Dental trauma: assessment and acute management of fractures.

Acute dental trauma is unscheduled and presents infrequently to the majority of practitioners. Therefore, a consistent, logical and systematic process for examination, prioritisation and management is imperative for all sustained injuries to have an optimal outcome. Fractures are a frequent sequela to dental trauma and can involve any aspect of the tooth structure or supporting alveolar bone. While some minor crown fractures may initially seem inconsequential, they may be a subtle indication to a more serious underlying root fracture. Concomitant injuries and injuries that have been initially missed are generally associated with poorer outcomes. The time sensitive management of traumatic dental injuries aims to preserve pulpal and periodontal health where possible. The follow up period for tooth or alveolar fractures are important to allow for early intervention if pathology develops.

Displacement Injuries: Assessment and Management.

This paper aims to aid clinicians in the assessment and immediate management of dental trauma displacement injuries to permanent teeth. Long term sequelae, the impact of such injuries, and the evidence-base for managing these are discussed.Clinical cases are provided to illustrate management challenges and highlight where further evidence-based guidance is needed. The role of the general dental practitioner in the immediate management and follow-up of traumatic dental injuries is outlined and sequelae, worthy of potential referral, described.

Contemporary management of horizontal root fractures to the permanent dentition: diagnosis--radiologic assessment to include cone-beam computed tomography.

Historically, obtaining several periapical radiographs has been recommended to diagnose horizontal root fractures. Assessing the 3-dimensional orientation of a fracture is correlated to treatment and outcome. However, conventional radiography yields only limited information for accurate diagnosis. Cone-beam computed tomography (CBCT) is a relatively new and useful technology, which provides an auxiliary imaging modality to supplement conventional radiography for evaluating horizontal root fractures. Despite the increasing application of this technology as well as a growing body of evidence supporting its value in diagnosing horizontal root fractures, there are no specific guidelines for its use. This article aimed to provide such preliminary guidelines for cases of suspected horizontal root fracture as a result of trauma. From a database search it was concluded that CBCT is most useful in cases in which conventional radiography yields inconclusive results or shows a fracture in the middle third of a root. In such cases CBCT may rule out false negatives, ie, a suspected root fracture not visualized with conventional radiography. For a root fracture in the middle third, CBCT may rule out or confirm an oblique course of fracture involving the cervical third in the labiolingual dimension. Although there are considerable advantages when CBCT is included in the assessment of horizontal root fracture and its possible sequelae, more experimental and clinical studies are warranted to determine the exact impact on outcomes.

Dysfunction prompts comprehensive oral health assessment.

A patient presented to the clinician's office as a result of discomfort from a fractured root. A systematic risk assessment revealed a combined periodontal/endodontic lesion associated with tooth No. 2, as well as the patient's history of orthodontic treatment, periodontal disease, and extensive restorative dentistry. It was also established that the patient was dissatisfied with her smile, which affected her self-esteem. Using a 10-step management system, the clinician was able to not only address the presenting complaint but also discover and treat the patient's cosmetic concerns. This case illustrates that through proper, comprehensive assessment of oral dysfunction dentists can do more than correct biomechanical and functional problems--they can also improve a patient's quality of life.

[Assessment of injuries to the neck and dentomandibular system complicated by the infectious process].

The objective of the present work was to consider problems pertaining to forensic medical examination of injuries to the neck and dentition system complicated by pyoinflammatory processes. Two clinical observations are reported to illustrate significant difficulties encountered by forensic medical experts during assessment of the severity of harm inflicted to human health in the cases requiring differential characteristic of injuries, evaluation of opportuneness and completeness of the provided medical aid, and the role of these factors in the development of fatal pyoseptic complications. Special emphasis is laid on the analysis of possibilities to attain these goals based on the "Medical criteria for the assessment of severity of harm inflicted to human health" (2008).

Fracture necrosis: diagnosis, prognosis assessment, and treatment recommendations.

INTRODUCTION: The presence of cracks and fractures in teeth can pose difficulties in diagnosis, prognosis assessment, and treatment recommendations. When a tooth has no significant restorations or caries, whereby the pulp is nonvital in the absence of a luxation injury, it is suggested that this necrosis is likely caused by a significant longitudinal crack that extends from the occlusal surface and into the pulp. This type of presentation has been termed "fracture necrosis." METHODS: Twenty-seven teeth with nonvital pulps were evaluated that had no restorations or minimally deep restorations and no signs of caries. These teeth were extracted and evaluated as to the depth and location of any potential fracture. RESULTS: All evaluated teeth were found to have cracks that extended from the occlusal surface into the pulp and progressed to an external root surface. CONCLUSION: Pulp necrosis, in the absence of restorations, caries, or luxation injuries, is likely caused by a longitudinal fracture extending from the occlusal surface and into the pulp. Based on the available literature, these types of teeth may have a poor prognosis after endodontic treatment, with the potential ramification of extensive periodontal and/or periapical bone loss. Extraction may be considered as the primary treatment option.

Mineral trioxide aggregate pulpotomies: a case series outcomes assessment.

BACKGROUND: The greatest threats to developing teeth are dental caries and traumatic injury. A primary goal of all restorative treatment is to maintain pulp vitality so that normal root development or apexogenesis can occur. If pulpal exposure occurs, then a pulpotomy procedure aims to preserve pulp vitality to allow for normal root development. Historically, calcium hydroxide has been the material of choice for pulpotomy procedures. Recently, an alternative material called mineral trioxide aggregate (MTA) has demonstrated the ability to induce hard-tissue formation in pulpal tissue. The authors describe the clinical and radiographic outcome of a series of cases involving the use of MTA in pulpotomy procedures. METHODS: Twenty-three cases in 18 patients were treated with MTA pulpotomy procedures in an endodontic private practice. All of the patients had been referred to the practice for diagnosis and treatment of a symptomatic tooth. All of the authors provided treatment. Pulpal exposures were either due to caries or complicated enamel dentin fractures. RESULTS: Nineteen teeth in 14 patients were available for recall. The mean time of recall was 19.7 months. Of the 19 cases, 15 involved healed teeth, and three involved teeth that were healing. One of 19 cases involved a tooth with persistent disease. CONCLUSIONS: MTA may be useful as a substitute for calcium hydroxide in pulpotomy procedures. Further research, however, is required to clarify this conclusion. CLINICAL IMPLICATIONS: MTA conceivably could replace calcium hydroxide as the material of choice for pulpotomy procedures, if future research continues to show promising results.

[Assessment of traumatic tooth injuries in the emergency room]. / Vurdering av tannskader ved legevakt.

Many patients with facial injuries are first seen by doctors in the emergency room. Injuries affecting teeth and alveolar process are common in children; approximately half of all children have sustained such an injury before adulthood. Dentoalveolar trauma does not pose a significant morbid risk for the trauma patient. However, failure to recognise or obtain appropriate consultation can result in premature tooth or alveolar bone loss, resulting in problematic prosthetic rehabilitation. Emergency room doctors should know the initial treatment guidelines for traumatic dental injuries to provide optimal treatment before the patient can seen by a dentist. An avulsed tooth should be replanted immediately, or kept moist until it can be replanted. Prognosis is related to storage media and the length of the extra-alveolar period. Teeth replanted within 5 minutes have the best prognosis. If the primary consultation is by phone the patient, or the parent, should be informed to replant the avulsed tooth. If this is not feasible the tooth should be stored in milk, saliva (oral cavity) or physiologic saline until replanted. Primary teeth are not replanted.

[Usefulness of hydroxyapatite implants for the management of alveolar bone lesions at tooth hemisection sites]. / Badanie skutecznosci wszczepów hydroksyapatytowych w leczeniu zniszczen wyrostka zebodolowego w obrebie zebów leczonych metoda hemisekcji.

INTRODUCTION: Hemisection is a surgical method for treating lesions of two- and multi-rooted teeth. This procedure includes amputation of one or two lesioned roots together with the attached dental crown, leaving an endodontically treated root and the remaining dental crown prepared for future prosthetic restoration. The results of this study demonstrate that HA Biocer implants create optimal conditions for new bone growth. MATERIAL AND METHODS: The study was done in 51 patients after hemisection treated with HA Biocer in the form of granules implanted into the alveolus. The control group consisted of 45 patients without an alloplastic implant. The following indices were assessed: radiological index of alveolar bone atrophy in the maxilla and mandible according to Engelberger, Marthaler and Rateischak [EMR]; gingival pocket depth with WHO 621 probe; tooth mobility index according to Entin; root denudation index according to Cieszyfiski; bacterial plaque index (P1.1.) according to Silness and Löe. Measurements were done before hemisection and were repeated after 1.5, 6, 12, 24, 36, 48, and 60 months thereafter. It was found that hydroxyapatite implants improved the condition of the hemisected tooth and arrested the destruction process in the alveolar bone. RESULTS: (1) In the study group (HA Biocer), no bone atrophy was noted in the root region after hemisection, whereas bone loss in the control group reached 11%. (2) The depth of gingival pockets in the study group was half of the depth in the control group. (3) Significant tooth stabilization was achieved in the study group, mainly during the first two years after implantation. Improved tooth stability was noted three times less often in the control group during the same period. (4) Root denudation diminished in patients treated with HA Biocer and increased or remained unchanged in controls. (5) A steady decrease in mean P1.1. index values was observed in both groups over the five-year follow-up period. However, the mean P1.1. value in the study group was one-third of the value in the control group.