A retrospective cohort study of pulp prognosis in luxated permanent teeth: a competing risk analysis.

AIM: The present retrospective cohort study aimed to evaluate luxated permanent teeth for pulp prognosis and risk factors. METHODOLOGY: Case records and radiographs of 224 patients, involving 427 luxated permanent teeth, referred for treatment at the Dental Trauma Center-School of Dentistry, Universidade Federal de Minas Gerais, (DTC-SD-UFMG) from 2014 to 2022, were assessed for pulp prognosis classified as vitality, necrosis and pulp canal obliteration (PCO). A competing risk survival analysis estimated the hazards of the three outcomes, and the effect of demographic, clinical and treatment variables was tested using a cause specific Cox regression model. RESULTS: Pulp vitality was found in163 teeth (38.2%), pulp necrosis in 120 teeth (28.1%) and 55 teeth (12.9%) developed PCO. Pulp vitality decreased in the presence of concomitant crown fractures (HR 0.38 95% CI [0.2-0.8] p = 0.006). The risk of pulp necrosis (HR 0.62 95% CI [0.4-0.96] p = 0.03) was lower in cases with open apices but increased with concomitant crown fractures (HR 4.0 95% CI [2.6-6.1] p = 0.001) and intrusions (HR 2.3 95% CI [1.2-4.1] p = 0.007). Lateral or extrusive luxations (HR 3.0 95% CI [1.3-6.9] p = 0.001) and open apices (HR 2.4 95% CI [1.2-4.7] p = 0.01) showed higher rates of PCO. CONCLUSION: Type of luxation, the diameter of the apical foramen, and the presence of concomitant crown fractures were main determinants of pulp prognosis after luxation injuries in permanent teeth. CLINICAL RELEVANCE: Pulp prognosis after tooth luxation is dependent on the presence and direction of tooth displacement together with infection control. CLINICAL TRIAL REGISTRATION: Not applicable.

Prevalence of traumatic dental injuries in emergency dental services: A systematic review and meta-analysis.

OBJECTIVES: This study aimed to perform a systematic review and meta-analysis regarding the prevalence of traumatic dental injuries (TDI) in emergency dental services. METHODS: Seven electronic and two grey literature databases were searched, up to December 2021, for studies that reported the TDI prevalence among dental emergencies. The Joanna Briggs Institute critical appraisal checklist for prevalence studies, and The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were used to assess the risk of bias and quality of evidence respectively. The R software was used to perform a proportion meta-analysis on a random-effects model to estimate the pooled prevalence and respective 95% CI. RESULTS: From a total of 1476 studies identified after excluding duplicates, 38 met the inclusion criteria, and another five were identified through hand searching, summing 43 included observational studies with a total sample of 209099 individuals searching for emergency dental care. The overall pooled prevalence of TDI was 15.4% (95% CI: 11%-21%, I² = 100%). Paediatric dental emergency services and age group from 0 to 21 years presented the highest prevalence, 29% (95% CI: 22%-38%, I² = 99.5%) and 24% (95% CI: 15%-35%, I² = 98%) respectively. CONCLUSIONS: The overall pooled prevalence of TDI in emergency dental services was 15.4%, and 24% in the age group under 21 years. Considering the impact of prompt and correct emergency care in the long-term prognosis of TDI, such knowledge is relevant to organize emergency healthcare and support public policies in this area.

Expression of matrix metalloproteinases 2 and 9 in replanted teeth with external root resorption: A cross-sectional study.

OBJECTIVE: To evaluate matrix metalloproteinase (MMP) expression in replanted permanent teeth with external root resorption (ERR). DESIGN: The present cross-sectional study included 42 patients with replanted permanent teeth, presenting with progressive forms of ERR, and referred for extraction according to the rehabilitation treatment plan or due to root fractures. The control group consisted of 12 healthy premolars, from 5 patients with good periodontal health and no radiographic evidence of root resorption, referred for extraction for orthodontic reasons. Root fragments were processed soon after extraction, and the supernatant was collected to measure matrix metalloproteinase 2/tissue inhibitor of metalloproteinase 2 (MMP-2/TIMP-2) and matrix metalloproteinase 9/tissue inhibitor of metalloproteinases 2 (MMP-9/TIMP-2) complexes through a double-ligand enzyme-linked immunosorbent assay (ELISA). RESULTS: Case groups with external inflammatory root resorption (EIRR) or external replacement root resorption (ERRR) showed significantly higher levels of MMP-2/TIMP-2 and MMP-9/TIMP-2 complexes than the control group. Additionally, comparisons between the case groups demonstrated that the MMP-2/TIMP-2 complex also had significantly higher levels in the ERRR group (p < 0.001). CONCLUSIONS: Our results suggest that MMP-2 and MMP-9 participate in the pathobiology of both types of ERR. In addition, the higher levels of MMP-2/TIMP-2 complex in the ERRR group support common modulation mechanisms with physiological bone turnover.

Pulp healing in immature replanted permanent teeth: A competing risk analysis.

BACKGROUND/AIM: Tooth displacement during avulsion causes total rupture of the pulp's neurovascular supply. Revascularization and pulp healing may occur in immature teeth, which gives rise to the recommendation that root canal treatment may not be required. The aim of this study was to evaluate the prognostic factors for the pulp's response after replantation of young permanent teeth. METHODS: Records from 117 patients with 133 replanted permanent immature teeth were reviewed, and pulp outcomes were classified as healing (hard tissue deposition on the dentinal walls followed by narrowing of the pulp lumen or ingrowth of bone-like tissue inside the pulp canal) or non-healing (pulp necrosis with infection). The effect of clinical and demographic co-variates on the hazards of both outcomes was assessed performing a competing risk model. RESULTS: Pulp necrosis with infection was diagnosed in 78.2% of the teeth, and healing was observed in 12.8% of the teeth. A total of 12 teeth (9.0%) were censored due to prophylactic removal of the pulp or severe external root resorption caused by eruption of adjacent canines. The cs-Cox model demonstrated that the hazards of pulp healing increased in teeth with extra-alveolar periods <15 min (csHR: 7.83, 95% CI 1.76-34.80, p = .01), while the hazards of pulp necrosis with infection decreased (csHR: 0.31, 95% CI: 0.10-0.92, p = .04). Teeth replanted with Moorrees' stages 4 and 5 of root development had higher hazards of pulp necrosis with infection than teeth with stage 2 of root development (csHR: 2.23, 95% CI 1.11-4.50, p = .03; csHR: 2.89, 95% CI: 1.40-5.95; p = .01). CONCLUSIONS: Pulp healing rarely occurred after replantation of young permanent teeth being associated with short extra-alveolar periods <15 min. Early stages of root development decreased the hazards of pulp necrosis with infection.

Prevalência de lesões traumáticas dentoalveolares em serviços odontológicos de urgência: revisão sistemática e meta-análise / Prevalence of traumatic dentoalveolar injuries in emergency dental services: systematic review and meta-analysis

As lesões traumáticas dentoalveolares (LTDA) consistem em lesões de natureza múltipla e aguda decorrentes de impactos abruptos sobre os dentes e suas estruturas de suporte. Em todo o mundo, estas lesões têm uma alta prevalência relatada e representam grande parte da procura por serviços de emergência odontológicos. No entanto, informações sobre a prevalência de LTDA dentro dos serviços odontológicos emergenciais ainda são dispersas e fragmentadas. Este estudo objetivou revisar a literatura de forma sistemática e sintetizar as informações disponíveis sobre esta prevalência através de meta-análise, conforme descrito no protocolo registrado no PROSPERO sob o código CRD42021243537. A busca bibliográfica foi realizada em sete principais bases de dados em saúde: PubMed; Embase; LILACS; LIVIVO; ScienceDirect; Scopus e Web of Science. E outras duas bases da literatura cinzenta: Google Acadêmico e OpenGrey. A partir da estratégia PICOS, a seguinte pergunta específica para a revisão foi definida: "Qual a prevalência de LTDA nos serviços odontológicos de urgência?". Foram incluídos estudos que apresentaram a prevalência de LTDA em serviços odontológicos emergenciais, publicados em alfabeto latino-romano. Foram excluídos resumos, revisões, relatos-de-caso, protocolos, opiniões de especialistas, cartas, pôsteres e publicações nas quais a versão do texto completo não pôde ser acessada. Estudos conduzidos em clínicas especializadas em traumatismos dentários e em condições extremas, tais como cenários de guerra e desastres ambientais, também foram excluídos. De 2464 estudos identificados pela busca bibliográfica, 1476 restaram após a exclusão de duplicatas. Destes, 1329 foram excluídos pela leitura do título e resumo. Dos 147 estudos remanescentes, 38 foram selecionados após a leitura do texto completo e outros 5 trabalhos foram incluídos através da busca manual pelas referências das publicações selecionadas. O ano de publicação dos 43 estudos variou de 1984 a 2021. A maioria dos trabalhos (30) apresentou risco de viés moderado de acordo com o checklist para estudos de prevalência do Joanna Briggs Institute. Foram observadas prevalências que variaram de 1,9% a 69,1% sendo que a prevalência global, para os 43 estudos incluídos, foi de 15,4% (11%-21%, i2=100%, IC:95%). Quando considerada a análise de subgrupos, a prevalência foi de 22% (13%-33%, I2 = 100%, IC:95%) para os estudos que avaliaram a faixa etária entre 0 e 21. A mesma prevalência de 29% (22%- 38%, I2=99.5%, IC:95%) foi observada para os estudos conduzidos em serviços odontopediátricos de urgência. Considerando-se que o atendimento emergencial é determinante do prognóstico das LTDA em longo prazo, o conhecimento da prevalência destas lesões entre as emergências odontológicas é fundamental para organizar estes serviços e subsidiar políticas públicas nesta área.

Traumatic dental injuries (TDI) consist of multiple and acute injuries resulting from abrupt impacts on teeth and their supporting structures. These injuries have a high prevalence reported worldwide and represent a large part of the demand for emergency dental services. However, information on the TDI prevalence rate within emergency dental services is still scattered and fragmented. This study aimed to systematically review the literature and synthesize the information available on this prevalence through meta-analysis, as described in the protocol registered in PROSPERO under code CRD42021243537. A bibliographic search was performed in seven health databases: PubMed; Embase; LILACS; LIVIVO; ScienceDirect; Scopus; and Web of Science. And two other grey literature bases: Google Scholar and OpenGrey. Based on the PICOS strategy, the following specific question for the review was defined: What is the prevalence of TDI in emergency dental services? Studies showing the TDI prevalence rate in emergency dental services, published in the Latin- Roman alphabet, were included. Abstracts, reviews, case reports, protocols, expert opinions, letters, posters, and publications in which the full-text version could not be accessed were excluded. Studies conducted in clinics specializing in dental trauma and in extreme conditions, such as war scenarios and environmental disasters, were also excluded. Of 2464 studies identified by the literature search, 1476 remained after excluding duplicates. Of these, 1329 were excluded by reading the title and abstract. Of the remaining 147 studies, 38 were selected after reading the full text and another 5 works were included through a manual search for the references of the selected publications. The year of publication of the 43 studies ranged from 1984 to 2021. Most studies (30) had a moderate risk of bias according to the Joanna Briggs Institute's checklist for prevalence studies. Prevalence rates ranging from 2% to 69% were observed and the overall prevalence, for the 43 studies included, was 15.4% (11%- 21%, i2=100%, CI:95 %). For subgroup analysis, the prevalence of 22% (13%-33%, I2=100%, CI: 95%) was observed for studies that evaluated the age group between 0 and 21. A prevalence of 29% (22%-38%, I2=99%, CI: 95%) was observed for studies conducted in emergency paediatric dental services. Considering that emergency care is a determinant of TDI's long-term prognosis, knowledge of the prevalence of these injuries among dental emergencies is essential to organize these services and support public policies in this area.