Prevalence of pulp canal obliteration after traumatic dental injuries: a systematic review and meta-analysis.

This systematic review aimed to answer the following question: What is the estimated prevalence of pulp canal obliteration in subtypes of traumatic dental injury (TDI) in deciduous and permanent teeth? The searches were conducted in PubMed, Embase, Scopus, Web of Science, LILACS, Grey Literature, and Google Scholar, and complemented by a manual search, until April 16th, 2023. Observational studies were selected based on population, exposure, and outcome (PEO) (P, deciduous or permanent teeth; E, TDI; O, pulp canal obliteration). Two reviewers (kappa 0.90) applied the eligibility criteria, extracted qualitative data, and assessed the methodological quality using the Newcastle-Ottawa tool. A meta-analysis was performed using MedCalc 17.2. Thirty-four articles were selected after screening. The methodological quality was moderate to high. The estimated prevalence of pulp canal obliteration was 27.6% (95%CI: 18.7-37.7) and 21.9% (95%CI:16.0-28.4), for permanent and deciduous teeth, respectively. Considering the TDI subtypes, the prevalence of pulp canal obliteration was higher in root fractures of the permanent teeth (78.6 %, 95%CI: 62.8-90.9) and lateral luxation injuries in deciduous teeth (29.4%, 95%CI:19.1-41.0). Our review of 34 articles of moderate and high methodological quality found that the prevalence of pulpal canal obliteration ranges from 21.9% to 27.6%. Pulp canal obliteration was most frequently detected following lateral luxation injuries of the deciduous teeth and root fractures of the permanent teeth (PROSPERO CRD42020179438).

The orthodontic-endodontic interface: trauma and pulpal considerations.

The interpretation of the clinical signs and symptoms arising from the interdisciplinary relationship between orthodontics and endodontics becomes more complicated when superimposed by dental trauma. A history of dental trauma before or during orthodontic tooth movement may have implications for pulpal health and clinical outcomes. An understanding of the biology is essential for appropriate treatment planning. This review and treatment recommendations will assist dental practitioners in managing orthodontic-endodontic interactions.

Pulp Survival of Cracked Teeth with Reversible Pulpitis after Orthodontic Banding and Coronal Coverage - A Prospective Cohort Study with One Year Follow Up.

INTRODUCTION: The aim of this prospective study was to investigate the 1-year pulp survival of cracked teeth with reversible pulpitis managed with initial stabilization using orthodontic bands, followed by coronal coverage restorations. METHODS: One-hundred-and-twenty-five patients with a cracked tooth with reversible pulpitis each were recruited. Preoperative patient and tooth data were collected. After definitive pulp diagnoses were determined following an interim period of orthodontic banding, coronal coverage restorations were placed. Cox and logistic regression analyses were used to assess possible prognostic factors and to correlate initial time to pulp stabilization while in orthodontic bands with eventual outcome. Pulp survival was determined using both clinical and radiographic findings. RESULTS: One-hundred-and-six cracked teeth were followed up at 1 year. Pulp survival based on clinical and radiographic findings was found in 81 teeth (76.4%). Out of 25 failures, 11 (44%) required root canal treatment (RCT) in the orthodontic band stage and 10 (40%) required RCT during the process of or after coronal coverage restorations. Four teeth (16%) had incidental findings of periapical radiolucencies at the 1-year review without clinical symptoms. Teeth requiring RCT were found to have required longer periods in orthodontic bands prior to a definitive pulp diagnosis (P < .05). CONCLUSION: A step-by-step approach by using orthodontic banding to monitor pulp status may reduce the incidence of RCT required through definitive coronal coverage restorations for cracked teeth with reversible pulpitis.

The consequences of Dental trauma.

Traumatic dental injuries pose a variety of complex ongoing issues to the dental practitioner. As dental injuries are commonly experienced at a young age, the treatment often takes place during adolescence or early in adulthood years at crucial development stages and very early in the life of the permanent successor. Therefore, the ability to correctly diagnose the injury, and follow an appropriate management plan should increase practitioners' ability to improve both the outcomes of dental trauma and long-term prognosis of the tooth.The consequences of dental trauma can be explored by taking into consideration the type of injury, which enables an assessment of the degree of insult to the pulpal tissues, neurovascular bundle, periodontal ligament and cemental cells. This has a direct influence on post-trauma complications. Early intervention, where indicated, and appropriate follow-up utilising international guidelines is imperative to identify changing diagnoses and act accordingly. This review paper will discuss the classification of traumatic injuries and their associated outcomes with management strategies for emerging disease including potential endodontic and restorative complexities and when to refer to secondary care.

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.

Long-term Outcome of Endodontically Treated Traumatized Immature Upper Incisors.

INTRODUCTION: In a growing child, preservation of traumatized immature permanent upper incisors is challenging. This study aimed to evaluate the long-term outcome of endodontically treated traumatized immature upper incisors and associated variables. METHODS: A total of 183 traumatized immature upper incisors treated with pulpotomy, apexification, or regenerative endodontic procedure (REP), with follow-up between 4 and 15 years, were assessed for presence of pulpal responses or periodontal/bone responses using standardized clinical and radiologic criteria. Logistic regression, including stage of root development, type and complexity of traumatic event, type of endodontic intervention, and history of orthodontic management, were used to estimate impact on tooth survival and occurrence of tissue responses. Study approved by Ethics Committee Research UZ/KU Leuven (S60597). RESULTS: After a median follow-up of 7.3 years (interquartile range, 6.1-9.2), 159 teeth (86.9%) were still functional. From these teeth, 58 (36.5%) developed tissue responses. This was significantly associated with stage of root development at moment of trauma (root length <¾) and type of endodontic intervention (REP presenting worst outcome). Tooth loss (24 teeth, 13.1%) occurred after a mean time span of 3.2 years (±1.5) and was significantly associated with type and complexity of the traumatic event and type of endodontic intervention, with apexification showing better results than REP (odds ratio, 0.30; 95% confidence interval, 0.11-0.79). CONCLUSIONS: A large number of endodontically treated traumatized immature teeth could be kept functional. Very immature teeth, teeth with periodontal tissue damage, and teeth treated with REP were at highest risk for an unfavorable outcome.

A 12-month Follow-Up Study of Pulp Oxygen Saturation in Deciduous Molars After Selective and Nonselective Carious-Tissue Removal: A Randomized Pilot Trial

ABSTRACT Objective: To compare the pulp vitality of deciduous molars before and after selective caries removal (SCR) or nonselective caries removal to hard dentin (NSCR) over one year, using oxygen saturation percentage (%SaO2). Material and Methods: Deciduous molars with deep occlusal/proximal-occlusal caries lesions were randomized to SCR (n=22) or NSCR groups (n=22). After the caries removal, the teeth were protected with calcium hydroxide cement and restored with composite resin (Filtek Z250). The pulp condition diagnosis was evaluated at baseline, immediately after caries removal, and follow-up (7 days, 1-, 6- and 12-months) by %SaO2. Pulp exposure and pulp necrosis were primary outcomes, and %SaO2 was secondary. Results: Intraoperative pulp exposure occurred in four teeth of the NSCR group (18.2%) and one tooth of the SCR group (4.5%) (p>0.05). Two cases of pulp necrosis occurred in the NSCR group (10%). No difference in %SaO2 pulp was observed in the inter-and intragroup comparison over time (p>0.05). Conclusion: Advantageously, the %SaO2 minimizes preoperatory pulp vitality diagnosis subjectivity before SCR/ NSCR treatments. Furthermore, the pilot study results suggest the pulp response of deciduous molars, when evaluated by clinical, radiographic, and pulp %SaO2 seems not to differ between teeth treated with SCR or NSCR.

[Diagnosis and treatment planning of traumatic dental injury].

Traumatic dental injury (TDI), one of the common dental diseases, is defined as acute injuries to tooth hard tissues, dental pulp and/or periodontal tissues caused by sudden forces. Based on the Guidelines for the Management of TDI by International Association of Dental Traumatology (2012) and the Recommended Guidelines of the American Association of Endodontists for the Treatment of TDI (2013) for the permanent teeth, and combined with the authors' clinical experiences, the contemporary classification and clinical perspective of TDI were introduced in detail. Dental clinicians should understand and master the international guidelines for the management of TDI, including proper diagnosis, standardized treatments and regular follow-up, so as to obtain the favorable outcomes.

Analgesic and Neuroprotective Effects of Electroacupuncture in a Dental Pulp Injury Model-A Basic Research.

Irreversible pulpitis is an extremely painful condition and its consequence in the central nervous system (CNS) remains unclear. A mouse model of dental pulp injury (DPI) resembles the irreversible pulpitis profile in humans. This study sought to determine whether pain induced by DPI activates microglia and astrocytes in the trigeminal subnucleus caudalis (Vc), as well as increases levels of proinflammatory cytokines, and whether electroacupuncture (EA) can be a potential analgesic and neuroprotective therapy following DPI. Pain behavior was measured via head-withdrawal threshold (HWT) and burrowing behavior at days 1, 3, 7, 14 and 21 after DPI. A marked decrease in HWT and burrowing activity was observed from day 1 to 14 after DPI and no changes were seen on day 21. Microglial and astrocytes activation; along with high cytokine (TNFα, IL-1ß, and IL-6) levels, were observed in the Vc at 21 days after DPI. These effects were attenuated by verum (local and distal) EA, as well as oral ibuprofen administration. The results suggest that DPI-induced pain and glial activations in the Vc and EA exert analgesic efficacy at both local and distal acupoints. Furthermore, verum (local and distal) EA might be associated with the modulations of microglial and astrocytes activation.

Extreme intrusive force affects the expression of c-Fos and matrix metallopeptidase 9 in human dental pulp tissues.

This study aimed to investigate the expression of c-Fos and matrix metallopeptidase 9 (MMP-9) in dental pulp of patients receiving orthodontic treatment via wire appliance.Fifteen patients (30 teeth in total) were randomly assigned to five groups: t = 0, t = 1, t = 4, t = 8 and t = 12 (n = 6). The first maxillary premolars of patients in the t = 0 group were extracted without any orthodontic treatment. An intrusive force of 300 g was applied on first maxillary premolars in the other four groups via wire appliances. This force was maintained for 1 week for t = 1 group, 4 weeks for t = 4 group, 8 weeks for t = 8 group, or 12 weeks for t = 12 group, before the teeth were extracted.The expression of c-Fos and MMP-9 in the pulps of each group was analyzed by immunohistochemical staining and real-time PCR. The relationship in the protein expression between c-Fos and MMP-9 in the dental pulp was analyzed by Pearson correlation analysis.Intrusive force of 300 g increased the expression of both c-Fos and MMP-9 in the dental pulp. The protein expression of MMP-9 in the dental pulp was significantly correlated with the expression of c-Fos (P < .001).Extreme intrusive force upregulates c-Fos and MMP-9 expression in the dental pulp. Moreover, protein expression of c-Fos and MMP-9 is significantly correlated under intrusive force.

Evoked and spontaneous pain assessment during tooth pulp injury.

Injury of the tooth pulp is excruciatingly painful and yet the receptors and neural circuit mechanisms that transmit this form of pain remain poorly defined in both the clinic and preclinical rodent models. Easily quantifiable behavioral assessment in the mouse orofacial area remains a major bottleneck in uncovering molecular mechanisms that govern inflammatory pain in the tooth. In this study we sought to address this problem using the Mouse Grimace Scale and a novel approach to the application of mechanical Von Frey hair stimuli. We use a dental pulp injury model that exposes the pulp to the outside environment, a procedure we have previously shown produces inflammation. Using RNAscope technology, we demonstrate an upregulation of genes that contribute to the pain state in the trigeminal ganglia of injured mice. We found that mice with dental pulp injury have greater Mouse Grimace Scores than sham within 24 hours of injury, suggestive of spontaneous pain. We developed a scoring system of mouse refusal to determine thresholds for mechanical stimulation of the face with Von Frey filaments. This method revealed that mice with a unilateral dental injury develop bilateral mechanical allodynia that is delayed relative to the onset of spontaneous pain. This work demonstrates that tooth pain can be quantified in freely behaving mice using approaches common for other types of pain assessment. Harnessing these assays in the orofacial area during gene manipulation should assist in uncovering mechanisms for tooth pulp inflammatory pain and other forms of trigeminal pain.

Evaluation and diagnosis of the traumatized dentition.

Traumatic dental injuries comprise a number of the dental emergency patients who are often seen after hours or on an unscheduled basis in a dental practice environment. Although there are a variety of traumatic dental injuries that can occur, each with their own recommended treatment protocols, the initial evaluation and diagnosis of the traumatized dentition make up a critical aspect of the management of these cases. This article will highlight the key components of a thorough and efficient examination process of the traumatized dentition to include (a) documenting an accurate history of the events causing the injury, (b) performing a systematic clinical examination to include the use of clinical photographs and pulp sensibility tests, (c) obtaining appropriate radiographic images and scans, (d) understanding some considerations unique to evaluating young patients with traumatic injuries, and (e) recognizing the importance of having accurate and thorough documentation of these types of cases. Once the evaluation and diagnosis phase has been completed, the necessary treatment protocols can be initiated in an appropriate manner.

Pulp aspects of traumatic dental injuries in primary incisors: Dark coronal discoloration.

Dark coronal discoloration is a common outcome of traumatic dental injuries in primary incisors. However, there are only a few research studies on the mechanism that causes dark discoloration, the condition of the pulp, and the preferred treatment of such teeth. This article is a summary of the author's research studies and personal experience regarding dark coronal discoloration of traumatized primary incisors.

Vitality Tests for Pulp Diagnosis of Traumatized Teeth: A Systematic Review.

INTRODUCTION: The objective of this systematic review was to evaluate the efficacy of vitality tests (pulse oximetry and flowmetry) in the pulpal diagnosis of traumatized teeth in comparison with sensibility tests. METHODS: This review was registered in the PROSPERO database (CRD42018097361) and was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An electronic systematic search of the literature was performed in the PubMed (Medline), Scopus, Web of Science, Cochrane Library, Lilacs, and Gray Literature databases and the reference lists of articles published until May 2018. The data of the included articles were extracted, and the methodological quality was judged using the QUADAS-2 quality assessment tool following the Cochrane recommendations. RESULTS: The initial search retrieved 173 potential articles. After the duplicates were removed, 77 articles remained; the titles and abstracts of these 77 articles were read, resulting in the selection of 19 articles for reading the full text. Five articles were selected for data extraction and qualitative analysis. The vitality tests evaluated in the studies were pulse oximetry, laser Doppler flowmetry, and ultrasound Doppler flowmetry compared with cold testing, electrical testing, or both. In all articles, the results were favorable for vitality tests; however, a high risk of bias was found in at least 1 item of the quality evaluation of the included studies. CONCLUSIONS: Because of the high risk of bias and deficiency in the research design, there is still a need for further studies in relation to pulse oximetry, laser Doppler flowmetry, and ultrasound Doppler flowmetry, which consistently prove the diagnostic accuracy and superiority when compared with sensibility tests on traumatized teeth.

Dissecting dentine-pulp injury and wound healing responses: consequences for regenerative endodontics.

A thorough understanding of the biology of the dentine-pulp complex is essential to underpin new treatment approaches and maximize clinical impact for regenerative endodontics and minimally invasive vital pulp treatment (VPT) strategies. Following traumatic and carious injury to dentine-pulp, a complex interplay between infection, inflammation and the host defence responses will occur, which is critical to tissue outcomes. Diagnostic procedures aim to inform treatment planning; however, these remain clinically subjective and have considerable limitations. As a consequence, significant effort has focussed on identification of diagnostic biomarkers, although these are also problematic due to difficulties in identifying appropriate diagnostic fluid sources and selecting reproducible biomarkers. This is further compounded by the link between inflammation and repair as many of the molecules involved exhibit significant multifunctionality. The tertiary dentine formed in response to dental injury has been purposefully termed reactionary and reparative dentine to enable focus on associated biological processes. Whilst reactionary dentine produced in response to milder injury is generated from surviving primary odontoblasts, reparative dentine, in response to more intense injury, requires the differentiation of new odontoblast-like cells derived from progenitor/stem cells recruited to the injury site. These two diverse processes result in very different outcomes in terms of the tertiary dentine produced and reflect the intensity rather than specific nature (nonexposure versus exposure) of the injury. The subsequent identification of the odontoblast-like cell phenotype remains challenging due to lack of unique molecular or morphological markers. Furthermore, the cells ultimately lining the newly deposited dentine provide only a snapshot of events. The specific source and plasticity of the progenitor cells giving rise to the odontoblast-like cell phenotype are also of significant debate. It is likely that improved characterization of tertiary dentine may better clarify the influence of cell derivation for odontoblast-like cells and their diversity. The field of regenerative endodontics offers exciting new treatment opportunities, and to maximize outcomes, we propose that the term regenerative endodontics should embrace the repair, replacement and regeneration of dentine-pulp.

Promotion of Dental Pulp Wound Healing in New Zealand White Rabbits' Teeth by Thai Propolis Product.

This study examined and compared wound healing between Thai propolis product and calcium hydroxide paste as pulp-capping agents after partial pulpotomy in New Zealand white rabbits. Forty incisor teeth from 10 rabbits were treated. Thirty-six teeth received class V cavity preparations with partial pulpotomy and application of either propolis or calcium hydroxide paste. Similar cavity preparations were performed in 2 teeth without any capping material as a positive control, whereas 2 teeth without the cavity preparation served as a negative control. Histological evaluation showed that both groups had dentin bridge formation. Dentinal tubules in the dentin bridge were more orderly arranged in the Thai propolis group than in the calcium hydroxide group. Wound healing and the median number of hyperemic blood vessels were not statistically significant different between the 2 groups. Thai propolis product may be used as a pulp-capping agent.

Tooth pulp injury induces sex-dependent neuronal reshaping in the ventral posterolateral nucleus of the rat thalamus.

Orofacial injuries often result in persistent pain and are therefore considered a common health problem worldwide. Considerable evidence suggests that peripheral sensory nerve injury results in diverse plastic changes in the central nervous system (CNS). Tooth pulp is innervated by trigeminal afferents which extend to the trigeminal brainstem sensory nuclear complex and send input to higher level neurons in the CNS, including the ventral posterolateral nucleus of the thalamus (VPL). In the present study, we examined the long term effects of pulpal injury on neuronal arborization in the VPL using morphological analysis via Golgi-Cox staining. In addition, we examined these effects in both male and female rats due to the major prevalence of oral pain in women. Quantitative morphological analysis revealed that pulpal injury induced neuronal hypertrophy in VPL neurons of female rats. In clear contrast, pulpal injury increased arborization close to the soma and reduced arborization distal to the soma without modification of total dendritic length in male rats. As a result, we show, for the first time, sex-dependent morphological alterations in VPL neurons after orofacial peripheral injury. Since dental injuries are readily reproducible in rat dental molars and closely mimic the clinical setting in humans, this model represents a useful tool to further understand mechanisms of orofacial pain.

Dental Imaging - A basic guide for the radiologist. / Dentale Bildgebung ­ Eine Einführung für den Radiologen.

BACKGROUND: As dental imaging accounts for approximately 40 % of all X-ray examinations in Germany, profound knowledge of this topic is essential not only for the dentist but also for the clinical radiologist. This review focuses on basic imaging findings regarding the teeth. Therefore, tooth structure, currently available imaging techniques and common findings in conserving dentistry including endodontology, periodontology, implantology and dental trauma are presented. METHODS: Literature research on the current state of dental radiology was performed using Pubmed. RESULTS AND CONCLUSION: Currently, the most frequent imaging techniques are the orthopantomogram (OPG) and single-tooth radiograph, as well as computer tomography (CT) and cone beam CT mainly for implantology (planning or postoperative control) or trauma indications. Especially early diagnosis and correct classification of a dental trauma, such as dental pulp involvement, prevents from treatment delays or worsening of therapy options and prognosis. Furthermore, teeth are commonly a hidden focus of infection.Since radiologists are frequently confronted with dental imaging, either concerning a particular question such as a trauma patient or regarding incidental findings throughout head and neck imaging, further training in this field is more than worthwhile to facilitate an early and sufficient dental treatment. KEY POINTS: · This review focuses on dental imaging techniques and the most important pathologies.. · Dental pathologies may not only be locally but also systemically relevant.. · Reporting of dental findings is important for best patient care.. CITATION FORMAT: · Masthoff M, Gerwing M, Masthoff M et al. Dental Imaging - A basic guide for the radiologist. Fortschr Röntgenstr 2019; 191: 192 - 198.

Management of After-Hours Pediatric Dental Emergencies Among Pediatric and General Dentists.

Purpose: Assess how pediatric dentists (PD) and general practitioners (GP) manage after-hours pediatric dental emergencies according to perceived urgency. Methods: A survey was e-mailed to PD and GP in North Carolina. Participants responded to management of 18 cases (primary and permanent dentition) according to perceived urgency. Repeated-measures logistic regression was used to analyze factors influencing perception of clinical scenarios. Results: Response rates for PD and GP were 45.5% and 36.3%, respectively. Perceived urgency varied by clinical scenarios, dentition (primary vs. permanent), and practitioner (PD vs. GP) (P<.001). Practitioners with fewer years in practice or seeing fewer pediatric patients managed more cases as urgent. Traumatic injuries in primary dentition (intrusion, pulp exposure, palatal displacement, avulsion) were managed as more urgent by GP than PD (P<.001). Emergencies related to infection and permanent dentition were perceived similarly by PD and GP. Conclusions: Clinical scenarios highlighted disagreement in the management of after-hours pediatric dental emergencies between GP and PD, especially trauma in primary dentition. General practitioners tended to refer to an ED or see urgently, and PD tended to defer care. By identifying needs for improved education in dental trauma management, we can increase utilization of the dental home, avoiding use of overburdened EDs.

Factors associated with dental fractures in Brazilian individuals.

AIM: The aim of the present study was to assess the association of sex, age, group of teeth, and type of accident (exposure) with dental fractures (outcome: enamel-dentine fracture without [EDF] or with pulp exposure [EDPF] and root fracture RF]). METHODS: In total, 1046 patients were selected. Logistic binary regression was used. RESULTS: The findings showed that EDF has less change of affecting individuals ≤9 years of age than ≥40 years of age (odds ratio [OR]: 0.58, 95% confidence interval [CI]: 0.35-0.95). Violence (OR: 3.07, 95% CI: 1.77-5.31), traffic accidents (OR: 1.50, 95% CI: 1.05-2.13), and sporting accidents (OR: 1.70, 95% CI: 1.19-2.44)] were associated with EDF. Regarding EDPF, the mandibular lateral incisors had a 10 times higher chance of being injured than canines and posterior teeth (OR: 10.43, 95% CI: 1.74-62.4). Those aged ≤9 years (OR: 0.21, 95% CI: 0.07-0.58) and 10-19 years (OR: 0.38, 95% CI: 0.17-0.88) had a significantly lower chance of being affected by RF. CONCLUSION: EDF and RF are associated with individuals ≥40 years of age; violence and traffic and sporting accidents are also associated with EDF, and mandibular incisors have a greater chance of being affected by EDPF.