The risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment: a systematic review and meta-analysis.

PURPOSE: To identify the factors affecting the risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment. METHODS: The study protocol followed the best practices of evidence-based medicine and was registered in PROSPERO. A comprehensive literature search was performed electronically in six databases (PubMed, Embase, SCOPUS, Web-of-Science, Lilacs, and Cochrane) on 18-09-2023. It was saved in EndNote-online and duplicates were removed. Selection of articles was performed in two stages, followed by data-extraction, risk of bias assessment, data-analysis, and meta-analysis. The quality of evidence for the outcomes was assessed by the GRADE-approach. RESULTS: The study included six articles that had similar selection protocols with variations in duration from trauma to treatment and the observation period. Only one study employed pre-attachment fragment preparation and three performed post-attachment reinforcements. Overall loss of fragment was 20% (95%CI-13,30%). When the risk ratio for loss of restoration or fragment was compared, it was found to be 2.21 (95%CI-1.52,3.21) in uncomplicated crown fractures, 2.54 (95%CI-1.35,4.79) in complicated crown fractures. The risk of bias was found to be low in two and moderate in four studies. Grade of evidence for all the outcomes was very low. CONCLUSION: Fragment loss was lowest in uncomplicated crown fractures where reinforcement had been performed, and highest when bonding was done in complicated crown fractures without reinforcement. The risk of fragment loss was higher than the loss of composite restorations.

Contemporary issues in the management of dental trauma.

Contemporary diagnosis and management of traumatic dental injuries requires a multifaceted understanding of the pathological and psychological impact over a patient's lifetime. The legacy of dental trauma injuries can have repercussions for the dentition and supporting tissues, requiring complicated multidisciplinary clinical input. Foresight is required to ensure optimal aesthetic and functional outcomes. Mitigating risks and maximising benefits in patients presenting with polytrauma can be challenging, but if optimally managed at the acute presentation, the long-term burden to the patient and the clinician is reduced. This paper aims to discuss the contemporary clinical dilemmas, challenges and controversies related to the management of dental trauma.

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.

Prevalence of sports-related traumatic orofacial and dental injuries in Asian countries: a systematic review and meta-analysis.

INTRODUCTION: The head and face, due to their prominent positions, are at risk of intentional and unintentional injuries in the majority of competitive sports. There are regional preferences for sports and differences in infrastructural facilities. The majority of the recommendations for sports have been based on the studies conducted in the western world. Hence, this systematic review aimed to estimate the prevalence of sports-related orofacial and dental injuries in professional-sportspersons living in Asian countries. EVIDENCE ACQUISITION: A protocol was prepared as per the best practices of evidence-based medicine and registered (PROSPERO-CRD42021252488). Search strategy was based on the research question and conducted in six databases using text words and MeSH terms. Scrutiny of title and abstracts and later full-texts were done as per eligibility criteria. Data extraction was done using a pre-piloted sheet and the risk of bias (ROB) was assessed. Qualitative synthesis and meta-analyses were performed and the strength of evidence was assessed by using GRADE-approach. EVIDENCE SYNTHESIS: Twenty-three studies published between 1998 to 2021 and from nine countries were included. The highest numbers were from Türkiye (N.=7). The total number of professional sportspersons assessed in all the included studies was 14,457. The highest prevalence of orofacial and dental injuries observed was 66.18% and the highest prevalence of dental injuries was 39.81%. Low risk of bias was seen only in four studies. The changes were observed during the sensitivity analysis with all the meta-analyses showing significant publication bias and heterogeneity. CONCLUSIONS: The pooled prevalence of the combined orofacial and dental injuries was found to be 40.6%, while that of orofacial injury was 17.1% and dental injuries was 15.9%. There were 23 studies included in this review which covered 27 different sports from nine Asian countries. A high level of heterogeneity and the high ROB were observed in the majority of the studies. Further studies on the basis of the recommendations provided in the systematic review will improve the quality of evidence in this area in future.

The paediatric dentistry-restorative dentistry interface.

This paper examines the various contemporary clinical interfaces between paediatric dentistry and restorative dentistry for patients with both acquired and congenital abnormalities presenting to primary and secondary care. Dental trauma of the child or adolescent has long-standing implications on future oral health due to conditions such as ankylosis, pulp necrosis, coronal tissue loss or tooth loss, all of which provide significant challenges into adulthood. Similarly, congenital conditions, such as hypodontia and structural deficiencies or malformations, such as amelogenesis and dentinogenesis imperfecta, result in the need for collaborative, multi-speciality decision-making from a young age, creating a pathway for longitudinal multi-disciplinary team treatment planning.

Acute endodontic and dental trauma provision during the COVID-19 crisis.

COVID-19 (also known as coronavirus) has had a profound impact on dentistry, with all elective treatment grinding to a halt initially and a slow phased return to normal services. The guidance available regarding treating dental emergencies is currently advice, analgesia and antimicrobials, where indicated in the first instance. Some patients cannot be managed successfully with this approach and require face-to-face consultation. Unless dental practices have the appropriate PPE and follow strict infection prevention and control guidance, face-to-face consultation may not be possible. If treatment is required, this is based on minimum intervention and avoidance of aerosol generating procedures (AGPs) on patients who are free of COVID-19. COVID-19-positive or suspected patients still require treatment at designated Urgent Dental Care centres.The aim of this article is to provide an insight into the COVID-19 pandemic and its implications on current emergency dental care. Commonly presenting dental conditions which require endodontic management will be discussed. Finally, an endodontic management protocol is suggested. The intention of the protocol is to describe practical techniques to minimise potential viral load and reduce risk of COVID-19 transmission when AGPs are instigated.

Adult Dental Trauma: What Should the Dental Practitioner Know?

The management of adult dental trauma can be a daunting challenge for practitioners at any level. Like medical emergencies, initial management can have a large influence on prognosis. It is important that practitioners understand the basic principles of managing the acute presentations of dental trauma. This article aims to illustrate a step-by-step approach in order to improve the management within general dental practice for better outcomes for patients.

Adult Dental Trauma: What Should the Dental Practitioner Know?

The management of adult dental trauma can be a daunting challenge for practitioners at any level. Like medical emergencies, initial management can have a large influence on prognosis. It is important that practitioners understand the basic principles of managing the acute presentations of dental trauma. This article aims to illustrate a step-by-step approach in order to improve the management within general dental practice for better outcomes for patients.

Clinical issues in occlusion - Part II.

Occlusal diagnosis plays an important role in the planning and subsequent delivery of predictable functional and aesthetic restorations and prostheses. Once an occlusal problem is identified there are a number of techniques and materials that can be utilised to record occlusal relationships, subsequently analyse them and incorporate information obtained into the delivery of tooth restoration or replacement. This paper discusses the clinical and technical aspects of occlusal examination and analysis outlining contemporary and traditional techniques in their utilisation. Aspects of occlusal examination will be revisited; the identification and recording of centric occlusion as well as subsequent articulation will be discussed. The requirement for occlusal splint provision will also be discussed and illustrated.

Clinical issues in occlusion - Part I.

Good occlusal practise provides an important cornerstone to optimal patient care. Occlusal problems can manifest in different areas of dentistry but these are more apparent when there are restorative aspects to the patient׳s problem. This review highlights areas of restorative dentistry where the appreciation of occlusal aspects can optimise diagnosis and follow up care.

Traditional and contemporary techniques for optimizing root canal irrigation.

UNLABELLED: Canal irrigation during root canal treatment is an important component of chemo-mechanical debridement of the root canal system. Traditional syringe irrigation can be enhanced by activating the irrigant to provide superior cleaning properties. This activation can be achieved by simple modifications in current technique or by contemporary automated devices. Novel techniques are also being developed, such as the Self-adjusting File (Re-Dent-Nova, Ra'anana, Israel), Ozone (Healozone, Dental Ozone, London, UK), Photoactivated Disinfection and Ultraviolet Light Disinfection. This paper reviews the techniques available to enhance traditional syringe irrigation, contemporary irrigation devices and novel techniques, citing their evidence base, advantages and disadvantages. CLINICAL RELEVANCE: Recent advances in irrigation techniques and canal disinfection and debridement are relevant to practitioners carrying out root canal treatment.

Systemic medication and the inflammatory cascade.

Periodontal disease is caused by inflammatory processes initiated by the presence of a biofilm. The management of this disease process is largely achieved by disrupting the biofilm to allow regression of inflammation and healing. As our patients are living for longer they are likely to have been exposed to systemic medications that aim to reduce inflammation. These drugs have been shown to decrease inflammation within the periodontal tissues despite not being a primary function of their use. This paper aims to review the relative effects of common systemic medications on the periodontal tissues by analyzing their modes of action and discussing current research and the implications for periodontal treatment.

Decision-making in the provision of extra-coronal restorations.

UNLABELLED: Decision-making when choosing an extra-coronal restoration for a molar tooth is often multifactorial, requiring consideration for material properties, the underlying tooth tissue, aesthetics and functional requirements. This article reviews the various factors associated with the decision-making when considering an extra-coronal restoration for a molar tooth. The current literature is disseminated and compared to results obtained from clinicians at the Dental Pan Society meeting in 2007. Dentists were seemingly less likely to consider restorations with greater complications for themselves than they were for their patients. The various implications of the results are discussed. CLINICAL RELEVANCE: With the plethora of dental materials available, the clinician has a wide choice of restorations. As clinicians become increasingly aware of the relative complications associated with different restorations, they are less likely to choose those that may result in problems, such as loss of vitality. In comparison, patients, if not kept fully informed, are unlikely to be aware of these problems and therefore may be happy to accept a more 'aesthetic' restoration. This decision dynamic-is examined in this article.

Contemporary management of tooth replacement in the traumatized dentition.

Dental trauma can result in tooth loss despite best efforts at retaining and maintaining compromised teeth (Dent Traumatol, 24, 2008, 379). Upper anterior teeth are more likely to suffer from trauma, and their loss can result in significant aesthetic and functional problems that can be difficult to manage (Endod Dent Traumatol, 9, 1993, 61; Int Dent J 59, 2009, 127). Indeed, teeth of poor prognosis may not only present with compromised structure but trauma may also result in damage to the support tissues. Injury to the periodontium and alveolus can have repercussions on subsequent restorative procedures (Fig. 19). Where teeth are identified as having a hopeless prognosis either soon after the incident or at delayed presentation; planning for eventual tooth loss and replacement can begin at the early stages. With advances in both adhesive and osseointegration technologies, there are now a variety of options for the restoration of edentate spaces subsequent to dental trauma. This review aims to identify key challenges in the provision of tooth replacement in the traumatized dentition and outline contemporary methods in treatment delivery.

Aggressive periodontitis: how does an understanding of the pathogenesis affect treatment?

UNLABELLED: Aggressive periodontitis is a relatively rare periodontal condition that can result in significant attachment loss over a short period of time. As the disease is difficult to manage, owing to its rapid progression and severity, a variety of adjuncts have been advocated in its management. The authors outline concepts of the aetiology and pathogenesis of aggressive periodontitis and how the different treatment regimens relate to the current understanding of the disease process. CLINICAL RELEVANCE: There is a wide variety of treatment regimens advocated for the treatment of aggressive periodontitis. General dental practitioners and specialists should be aware of the relative advantages and disadvantages of these and how they relate to the disease process.

The use of implants for anchorage in the correction of unilateral crossbites.

The provision of orthodontic anchorage in the adult patient can be compromised due to reduced periodontal support, insufficient number of teeth and limited supra-gingival tooth tissue. Where tooth borne anchorage is unavailable for significant orthodontic movement implants represent a viable alternative. This paper describes the use of dental implants for orthodontic anchorage in a partially dentate patient with a severe unilateral cross-bite where orthognathic surgery was the only other realistic option. The implants were successfully engaged using a composite bridge and a modified quad helix appliance for correction of the malocclusion. Once orthodontics was completed the patient was restored using highly sintered ceramic crowns and bridges. This paper highlights the importance of the multi-disciplinary team and the close liaison between the restorative dentist, orthodontist and technician in treatment planning and provision.

Ion release characteristics, precipitate formation and sealing ability of a phosphate glass-polycaprolactone-based composite for use as a root canal obturation material.

OBJECTIVES: The filling material used to obturate root canal systems during the common dental procedure, root canal treatment, has popularly involved gutta-percha (GP) in one of its many forms for almost a 100 years. An optimal root filling material should provide a predictable seal, inhibit or kill residual bacteria, prevent re-contamination and facilitate periapical healing. Although the goal of obturation is stated as the creation of a "seal", its precise role still remains elusive and the seal offered suspect. The primary goal of the study was to develop a novel polycaprolactone/phosphate glass composite deliverable as a root filling and capable of releasing ionic species to enable a predictable seal in an aqueous environment. MATERIALS AND METHODS: Different compositions of polycaprolactone-iron phosphate glass (Fe(2)O(3) 1, 3 and 5mol%) composites were produced and delivered into an ex vivo root canal model. Standardized root canals were prepared in extracted human teeth. The teeth were examined for root filling adaptation and precipitate formation (SEM), ion release (Na(+), Ca(2+), PO(4)(3-), P(2)O(7)(4-), P(3)O(9)(3-), and P(5)O(10)(5-)), and sealing ability. The experiments were controlled with teeth obturated with contemporary GP and a conventional zinc-oxide/eugenol sealer. RESULTS: Adaptation of the experimental material was statistically significantly better than the GP control groups. Precipitate formation was noted in some specimens but all released various ionic species in an inverse proportion to the iron oxide concentration. The experimental material exhibited significantly (P<0.001) less leakage after 7 days immersion in saline compared with those not immersed, or the control GP group. SIGNIFICANCE: PCL-phosphate glass composites showed good potential as a root filling material capable of producing a seal in an aqueous environment without a sealer.

A report on the clinical and radiographic outcomes of 38 cases of apexification with mineral trioxide aggregate.

The aim of the study was to report on the clinical and radiographic assessment of 38 cases of apexification using MTA over a three year period. Thirty-eight cases of immaturely developed teeth requiring endodontic therapy were treated using MTA to achieve an apical barrier prior to obturation with gutta-percha. The teeth were clinically and radiographically assessed. The findings indicate that apexification using MTA is a predictable procedure. In particular, the number of visits and the total time taken to achieve an apical barrier was markedly less than conventional techniques using calcium hydroxide. The presence of a preoperative periapical radiolucency had no effect on the outcome. MTA shows promise as a viable alternative to calcium hydroxide to achieve root-end closure and using MTA, the number of visits to achieve a successful apical barrier may be markedly reduced. The presence of preoperative periapical radiolucencies did not affect the outcome or the treatment protocol.