooth avulsion setting. YouTubeTM was searched using the terms 'how to deal with an avulsed tooth', 'replantation of an avulsed tooth' and 'tooth avulsion'. The videos obtained were submitted to inclusion-exclusion criteria. The videos included were analyzed based on eight variable topics that are consistent with adequate information on the sequence of tooth avulsion management that is independent of a dentist's performance, based on International Association of Dental Traumatology (IADT) guidelines. Video engagement and year of publication were also evaluated. Descriptive statistics were consequently generated based on the frequency of data repetition. A total of 71 videos were analysed. 39 (54.92%) met the inclusion criteria. Most of the had been upload by professionals (74.35%) and in 2021 (23.07%). Three videos (7.7%) present all the topics considered indispensable in the correct management of avulsion, corresponding to the desired gold standard to be obtained during the search on YouTubeTM. 'Urgent dental referral' is the recommendation in all videos. All videos presented true information even in the incompleteness of the 8 topics. The platform features few videos on the complete sequence of avulsion management. Even with veracity in all videos, the absence of just one topic compromises the prognosis. The predominance of content infers that YouTube™ is insufficient in videos referring to the procedures to be followed in a case of evident tooth avulsion that are in accordance with the topics based on IADT guideline even with the absence of false information on the management of tooth avulsion(AU)

Accidental avulsion of a recently traumatised maxillary anterior tooth during rubber dam application.

Avulsion injuries are usually seen in the anterior maxillary teeth as a result of trauma. Avulsion as an endodontic mishap is extremely rare. This report highlights an unusual instance of exarticulation of a recently traumatised maxillary central incisor tooth when the rubber dam was applied during a routine non-surgical endodontic procedure. The tooth was immediately repositioned and stabilised with wire composite splint. Endodontic treatment was initiated after rubber dam isolation with a modified technique. Calcium hydroxide was used as intracanal medicament dressing, and obturation was done after 2 weeks. The treatment was successful with uneventful periodontal healing at 24-month follow-up. The presence of well-demarcated periodontal ligament space and absence of any resorptive area on the radiograph could be defined as a successful outcome for the present case.

Conhecimento de acadêmicos de Odontologia acerca da avulsão dentária / Knowledge of dental students about tooth avulsion

Objetivo: verificar o conhecimento de acadêmicos de Odontologia de uma instituição de ensino superior da Paraíba acerca da avulsão dentária. Métodos: foi realizado um estudo transversal, no qual 64 acadêmicos responderam um formulário com perguntas objetivas relativas a dados sociodemográficos, período de formação do curso e conhecimento e condutas em casos de avulsão dentária. Foi realizada análise descritiva de frequência absoluta e relativa dos dados (SPSS, v. 20.0). Resultados: a maioria dos acadêmicos recebeu informações sobre avulsão dentária em aulas ministradas no curso (86%) e indicaria a irrigação com soro fisiológico seguida de reimplante quando da ocorrência do trauma há menos de uma hora (64,1%) e há mais de uma hora (43,8%). O tratamento endodôntico foi indicado, independentemente do tempo do dente fora do alvéolo, por 34,4% da amostra. A contenção rígida foi a mais indicada para o dente reimplantado (48,4%) e seu tempo mínimo de proservação radiográfica respondido pela maioria dos pesquisados foi de 6 meses (48,4%). Conclusões: apesar de a maioria dos acadêmicos ter recebido informações acerca da temática, o conhecimento foi considerado insuficiente em relação a condutas referentes ao reimplante dentário, indicação do tratamento endodôntico, tipo de contenção e tempo de proservação.(AU)

Objective: to verify the knowledge of dental students from a Higher Education Institution of Paraíba about dental avulsion. Methods: a cross- -sectional study was carried out, in which 64 students answered a form with objective questions regarding sociodemographic data, course period, knowledge and conduct in cases of tooth avulsion. Descriptive analysis of absolute and relative frequency of data was performed (SPSS, v. 20.0). Results: most students received information about dental avulsion during the graduation classes (86%) and would indicate irrigation with saline solution followed by reimplantation when the trauma occurred less than one hour (64.1%) and more than one hour (43.8%). Endodontic treatment was indicated, regardless of the time the tooth was out of the dental socket, according 34.4% of the sample. Rigid retention was the most indicated for the reimplanted tooth (48.4%) and six months was the minimum radiographic follow-up time answered by most students (48.4%). Conclusions: although most students have received information about the topic, the knowledge was considered insufficient in relation to some aspects of the protocols recommended for emergency care for dental avulsion, with emphasis on behaviors related to dental reimplantation, indication of endodontic treatment, type of containment and follow-up.(AU)

Low-intensity pulsed ultrasound attenuates replacement root resorption of avulsed teeth stored in dry condition in dogs.

This study aimed to investigate the effects of low-intensity pulsed ultrasound (LIPUS) on replacement root resorption after replantation of avulsed teeth stored in a dry condition in dogs. A total of 73 premolar roots from four male mongrel dogs were intentionally avulsed with forceps and divided into four groups-HN, HL, DN, and DL-according to storage conditions and whether or not they received LIPUS treatment. Thirty-eight roots were kept in Hanks' Balanced Salt Solution for 30 min (HN and HL groups), whereas the remaining 35 roots were left to dry in the air for an hour (DN and DL groups) prior to replantation. Following replantation, the roots in the HL and DL groups (21 and 18 roots, respectively) received a 20-min daily LIPUS treatment for 2 weeks. The animals were euthanized 4 weeks after the operation. Micro-computed tomography images were acquired for each root and the amount of replacement root resorption was measured three-dimensionally. Histological assessments were also carried out. There was significantly less replacement root resorption for the roots in the DL group compared to the DN group (p < 0.01). Histological findings in the DN group demonstrated evident replacement root resorption, whereas the DL group revealed less severe resorption compared to the DN group. Within the limitations, these results suggest that LIPUS could attenuate the replacement resorption of avulsed teeth stored in a dry condition, thereby improving their prognosis.

Complications following replantation of primary teeth: a case report / Complicações após reimplante de dentes decíduos: um relato de caso clínico

Abstract Introduction: the avulsion of primary teeth is a disturbing and unexpected event. Description: this report describes the clinical case of a three-year-old child who suffered an avulsion and replantation of the primary upper central incisors at the site of the injury. The guardians sought treatment for the child at the Federal University of Minas Gerais after the replantation. Four months later, the child suffered a new trauma and the replanted teeth presented advanced mobility, root resorption and fistula. The clinical conduct was extraction and rehabilitation with a fixed esthetic maintainer. Discussion: the literature describes two treatment options for avulsion of primary incisors: replantation and non-replantation. According to a recent systematic review, the difficulty in obtaining a consensus regarding the best clinical conduct is due, in part, to the scarcity of publications that present not only follow-ups with clinical success, but also with failures. The outcomes of replantation can be influenced by several factors. The time elapsed between replantation and splinting, and the new episode of trauma, negatively influenced the prognosis in the present case, leading to failure. Replantation of primary incisors is not yet evidence-based treatment. Therefore, this option must be chosen with caution and in ideal situations. It requires constant clinical and radiographic monitoring for evaluation of outcomes.

Resumo Introdução: a avulsão de dentes decíduos é um evento perturbador e inesperado. Descrição: o presente relato descreve o caso clínico de uma criança de três anos que sofreu avulsão e reimplante dos incisivos centrais superiores decíduos no local do acidente. Os responsáveis procuraram atendimento para a criança na Universidade Federal de Minas Gerais após reimplante. Quatro meses depois, a criança sofreu novo trauma e os dentes reimplantados apresentavam mobilidade avançada, reabsorção radicular e fístula. A conduta clínica foi extração e reabilitação com mantenedor estético fixo. Discussão: a literatura descreve duas opções de tratamento para avulsão de incisivos decíduos: o reimplante e o não reimplante. De acordo com revisão sistemática recente, a dificuldade de se obter um consenso sobre a melhor conduta clínica se deve, em parte, à escassez de publicações que apresentem não apenas acompanhamentos com sucesso clínico, mas também com falhas. O reimplante pode ser influenciado por vários fatores. O tempo decorrido entre o reimplante e a contenção, e o novo episódio de trauma, influenciaram negativamente o prognóstico do presente caso, levando ao insucesso. O reimplante de incisivos decí- duos ainda não é um tratamento baseado em evidências. Portanto, essa opção deve ser escolhida com cautela e em situações ideais. Requer monitoramento clínico e radiográfico para constante avaliação do desfecho.

Evaluation of conditioned medium from placenta-derived mesenchymal stem cells as a storage medium for avulsed teeth: An in vitro study.

BACKGROUND/AIM: The viability of periodontal ligament cells on the root surface is a major factor that influences the healing of replanted teeth. A suitable storage medium is necessary to preserve avulsed teeth before replantation. Conditioned medium from placenta-derived mesenchymal stem cells (PMSC-CM) contains a variety of growth factors. The aim of this study was to evaluate the effectiveness of PMSC-CM as a storage medium to maintain the cell viability of avulsed teeth. MATERIAL AND METHODS: Extracted premolars from healthy humans were randomly stored in Hank's balanced salt solution (HBSS) and PMSC-CM for 6, 12 and 24 hours, respectively, at room temperature, and then the ratio of apoptosis of the periodontal ligament (PDL) cells was identified by flow cytometry. Human periodontal ligament stem cells (PDLSCs) were incubated with HBSS and PMSC-CM, respectively, for 6, 12, 24 and 48 hours in 5% CO2 at 37°C. Then, the cell viability of PDLSCs was determined using the cell counting kit-8 (CCK-8) and a cell cycle assay was performed. RESULTS: The apoptosis rate of PDL cells in PMSC-CM was significantly lower than that in HBSS at 24 hours (P < .001), while the two groups showed similar cell apoptosis rates at 6 and 12 hours (P > .05). The cell proliferation of PDLSCs treated with PMSC-CM significantly increased compared with the HBSS group (P < .05). The cell cycle assay revealed that the PDLSCs treated with HBSS were arrested at the G1 phase, while there was no difference between the PMSC-CM group and the control group (P > .05). CONCLUSIONS: Compared with HBSS, PMSC-CM showed better inhibition of apoptosis of PDL cells and promoted the proliferation of PDLSCs. Thus, PMSC-CM could be a promising storage medium for avulsed teeth.

Conservative treatment in adult patient with reimplanted anterior teeth after traumatic avulsion with extensive bone loss: an 8-year follow-up

ABSTRACT Introduction: Orthodontic treatment in patients with traumatized teeth is a condition that needs good planning in order to achieve satisfactory results. Objective: To discuss approaches to orthodontic treatment of malocclusions associated with trauma followed by avulsion of anterior teeth, reimplanted after a short period of time. Case report: The treatment started with the distalization of upper posterior teeth, with the aid of mini-implants and sliding jigs, followed by the inclusion of anterior teeth in the arch, followed by intrusion of these teeth. Results: With the treatment, improved mobility of the anterior teeth was achieved, with better insertion into bone tissue. The most important factor for satisfactory treatment and a good prognosis for avulsion is the time the tooth remains outside the socket. Orthodontic treatment in patients with traumatized teeth is not contraindicated; however, clinical and radiographic aspects must be considered. Conclusion: Among the feasible orthodontic treatment options, the conservative approach can be a very favorable treatment alternative.

RESUMO Introdução: O tratamento ortodôntico em pacientes com dentes traumatizados é uma condição que necessita de um bom planejamento, a fim de se conseguir resultados satisfatórios. Objetivo: Discutir as abordagens de tratamento ortodôntico de más oclusões associadas ao trauma seguido de avulsão de dentes anteriores, reimplantados após curto espaço de tempo. Relato do Caso: O tratamento realizado iniciou-se com a distalização dos dentes posteriores superiores, com auxílio de mini-implantes e sliding jigs, seguida da inclusão dos dentes anteriores na arcada e intrusão desses dentes. Resultados: Com a realização do tratamento, conseguiu-se melhoria na mobilidade dos dentes anteriores, com inserção mais favorável no tecido ósseo. O fator mais importante para o tratamento satisfatório e um bom prognóstico da avulsão é o tempo em que o dente permanece fora do alvéolo. O tratamento ortodôntico em pacientes com dentes traumatizados não é contraindicado; porém, aspectos clínicos e radiográficos devem ser considerados. Conclusão: Entre as opções de tratamento ortodôntico factíveis, a abordagem conservadora pode ser uma opção de tratamento bastante favorável.

Utilização do BIO-C TEMP® como medicação intracanal em tratamento de um dente permanente avulsionado e reimplantado tardiamente: relato de caso / Use of BIO-C TEMP® as intrachanal medication in treatment of a permanent tooth permanent and replanted later: case report

A avulsão dentária consiste no completo deslocamento traumático do dente do interior de seu alvéolo, ocasionando rompimento do suprimento sanguíneo e fibras periodontais. O reimplante imediato é considerado como melhor conduta, porém, nem sempre é possível. Quando necessário o tratamento endodôntico, é desejável que se utilizem materiais com boas propriedades biológicas e principalmente uma medicação intracanal biocompatível e que estimule a reparação tecidual. Objetivo: relatar um caso clínico de tratamento endodôntico utilizando um material à base de silicato de cálcio como medicação intracanal em um dente permanente avulsionado e reimplantado tardiamente. Relato de caso: paciente do gênero masculino, 13 anos de idade, compareceu à clínica odontológica com o dente 12 avulsionado. O dente permaneceu fora da cavidade oral por cerca de 30 minutos e o meio de armazenamento foi soro fisiológico. Após a limpeza e o reposicionamento do elemento dentário, fez-se necessária a instalação da contenção com fio semirrígido. Posteriormente, o tratamento endodôntico foi realizado, no qual a medicação intracanal de escolha foi o BIO-C TEMP®, sendo realizada a proservação por 24 meses. Consideração final: o uso de um material à base de silicato de cálcio que possui propriedades biológicas importantes e formulação "pronta para uso" pode ser uma alternativa promissora como medicação intracanal em dentes traumatizados.(AU)

Tooth avulsion consists of the complete traumatic displacement of the tooth from the inside of its alveolus, causing rupture of the blood supply and periodontal fibers. Immediate reimplantation is considered the best approach, however, it is not always possible. When endodontic treatment is necessary, it is desirable to use materials with good biological properties and especially biocompatible intracanal medication that stimulates tissue repair. Objective: to report a clinical case of endodontic treatment using a material based on calcium silicate as intracanal medication in an avulsed and late reimplanted permanent tooth. Case report: male patient, 13 years old, came to the dental clinic with the tooth 12 avulsed, remained outside the oral cavity for about 30 minutes, the storage medium was saline. After cleaning and repositioning the element, it was necessary to install the containment with semi-rigid wire. Subsequently, endodontic treatment was performed, in which the intracanal medication was BIO-C TEMP® and followed up for 24 months. Final consideration: the use of calcium silicate-based material has important biological properties and a "ready-to-use" formulation, which can be a promising alternative as an intracanal medication in traumatized teeth.

Estudo do processo de reparo do reimplante de dentes de ratos mantidos em albumina / Study of the reimplant repair process of teeth mainted on albumin

Quando o reimplante imediato não é possível, os meios de conservação têm papel fundamental para a manutenção da integridade do ligamento periodontal do dente avulsionado, para que um tratamento adequado seja alcançado. A clara do ovo apresentou resultados favoráveis para esse fim e a albumina constitui seu principal componente. Assim o propósito desse estudo foi analisar se a albumina pasteurizada em pó possui o mesmo potencial que a sua forma natural, como meio de conservação. Para isso foram utilizados 40 ratos divididos em 4 grupos de 10 animais. Após a extração do incisivo superior direito, os dentes do grupo IM foram reimplantados em seus respectivos alvéolos após 5 minutos (controle positivo grupo AP os dentes serão imersos em 40 ml de clara de ); No ovo pasteurizada em pó, reconstituída em água (10 gramas de pó em 30ml de água); No grupo CO dentes foram imersos em 40 ml de clara de ovo in natura; No grupo SE - os dentes serão mantidos em meio seco (controle negativo ). Com exceção do grupo IM, os demais dentes foram mantidos em seus respectivos meios por 60 minutos em temperatura ambiente para serem então reimplantados em seus respectivos alvéolos. Os animais receberam em dose única, antibiótico e analgésico. Na análise histológica da inserção epitelial e ligamento periodontal, foram consideradas a ocorrência de inflamação e a localização. Na superfície radicular foi analisada a ocorrência de reabsorção inflamatória, reabsorção por substituição, total de reabsorção, áreas reparadas por ligamento periodontal, anquilose. Os dados foram submetidos à análise estatística a um nível de significância de 5%. Os resultados demonstraram que a intensidade da inflamação aguda no tecido conjuntivo da inserção epitelial, foi maior no grupo SE em relação ao grupo IM. O grupo SE foi o mais comprometido que os demais grupos em relação à reabsorção total, reabsorção inflamatória e reabsorção por substituição. O grupo SE apresentou a menor extensão de ligamento periodontal que os demais grupos. Para o ligamento periodontal reinserido, o grupo SE apresentou menor extensão do que os grupo IM e AP. Pode-se concluir que a albumina em pó apresentou resultado histológico semelhante ao da clara de ovo in natura e do reimplante imediato, constituindo uma opção como meio de conservação de dentes avulsionados(AU)

When immediate replantation is not possible, preservatives play a fundamental role in maintaining the integrity of the periodontal ligament of the avulsed tooth so that proper treatment is achieved. Egg white showed favorable results for this purpose and a lbumin is its main component. Thus the purpose of this study was to analyze whether pasteurized albumin powder has the same potential as its natural form as a preservative medium. Forty rats were divided into 4 groups of 10 animals. After extraction of the right upper incisor, the teeth of the IM group were reimplanted in their respective alveoli after 5 minutes ( group AP positive control); In the teeth will be immersed in 40 ml of pasteurized egg white powder, reconstituted in water (10 grams of powder i n 30ml of water); In group CO were immersed in 40 ml of fresh egg white; In the SE group -- the teeth the teeth will be kept in a dry environment ( negative control). With the exception of the IM group, the remaining teeth were kept in their respective mea ns for 60 minutes at room temperature and then reimplanted in their respective alveoli. The animals received a single dose, antibiotic and analgesic. Histological analysis of epithelial insertion and periodontal ligament considered the occurrence of inflam mation and location. The root surface was analyzed for inflammatory resorption, replacement resorption, total resorption, areas repaired by periodontal ligament, ankylosis. Data were subjected to statistical analysis at a significance level of 5%. The resu lts showed that the intensity of acute inflammation in the connective tissue of the epithelial insertion was higher in the SE group than in the IM group. The SE group was the most compromised than the other groups in terms of total resorption, inflammatory resorption and replacement resorption. The SE group had the smallest periodontal ligament extension than the other groups. For the reinserted periodontal ligament, the SE group presented smaller extension than the IM and AP groups. It can be concluded tha t albumin powder presented histological results similar to that of fresh egg white and immediate replantation, constituting an option as a means of preserving avulsed teeth(AU)

Dental Injuries and Management.

Traumatic dental injuries affect 1 to 3% of the population, and disproportionately affect children and adolescents. The management of these injuries incorporates the age of patients, as children between 6 and 13 years of age have a mixed dentition. This helps to preserve the vitality of teeth that may be salvaged after a traumatic event. The clinical examination of these cases involves a thorough examination of the maxilla and mandible for associated fractures and any lodged debris and dislodged teeth or tooth fragments. The objective is to rule out any accidental aspiration or displacement into the nose, sinuses, or soft tissue. After ruling out any complications, the focus is on determining the type of injury to the tooth or teeth involved. These include clinical examination for any color change in the teeth, mobility testing, and testing for pulp vitality. Radiographic evaluation using periapical, occlusal, panoramic radiographs, and cone beam computed tomography is performed to view the effect of trauma on the tooth, root, periodontal ligament, and adjoining bone. The most commonly used classification system for dental trauma is Andreasen's classification and is applied to both deciduous and permanent teeth. Managing dental trauma is based on the type of injury, such as hard tissue and pulp injuries, injuries to periodontal tissue, injuries of the supporting bone, and injuries of the gingiva and oral mucosa. Hard-tissue injuries without the involvement of the pulp typically require restoration only. Any pulp involvement may require endodontic treatment. Fractures involving the alveolar bone or luxation of the tooth require stabilization which is typically achieved with flexible splints. The most common procedures employed in managing dental injuries include root canal/endodontics, surgical tooth repositioning, and flexible splinting. Recognition and treatment of these injuries are necessary to facilitate proper healing and salvage of a patient's natural dentition, reducing future complications to patients.

Reimplante dentário após o uso do BCAA como meio de conservação: estudo histométrico em ratos / Dental replantation after the use of BCAA as a preservative: histometric study in rats

A melhor forma de tratamento para os casos de avulsão dentária por trauma é o reimplante imediato, no entanto, existem diversas condições que impedem sua realização. Nesses casos, os meios de conservação tem papel fundamental para a manutenção da integridade do ligamento periodontal do dente avulsionado, dando tempo para que um tratamento adequado seja alcançado. Compostos proteicos como o leite, o soro do leite apresentaram resultados favoráveis para esse fim. Acessibilidade e facilidade de manuseio também contribuem favoravelmente. Existem compostos de aminoácidos que poderiam servir para esse fim, assim o propósito desse estudo foi o de analisar se o BCAA (aminoácidos de cadeia ramificada) possui o mesmo potencial como meio de conservação por também ser um composto proteico. Para isso foram utilizados 50 ratos divididos em 5 grupos de 10 animais. Após a extração do incisivo superior direito, os dentes do grupo (IM) foram reimplantados em seus respectivos alvéolos após 5 minutos; No grupo (L) - os dentes foram imersos em 40 ml de leite bovino pasteurizado (UHT); No grupo (SL) - os dentes foram imersos em 40 ml de soro de leite fresco; No grupo (BC) - os dentes foram imersos em 40 ml de uma solução à base de aminoácidos de cadeia ramificada (7 gramas de pó em 200ml de água); No grupo (SE) - os dentes foram mantidos em meio seco sobre bancada. Os dentes serão mantidos em seus respectivos meios por 60 minutos em temperatura ambiente para serem então reimplantados em seus respectivos alvéolos Os animais receberam, em dose única, antibiótico e analgésico. A eutanásia foi realizada 60 dias após e os espécimes obtidos foram processados para obtenção de lâminas que foram coradas pela Hematoxilina e eosina. Na análise histológica foram analisadas as características da inserção epitelial, do ligamento periodontal, cemento e dentina. Nessas estruturas foi quantificada a ocorrência de reabsorção inflamatória, reabsorção por substituição, total de reabsorção, áreas reparadas por ligamento periodontal, anquilose. Os dados foram submetidos à análise estatística a um nível de significância de 5%. Os resultados demonstraram que a ocorrência de reabsorção radicular foi maior no grupo SE em relação aos demais grupos. Da mesma forma a reabsorção inflamatória foi superior neste grupo em relação aos demais. Maior extensão de infiltrado inflamatório crônico foi encontrado no grupo SE em relação grupo IM. Maior extensão de ligamento periodontal reinserido foi encontrado no grupo IM em relação ao grupo SE. O grupo SE apresentou menor extensão de ligamento periodontal que os demais grupos (p<0,05). Pode-se concluir que o BCAA, assim como o leite e o soro de leite, apresentou resultado histológico semelhante ao reimplante imediato, constituindo uma opção como meio de conservação de dentes avulsionados(AU)

The best form of treatment for cases of dental avulsion due to trauma is immediate replantation, however, there are several conditions that prevent its implementation. In such cases, the preservative means play a fundamental role in maintaining the integrity of the periodontal ligament of the avulsed tooth, allowing time for proper treatment to be achieved. Protein compounds such as milk and whey showed favorable results for this purpose. Accessibility and ease of handling also contribute favorably. There are amino acid compounds that could serve this purpose, so the purpose of this study was to examine whether BCAA (branched chain amino acids) has the same potential as a preservative as it is also a protein compound. For this, 50 rats divided into 5 groups of 10 animals were used. After extraction of the right upper incisor, the teeth of group (IM) were reimplanted in their respective alveoli after 5 minutes; In group (M) - the teeth were immersed in 40 ml of pasteurized bovine milk (UHT); In group (W) - teeth were immersed in 40 ml of fresh whey; In group (BC) - the teeth were immersed in 40 ml of a branched chain amino acid solution (7 grams of powder in 200ml of water); In group (D) - the teeth were kept in a dry medium on a bench. The teeth will be kept in their respective means for 60 minutes at room temperature and then reimplanted in their respective alveoli. The animals received antibiotic and analgesic in a single dose. Euthanasia was performed 60 days later and the specimens obtained were processed to obtain slides that were stained with Hematoxylin and eosin. Histological analysis analyzed the characteristics of epithelial insertion, periodontal ligament, cementum and dentin. In these structures, the occurrence of inflammatory resorption, replacement resorption, total resorption, areas repaired by periodontal ligament, ankylosis were quantified. Data were subjected to statistical analysis at a significance level of 5%. The results showed that the occurrence of root resorption was higher in the D group than in the other groups. Similarly, inflammatory resorption was higher in this group compared to the others. A greater extent of chronic inflammatory infiltrate was found in the SE group than in the IM group. Greater extension of reinserted periodontal ligament was found in the IM group compared to the D group. The D group had less periodontal ligament extension than the other groups (p <0.05). It can be concluded that BCAA, as well as milk and whey, presented histological results similar to immediate replantation, constituting an option as a means of preserving avulsed teeth(AU)

Abordagem quanto ao diagnóstico e ao tratamento da avulsão dentária: uma revisão de literatura / Approach to diagnosis and treatment of dental avulsion: a literature review

Objetivo: descrever uma revisão da literatura que apresente as principais consequências que podem ocorrer quando o dente avulsionado é reimplantado de forma tardia, proporcionando um prognóstico desfavorável. Revisão de literatura: a avulsão dental é uma lesão traumática que se caracteriza pelo completo deslocamento do dente de seu alvéolo, acarretando danos tanto às estruturas de suporte do elemento dental quanto às estruturas pulpares. A permanência extraoral do elemento dental avulsionado por períodos longos ou em meios de armazenamento inadequados pode provocar danos adicionais. Considerações finais: as lesões de inserções são as principais consequências da pós-avulsão dentária, isso devido a uma ruptura do ligamento periodontal, com uma secagem excessiva antes do reimplante, danificando as células do ligamento periodontal, o que, por sua vez, provoca uma resposta inflamatória exacerbada em uma ampla área da superfície radicular. (AU)

Objective: to describe a literature review, which presents the main consequences of late reimplantation of the avulsed tooth, providing an unfavorable prognosis. Literature review: tooth avulsion is a traumatic lesion characterized by the complete displacement of the tooth from the socket, causing damage to the support structures of the dental element as well as to pulp structures. The long extraoral time of the avulsed tooth or the time in inadequate storage may cause additional trauma. Final considerations: insertion lesions are the main consequences of tooth post-avulsion due to a rupture in the periodontal ligament, with an excessive drying prior to reimplantation, which damages the periodontal ligament cells and causes an exacerbated inflammatory response in a large root surface area. (AU)

Alternativa estética ante la pérdida de piezas primarias en el sector anterior: resolución clínica / Esthetic alternative to the loss of primary pieces in the previous sector

La pérdida de piezas permanentes en el sector anterior sigue siendo una preocupación clínica en el tratamiento odontológico de niños y adolescentes. Es importante destacar que la pubertad y la adolescencia son etapas donde las relaciones con los pares son de suma importancia. Las restauraciones protéticas convencionales no cumplen las expectativas estéticas, pero siguen siendo el tratamiento de elección, ya que los implantes solo pueden ser realizados una vez finalizados el crecimiento y el desarrollo. Los sistemas adhesivos mediante cinta de fibra de vidrio han simplificado el trabajo, brindando una alternativa intermedia conservadora y estética. El objetivo de este trabajo es presentar la resolución clínica en dos pacientes que concurrieron a la Cátedra de Odontología Integral Niños luego de haber sufrido traumatismos que provocaron la pérdida de piezas dentarias permanentes logrando la restitución de la longitud de arco, la devolución de la estética y la fonación con la colocación de una prótesis tipo Maryland, realizada con cinta de fibra de vidrio preimpregnada con resina compuesta (AU)

Premature loss of anterior permanent teeth is still a cause for concern in dental treatment of children and adolescents. Social relationships with peers are particularly important during puberty and adolescence. Removable prosthesis has always been a choice but they may not satisfy patients' esthetic expectations and dental implants can only be placed after the jaw has finished growing. Adhesive directly bonded splints with glass fibers reinforced composite resins can be an alternative to conventional space maintainers. The aim of this report is to describe the treatment of two patients who attended at the Department of Comprehensive Children´s Dentistry after suffering traumatic dental injuries using bridges as an approach to restore arch length, esthetics and function (AU)

Awareness of dentists regarding immediate management of dental avulsion: Knowledge, Attitude, and Practice study.

OBJECTIVE: To assess the knowledge of practising dentists regarding immediate management of dental avulsion. METHODS: The cross-sectional analytical study was conducted in various dental colleges and teaching hospitals of Karachi, Pakistan, in October-November 2016, and comprised dentists working in academic institutions / departments or as general dental practitioners for at least 1 year. The subjects were asked to fill out a self-administered questionnaire. Questions related to knowledge and practice regarding immediate management of dental avulsion was asked and then responses were categorised as good knowledge, moderate and poor knowledge. SPSS 22 was used for data analysis.. RESULTS: Of the 282 subjects, 179 (63.5%) were females and 103(36.5%) were males. The overall mean age was 28. 33±4.7 years, and 194 (68.8%) had clinical experience of less than 5 years. Of the total, 30(11%) dentists had good knowledge while 130(46%) had moderate and 122(43%) had poor knowledge. Statistically significant association of knowledge regarding tooth avulsion was observed with the specialty (p= 0.006) and qualification (p=0.001). CONCLUSIONS: The knowledge of dentists regarding immediate management of avulsion injuries was inadequate. Knowledge was significantly associated with specialty and qualification of the dentist.