RESUMO
Introduction: Vertical root fractures (VRFs) typically have a poor prognosis with an extraction or occasionally root amputation as the preferred treatment. VRFs have been considered an epidemic, motivating changes in the access openings, as well as in the preparation and disinfection protocols of endodontic treatment. Hence, we aimed to evaluate the prevalence of VRFs by tracking cases in both a University Endodontic Program (UEP) and a private endodontics practice (PP). We also evaluated changes in prevalence during COVID-19 along with the alterations in the frequency of cases diagnosed by clinical and radiographic signs which were later confirmed by direct visualization compared to those in which the suspicion was based on clinical and radiographic signs alone. Methods and Materials: This retrospective study looked at the prevalence of VRF in patient records at UEP and a PP. Data for the pre-COVID-19 and COVID-19 time periods were extracted from patient records and referral letters then compared. Data for suspected and confirmed prevalence were compared. Results: The UEP group included 21,156 patients while the PP group comprised 7,209 patients. The prevalence of VRFs in the former cohort was 1.80%, while 2.62% of the latter cohort exhibited VRFs with a combined total of 2.01%. The combined total prevalence of VRFs pre-COVID-19 was 1.72%, increasing from 2.1% to 3.82% during COVID-19 (p < 0.0001). The same applied to suspected cases for both clinical settings. The increase in confirmed cases between the two periods was statistically significant for the UEP group (p=0.0202) but it was insignificant for the PP group (p=0.0721). Conclusion: The combined prevalence for VRFs was 2.01% for all years denying the claim that VRF is a pandemic phenomenon. COVID-19 period saw almost a double increase in the prevalence of VRF compared to pre-COVID-19 era. This was consequently associated with a significant increase in the number of suspected VRF cases.
RESUMO
AIM: To demonstrate an exceptional result in the treatment of an avulsed tooth that had been stored in a dry environment for over 2 hours before being replanted. BACKGROUND: Sixteen percent of all traumatic injuries to the permanent dentition are avulsions. Maxillary central and lateral incisors are most commonly affected. CASE DESCRIPTION: In this report, a 7-year-old girl sustained trauma to the upper right maxillary incisor during a bicycle accident. The tooth was avulsed and remained outside the oral cavity for more than 2 hours in a dry napkin before eventual reimplantation in the emergency room. Upon presentation to the endodontic clinic at the University of Southern California, the case was assessed, and the available treatment options discussed with the patient's parents. Revascularization using BC putty was the chosen mode of treatment. At a 6-month recall appointment, the patient presented with a sinus tract. A decision was then made to perform apexification using the mineral trioxide aggregate (MTA) as an apical filling material. To date, the tooth remains intact and functional. CONCLUSION: Although both of the described treatment modalities are acceptable and commonly used in modern endodontics, apexification of a tooth following a failed attempt of a regenerative procedure has not been described. In this case, a chronic abscess formed and the ultimate goal of revascularization was not achieved. However, the performance of the revascularization procedure was not without benefit since it allowed the tooth to develop in both length, dentinal volume, and aided in the partial closure of the apical foramen. Additional studies are needed regarding the treatment of avulsed teeth. This case study may provide a viable treatment alternative in a number of clinical situations. CLINICAL SIGNIFICANCE: The procedures described in this case report may be of clinical significance in the treatment and retention of teeth, which may otherwise be considered to have a poor prognosis and extracted.
