Diagnóstico clínico, radiográfico e histológico de un caso de fibrosis periapical posendodóntica / Clinical, radiographic, and histologic diagnosis of a postendodontic periapical fibrosis case

Objetivo: La fibrosis periapical posendodóntica es un proceso reparativo asintomático, radiolúcido y no progresivo que se interpreta con frecuencia como una lesión patológica persistente. El diagnóstico de esta entidad suele ser dudoso y sólo puede definirse mediante la correlación de las obser- vaciones clínicas, radiográficas e histológicas. El objetivo de este informe es describir el caso de un paciente que presenta un área radiolúcida periapical persistente y asintomática en un incisivo lateral superior. Caso clínico: Luego de cuatro años y dos meses de ha- ber recibido un tratamiento endodóntico el paciente concurre a la consulta para un examen de rutina. El examen radiográfico del diente revela un área radiolúcida persistente y bien defini- da. A causa de una fractura radicular irreparable, se indicó la extracción de la pieza dentaria. Esto permitió realizar el estu- dio histológico del tejido blando que permanecía adherido en el ápice de la raíz, lo que confirmó y completó el diagnóstico de fibrosis periapical posendodóntica.(AU)

Aim: The postendodontic periapical fibrosis is an asymp- tomatic radiolucent and non-progressive healing process that is often interpreted as a persistent pathological lesion. The diagnosis of this entity is usually uncertain, and it is only de- fined by the correlation of clinical, radiographic and histo- logical observations.The aim of this report is to describe the case of a patient with a long-term persisting asymptomatic and radiolucent area in a upper lateral incisor. Clinical case: Four years and two months after receiv- ing an endodontic treatment the patient comes to our office for a routine control. Radiographic examination revealed the presence of a persistent well defined radiolucent area. Sur- gical tooth extraction was required due to the presence of a complicated root fracture.This allowed to perform a histolog- ical study of the soft tissue attached to the apex of the ex- tracted root, which confirmed and completed the diagnosis of postendodontic periapical fibrosis (AU)

Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted.

BACKGROUND: Traumatic dental injuries are common. One of the most severe injuries is when a permanent tooth is knocked completely out of the mouth (avulsed). In most circumstances the tooth should be replanted as quickly as possible. There is uncertainty on which interventions will maximise the survival and repair of the replanted tooth. This is an update of a Cochrane Review first published in 2010. OBJECTIVES: To compare the effects of a range of interventions for managing traumatised permanent front teeth with avulsion injuries. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 March 2018), Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 2) in the Cochrane Library (searched 8 March 2018), MEDLINE Ovid (1946 to 8 March 2018), and Embase Ovid (1980 to 8 March 2018). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We considered randomised and quasi-randomised controlled trials that included a minimum follow-up period of 12 months, for interventions for avulsed and replanted permanent front teeth. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data and assessed the risk of bias. Authors were contacted where further information about their study was required. MAIN RESULTS: Four studies, involving a total of 183 participants and 257 teeth were identified. Each of the interventions aimed to reduce infection or alter the inflammatory response or both at the time of or shortly after the tooth or teeth were replanted. Each study assessed a different intervention and therefore it was not appropriate or possible to numerically synthesise the data. All evidence was rated as being of very low quality due to problems with risk of bias and imprecision of results. This means that we are very uncertain about all of the results presented in this review.One study at high risk of bias with 69 participants (138 teeth) compared a 20-minute soak with gentamycin sulphate for both groups prior to replantation with the experimental group receiving daily hyperbaric oxygen for 80 minutes for the first 10 days. There was some evidence of a benefit for the hyperbaric oxygen group in respect of periodontal healing, tooth survival, and pulpal healing.One study at unclear risk of bias with 22 participants (27 teeth) compared the use of two root canal medicaments, Ledermix and Ultracal. There was insufficient evidence of a difference for periodontal healing or tooth survival. This was the only study to formally report adverse events with none identified. Study authors reported that Ledermix caused a greater level of patient dissatisfaction with the colour of avulsed and replanted teeth.A third study at high risk of bias with 19 participants compared extra- or intra-oral endodontics for avulsed teeth which were stored dry for longer than 60 minutes before replantation. There was insufficient evidence of a difference in periodontal healing.The fourth study at high risk of bias with 73 participants compared a 10-minute soak in either thymosin alpha 1 or saline before replantation followed by daily gingival injections with these same medicaments for the first 7 days. There was some evidence of a benefit for thymosin alpha 1 with respect to periodontal healing and tooth survival. AUTHORS' CONCLUSIONS: Based on the results of the included studies, there is insufficient evidence to support or refute the effectiveness of different interventions for avulsed and replanted permanent front teeth. The overall quality of existing evidence was very low, and therefore great caution should be exercised when generalising the results of the included trials. There is urgent need for further well-designed randomised controlled trials.

A prospective clinical study of regenerative endodontic treatment of traumatized immature teeth with necrotic pulps using bi-antibiotic paste.

AIM: To evaluate the treatment outcomes of a revitalization endodontic technique (RET) for the management of traumatized immature teeth with necrotic pulps in children. METHODOLOGY: Fifteen healthy children (age range = 7-10 years) with traumatized immature maxillary incisors with necrotic pulps treated with bi-antibiotic revitalization endodontic technique were prospectively assessed over approximately two years (mean = 22 months). One operator undertook all treatments, clinical reviews and standardized radiographic exposures with radiographic analysis being carried out by two calibrated experienced clinicians. Crown colour change was assessed using an objective published methodology. Wilcoxon signed-rank test was used to compare root lengths, root dentinal widths and apical foramen widths over time. RESULTS: Interoperator measurement reliability was consistently strong for all measurements. There was no significant difference in root lengths or root dentinal wall widths following RET. A significant difference in apical foramen widths was observed after 2 years (P = 0.013) with resolution of clinical signs of infection in all cases. Despite omitting minocycline and using Portland cement (nonbismuth containing cement), a noticeable crown colour change (yellower, redder and lighter), as measured by an objective colour measurement system with ΔE = 7.39, was recorded. Most patients, however, were satisfied with the aesthetic outcome. CONCLUSION: Traumatized immature teeth with necrotic pulps treated with revitalization endodontic technique did not demonstrate continuation of root development or dentine formation when assessed by periapical radiographs. However, apical closure and periodontal healing were observed. A measurable change in crown colour (yellower, redder and lighter), with mostly no aesthetic concern to the patients/parents, was also observed.

Direct Resin Composite Restoration of Maxillary Central Incisors with Fractured Tooth Fragment Reattachment: Case Report.

This article presents a clinical protocol to reconstruct two accidentally damaged maxillary central incisors using composite resin material and a fractured tooth component. A patient was referred to the clinic with fracture of the two maxillary central incisors. Clinical examination revealed that both teeth were fractured in the middle third of the crown and that the fractures involved enamel and dentin with no pulp exposure. The patient had also suffered a lower lip laceration. When the lip was evaluated, a fractured fragment of the maxillary right central incisor was found inside the wound. The missing part of the tooth was replaced via adhesive attachment. Due to the damage of the fractured part of the maxillary left central incisor, direct composite restoration of this tooth was performed. With the advent of adhesive dentistry, the process of fragment reattachment has become simplified and more reliable. This procedure provides improved function, is faster to perform, and provides long-lasting effects, indicating that reattachment of a coronal fragment is a realistic alternative to placement of conventional resin composite restorations.

The Effect of Diode Laser With Different Parameters on Root Fracture During Irrigation Procedure.

The aim of this study is to compare the effect of a single diode laser application and agitation of EDTA with diode laser with different parameters at different time intervals on root fracture. Ninety mandibular incisors were instrumented except the negative control group. The specimens were divided randomly into 10 groups according to final irrigation procedure: (G1) non-instrumented; (G2) distilled water; (G3) 15% EDTA; (G4) ultrasonically agitated EDTA; (G5) single 1.5W/100 Hz Diode laser; (G6) single 3W/100 Hz Diode laser; (G7) 1.5W/100 Hz Diode laser agitation of EDTA for 20 s; (G8) 1.5W/100 Hz Diode laser agitation of EDTA for 40 s; (G9) 3W/100 Hz Diode laser agitation of EDTA for 20 s; and (G10) 3W/100 Hz Diode laser agitation of EDTA for 40 s. The specimens were filled, mounted in acrylic resin, and compression strength test was performed on each specimen. Statistical analysis was carried out using one way ANOVA and Tukey's post hoc tests (P = 0.05). The statistical analysis revealed that there were statistically significant differences among the groups (P < 0.05). Laser-agitated irrigation with a 3W/100 Hz Diode laser for both 20 s and 40 s decreased the fracture resistance of teeth.

Revascularization Induced Maturogenesis of Non-Vital Immature Permanent Tooth Using Platelet-Rich-Fibrin: A Case Report.

The aim of this report is to describe a novel method of revascularization therapy done in a non-vital, immature permanent tooth using Platelet-rich fibrin (PRF),in a recently developed scaffold material to overcome limitations associated with the traditional method of revascularization using natural blood clot. PRF prepared from autologous blood was placed in the root canal and patient was followed up regularly at one, three, six, nine and 12 months for detailed clinical and radiographic evaluation. At 12 months, radiographic examination revealed root elongation, root end closure, continued thickening of the root dentinal walls, obliteration of root canal space, and normal periradicular anatomy. However, more long term prospective trials and histological studies are highly needed before to testify PRF a panacea for the regenerative endodontic therapy in children.

The use of a single-step regenerative approach for the treatment of a replanted mandibular central incisor with severe resorption.

AIM: To report the clinical and radiographic treatment outcome of an immature replanted mandibular incisor with severe inflammatory external root resorption following a single-step regenerative approach. SUMMARY: A 7-year-old female patient was referred 1 week following an extrusion injury to her mandibular central incisor (tooth 31). There was a history of a 6 months previous avulsion injury to the same tooth, which had been replanted after 20 min of extra-oral time. On clinical examination, all teeth were asymptomatic and there was an arch wire splint placed on the mandibular incisors. Radiographic examination revealed severe inflammatory external root resorption of tooth 31. A diagnosis of necrotic pulp and asymptomatic apical periodontitis was made. Under local anaesthesia and rubber dam isolation, an access cavity was prepared. The canal was irrigated using 6% NaOCl solution delivered through the EndoVac negative pressure irrigation system (Endo Vac, Axis/SybronEndo, Coppell, TX, USA). A 17% EDTA solution was used for 5 min followed by a final rinse of sterile water. The periapical tissues were probed using a K-file, and bleeding was induced. A blood clot was allowed to form filling the entire canal. A thick plug of MTA was placed in direct contact with the blood clot. The tooth was restored with composite resin. All procedures were performed in a single visit. The splint was removed 2 weeks later. Recall examination after 24 months revealed healthy soft tissues with normal periodontal probing and mobility. The 24 months radiographic evaluation revealed healing of the severe inflammatory external root resorption and continuous root development/dentine wall thickening of the apical third. No signs of ankylosis or significant discoloration was present.

Fractura radicular en piezas primarias / Root fracture in primary teeth

Los traumatismos dentarios constituyen uno de los motivos más frecuentes en la consulta odontopediátrica. Si bien las fracturas radiculares en dentición primaria son las lesiones traumáticas menos prevalentes (2-4 por ciento), son de difícil resolución y ocasionan la pérdida de dichas piezas en la mayoría de los casos. Objetivo: describir la resolución del traumatismo con fractura radicular en ambos incisivos centrales superiores primarios. Diagnóstico de la situación inicial: paciente masculino de 4 años que acude con su madre a la Cátedra de Odontología Integral Niños de la FOUBA presentando un traumatismo dental de 2 horas de evolución. Diagnóstico clínico-radiográfico: fractura radicular horizontal de tercio medio del 5.1 y 6.1 (sin reabsorción fisiológica radicular), sin desplazamiento del fragmento coronario, con laceración de labio superior y encía marginal. Secuencia de procedimientos operatorios: historia clínica con consentimiento informado; anamnesis médica y odontológica; examen clínico y radiográfico de 5.1 y 6.1 y antagonistas; limpieza de tejidos blandos con clorhexidina; impresión con alginato; confección de placa posicionadora para ferulización; prueba e instalación de la placa; indicaciones al paciente y a su madre: uso permanente durante 45 días y uso nocturno, para comer y hacer deportes 45 días más. Recomendaciones de higiene; controles inmediatos: 30 y 45 días y 3 y 6 meses. Resolución del caso: en todos los controles, ambas piezas se presentaron asintomáticas. A los 6 meses se observa la correcta cicatrización radicular y la presencia de vitalidad en ambos incisivos. Conclusiones: el tratamiento temprano y los controles posteriores son fundamentales para preservar la salud pulpar y conseguir la reparación de los tejidos duros afectados.

Revascularization of immature, nonvital permanent tooth using platelet-rich fibrin in children.

The purpose of this paper was to present a new approach wherein revascularization of the immature, nonvital permanent tooth was performed using platelet-rich fibrin (PRF) as a novel scaffold material. This was performed after disinfection of the root canal space using triple antibiotic paste followed by placing a PRF membrane in the root canal. The patient was followed up regularly at three-, six-, nine-, and 12-month intervals for review. After 12 months, clinical examination showed negative response to percussion and palpation tests but positive response to cold and electric pulp tests. Radiographic examination revealed continued thickening of the root dentinal walls, narrowing of root canal space, root lengthening, and closure of the root apex with normal periradicular architecture. However, more clinical research using large samples is necessary to prove it advantageous for regenerative endodontic therapy in children.

Oral pathologies of the Neolithic Iceman, c.3,300 BC.

The famous Iceman 'Ötzi' (South Tyrol Museum of Archaeology, Bolzano, Italy), a Neolithic human ice mummy, offers a unique opportunity to study evolutionary aspects of oral disease. The aim of this study was to assess, for the very first time, his oral cavity, which surprisingly had never been examined systematically. Based on several computed tomography (CT) scans from 1991 onwards and on macroscopic investigation, only a few findings, such as a central maxillary diastema, heavy abrasions, and missing wisdom teeth, were known. We re-evaluated the latest CT scans from 2005 and found various oral pathologies. In line with the increase of tooth decay in the Neolithic - because of diet change in this historic transition phase - several carious lesions were found, one of which penetrated into the dental pulp. In accordance with the Iceman's troubled life, as several injuries on his body and his violent death attest, mechanical trauma of one of his upper front teeth is evident. Finally, the poor periodontal condition of the Iceman's dentition (e.g. loss of alveolar bone), indicative of periodontitis, was assessed. These oral pathological findings in the Iceman's dentition provide a unique glimpse into the evolutionary history of oral conditions.

Are you treating planned cases or treating teeth to stay busy?

Responsible aesthetics and comprehensive care requires a thorough patient examination and evaluation of risk factors that help to prevent and curtail re-restoration and more aggressive tooth preparation. Managing identified risks that could potentially lead to otherwise piecemeal dental procedures keeps dentists treating comprehensively planned cases, not just teeth. Dentistry that is comprehensive, desired, and evidence-based is a valuable service to patients and a satisfying endeavor for dentists and their teams. By choosing between the sure thing of a quick fix and discussing what the patient wants, dentists can embrace a MI, responsible aesthetic approach to treatment planning, case acceptance, and most importantly, patient oral care.

Surgical repositioning of osseointegrated malposed dental implant with segmental osteotomy.

After extensive research, the practice with dental implants has been used on a large scale. With the increase in its indications in various local conditions, more complications have been observed. Among these, one of the most frequent is the installation of the implants in a three-dimensional altered position, making the prosthesis and aesthetics more difficult to achieve. For this reason, techniques such as segmental osteotomy have been developed and adapted to implantology to reestablish the adequate position of these implants with correct aesthetic outcome and function. The present clinical report shows the segmental osteotomy technique in a malposed osseointegrated dental position of the upper central incisor with 1-year follow-up.

Tratamiento integral de las avulsiones dentarias: evolución y seguimiento / Comprehensive treatment of tooth avulsions: evolution and follow-up

El estudio incluyó 66 pacientes cuyuas edades oscilaban entre los 7 y 15 años, 44 varones y 22 mujeres, con 70 avulsiones en piezas dentarias permanentes, de las cuales 67 se produjeron en el maxilar superior y 3 en el maxilar inferior; 57 fueron incisivos centrales superiores, 10 incisivos laterales superiores y 3 incisivos centrales inferiores. Los pacientes bajo estudio fueron tratados de urgencia y tu y tuvieron un seguimiento mínimo de dos años en el área de residencia del Hospital Zonal Especializado en Odontología Infantil Dr. A. Bollini, de la ciudad de La Plata, en el período comprendido entre junio de 2003 y diciembre de 2009. Del total de piezas dentarias avulsionadas, 19 presentaban ligamento periodontal vital y 51 ligamento periodontal no vital. En los casos de avulsiones con ligamento periodontal vital, luego del tratamiento integral adecuado se detectó un 21,05 por ciento (N=4) con reabsorción sustitutiva y un 5.26 por ciento (N=1) con reabsorción inflamatoria, mientras que en el 73,68 por ciento (N=14) de los casos se observáo reabsorción superficial transitoria. En cuanto al pronóstico pulpar, todas las piezas dentarias sufrieron necrosis. En aquellos casos con ligamento periodontal no vital (N=51), luego del tratamiento integral adecuado, un 96,07 por ciento (N=49) de los casos presentaron reabsorción sustitutiva y un 3, 92 por ciento (N=2) reabsorción superficial. No se detectaron, en ningún caso, reabsorciones inflamatorias. Todos los casos tuvieron un seguimiento mínimo de dos años. Los pacientes con lesiones traumáticas deben ser tratados en forma integral, esto significa resolver no sólo correctamente la situación de urgencia, sino también hacer un adecuado seguimiento para realizar las intervenciones pertinentes en cada caso en particular, mejorando así el pronóstico.(AU)

Tratamiento integral de las avulsiones dentarias: evolución y seguimiento / Comprehensive treatment of tooth avulsions: evolution and follow-up

El estudio incluyó 66 pacientes cuyuas edades oscilaban entre los 7 y 15 años, 44 varones y 22 mujeres, con 70 avulsiones en piezas dentarias permanentes, de las cuales 67 se produjeron en el maxilar superior y 3 en el maxilar inferior; 57 fueron incisivos centrales superiores, 10 incisivos laterales superiores y 3 incisivos centrales inferiores. Los pacientes bajo estudio fueron tratados de urgencia y tu y tuvieron un seguimiento mínimo de dos años en el área de residencia del Hospital Zonal Especializado en Odontología Infantil Dr. A. Bollini, de la ciudad de La Plata, en el período comprendido entre junio de 2003 y diciembre de 2009. Del total de piezas dentarias avulsionadas, 19 presentaban ligamento periodontal vital y 51 ligamento periodontal no vital. En los casos de avulsiones con ligamento periodontal vital, luego del tratamiento integral adecuado se detectó un 21,05 por ciento (N=4) con reabsorción sustitutiva y un 5.26 por ciento (N=1) con reabsorción inflamatoria, mientras que en el 73,68 por ciento (N=14) de los casos se observáo reabsorción superficial transitoria. En cuanto al pronóstico pulpar, todas las piezas dentarias sufrieron necrosis. En aquellos casos con ligamento periodontal no vital (N=51), luego del tratamiento integral adecuado, un 96,07 por ciento (N=49) de los casos presentaron reabsorción sustitutiva y un 3, 92 por ciento (N=2) reabsorción superficial. No se detectaron, en ningún caso, reabsorciones inflamatorias. Todos los casos tuvieron un seguimiento mínimo de dos años. Los pacientes con lesiones traumáticas deben ser tratados en forma integral, esto significa resolver no sólo correctamente la situación de urgencia, sino también hacer un adecuado seguimiento para realizar las intervenciones pertinentes en cada caso en particular, mejorando así el pronóstico.

Histomorphometric analysis of inflammatory response and necrosis in re-implanted central incisor of rats treated with low-level laser therapy.

Low-level laser therapy is a tool employed in the management of post-operative inflammation process and in the enhancement of reparative process. The aim of the study was to perform histological evaluation of dental and periodontal ligament of rats central upper-left incisor teeth re-implanted and irradiated with low-level laser (InGaAl, 685 nm, 50 J/cm(2)) 15, 30, and 60 days after re-implantation. Seventy-two male rats had the central upper left incisor removed and kept for 15 min on dry gauze before replantation. Laser was irradiated over the root surface and empty alveolus prior replantation and over surrounding mucosa after the re-implantation. After histological procedures, all slices were analyzed regarding external resorption area and histological aspects. We observed an increase of root resorption (p < 0.05) in the control group compared to the laser group at 15, 30, and 60 days. These results showed that the laser groups developed less root resorption areas than the control group in all experimental periods. Additionally, histological analysis revealed less inflammatory cells and necrotic areas in laser groups.

Preservation of an injured vital tooth using ultrasonic device and mineral trioxide aggregate.

The purpose of this case report is to present a root fracture repair procedure for non devitalized injured tooth. One injured, non-endodontically treated maxillary anterior tooth in which an incomplete vertical root fracture involving only the buccal side was suspected, underwent an exploratory flap to visualize the pattern of bone loss and assess the type of root fracture. The pre-operative diagnosis was confirmed. A groove following fracture line was prepared using retro-tips driven by an ultrasonic device and sealed with Mineral Trioxide Aggregate (MTA), following filling of the bone defect with Calcium Sulphate. At 24 months follow up the case showed clinical and radiographic success. The present surgical approach showed preservation of function and vitality of tooth with a shallow incomplete vertical root fracture.

Case report: laser-assisted rebonding of a central incisor tooth due to a severe trauma - 4 years of follow-up.

BACKGROUND: The success of reattaching fractured tooth crowns fragments, as a result of trauma, has improved as a result of the introduction of lasers in dental care. This case report documents a 4 year follow-up of a re-bonded tooth fragment on a maxilary first permanent incisor. CASE REPORT: An 8-year-old girl presented with a fractured maxillary might first permanent incisor (II) as a result of a severe trauma. The child's parents had preserved the tooth fragment in a glass of milk immediately after the injury. TREATMENT: An Er,Cr:YSGG Laser with a wavelength of 2,780 nm was used with 20Hz, 5 W (250 mJ), 90 % air, 80% water for etching of the enamel and 20 Hz, 3W (150 mJ), 65% air, 55% water for dentine etching with a G6 (600 micron, sapphire, 6mm long) tip. For conditioning the enamel and dentine no additional acid etching was used. Only a 2 step self-etched adhesive system Clearfil Protect® (Kuraray Medical, Japan) was applied. Then a flowable composite resin, Grandi Flow® (Voco, Cuxhaven, Germany) was applied in order to bind the broken fragment onto the tooth. FOLLOW-UP: The re-bonded tooth fragment has been retained in place and symptom free, as assessed by clinical examination, intraoral photographs and radiographs for a period of 4 years. CONCLUSION: Laser-assisted re-bonding of a tooth fragment was found to be successful.

Study of the effectiveness of propolis extract as a storage medium for avulsed teeth.

The purpose of the present study was to evaluate the efficacy of propolis extract in maintaining the viability of human periodontal ligament (PDL) cells, and to radiographically analyze tooth replantation and the adjacent periodontium in dogs after storage in this extract. Human PDL cells were incubated with the experimental media propolis, milk, saliva, Hank's balanced salt solution (HBSS), and Dulbecco's modified Eagles medium (DMEM, positive controls), and distilled water (negative control). Cell viability was determined 0, 1, 3, 6, 12, and 24 h later by colorimetric MTT assay. Thirty incisors from dogs were divided into two storage time blocks (1 and 3 h) and were maintained in the experimental media. HBSS served as a positive control, and dry teeth (on gauze) as a negative control. The replanted teeth were radiographed once per month for 6 months. The radiographic images were standardized by the shortening/lengthening factor, and were both qualitatively and quantitatively analyzed. The in vitro results showed that the efficacy of propolis in maintaining functional viability of PDL cells was similar to that of milk. Propolis and milk were significantly better than controls from the 6-h time period. The in vivo results showed that teeth maintained in propolis medium exhibited replacement resorption with significant reduction in tooth length, similar to teeth maintained in saliva and dried teeth. This resorption was less intense with the 3-h storage time than the 1-h storage time. Conditions close to normal were found in teeth maintained in milk, similar to the HBSS control. Therefore, although propolis was effective in maintaining the viability of human PDL cells, resorption of the tooth replantation in dogs occurred under these experimental conditions.

Prevalence of dental trauma in Pan American games athletes.

The aim of this cross-sectional epidemiological survey was to assess the prevalence of dental trauma in athletes representing 42 countries competing at the most recent Pan American Games (XV Pan Am) held in Rio de Janeiro, Brazil in July of 2007, and to determine prior use and type of mouthguard among this group of athletes. The examiners participated in standardization and calibration training sessions before the field phase began. Invitations were sent to >5500 participating athletes competing in 41 sports and to the Medical Committee of the Pan American Sports Organization before and during the XV PAN. A convenience sample of 409 athletes was recruited. After signing an informed consent, all athletes answered a questionnaire. Data were collected at the clinical examination and recorded on a specific trauma form. The mean age of the athletes was 24.4 +/- 5.3 years. Males comprised 55% of the sample; females 45%. The prevalence of dental trauma among the athletes was 49.6% (n = 203) with no gender-based differences. Most of these injuries (63.6%) were related to activities during training or competition. Sports with the highest injury prevalence were wrestling (83.3%), boxing (73.7%), basketball (70.6%) and karate (60%). The most common injury was enamel fracture (39.8%); root fracture was the least common (0.4%). The teeth most affected were the maxillary permanent central incisors (n = 113), followed by the mandibular central incisors (n = 19). Based on the results of this study, nearly one-half of the subjects had experienced previous dental trauma; the majority related to sports activities. Furthermore, only 17% of the athletes reported prior mouthguard use; the most frequent mouthguards reported were boil-and-bite. These results suggest the importance of enhanced educational efforts and the use of properly fitted mouthguards to reduce dental trauma among athletes in international sports competition, especially in sports where mouthguards are not mandatory.