Risk of pulp necrosis and related complications in the permanent anterior teeth with lateral luxation: A systematic review and meta-analysis.

This systematic review aimed to evaluate the evidence related to the occurrence of pulp necrosis and related complications in permanent anterior teeth with lateral luxation. It was envisaged to address the ambiguity related to the recommendation for pulp extirpation in teeth with mature root apex. An a priori protocol was formulated as per the best practices of evidence-based medicine and registered in PROSPERO. A comprehensive search was performed electronically in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane on July 10,2023 without any restriction of language or year of publication. The screening of titles and abstracts and later the full-text articles were performed. Later, the data extraction was performed by using a self-designed sheet, risk of bias (ROB) assessment was done, meta-analysis was performed, and the GRADE approach was used to assess the quality of evidence. The qualitative synthesis was performed on 13 studies done from 1985 to 2020 in hospital settings. There was variability in the minimum and total observation periods, sample sizes, and characteristics of the sample population. The overall pooled prevalence of pulp necrosis was found to be 57% (95% CI: 42, 72%). It was 12% (95% CI: 8%, 18%, I2 = 0%) in immature teeth, and 58% (95% CI: 42, 73%, I2 = 86%) in mature teeth. The pooled prevalence of EIRR was found to be 11% (95% CI: 4, 27%, I2 = 95%) with greater risk in teeth with mature root apex (RR: 1.26, 95% CI: 1.12, 1.42, I2 = 0%). The ROB was moderate or high in nine studies and the GRADE of evidence was very low in 14 of 15 outcomes. There are greater chances of pulp necrosis in teeth with lateral luxation, especially with mature apex. However, it can still be less than 60% in most cases with the prevalence of EIRR less than 20%. Hence, an absolute recommendation for endodontic intervention in mature teeth with lateral luxation must be interpreted with slight caution.

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.

Dentofacial manifestations of a Paediatric patient with Goltz-Gorlin Syndrome.

Goltz-Gorlin syndrome is a rare X-linked inherited disorder associated with PORCN (porcupine homolog-Drosophila) gene mutation. It primarily affects the skin and its appendages. The characteristic cutaneous features include a blaschko-linear pattern, skin atrophy, pigmentary changes, and telangiectasia. The oral manifestations have been reported in more than half of the affected individuals. The most common oral findings include enamel hypoplasia, hypodontia, supernumerary teeth, microdontia, vertical grooving of the teeth, taurodontism, fusion, and abnormal root morphology reported in sporadic cases. The objective of this case report is to describe the dentofacial characteristics of a middle childhood aged girl with Goltz-Gorlin syndrome.

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 1: General introduction.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 4: Faceshields for the prevention of dental and oral trauma.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 5: Secondary prevention of dental injuries.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 3: Mouthguards for the prevention of dental and oral trauma.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 10: First aid education.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 2: Primary prevention of dental trauma across the life course.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 6: Education.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 8: ToothSOS app.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

Development of patient-specific finite element model for study of composite dental implants.

Traumatic dental injuries can occur due to various reasons such as accidents, sports injuries, fights, falls, and others. These injuries can affect the teeth, gums, and surrounding tissues, and can range from minor chips and cracks to severe fractures, dislocations, and avulsions (when the tooth is completely knocked out of the socket). The most common way to address this is by replacing affected teeth with dental implants. The purpose of this research is to evaluate the use of composite materials in dental implants and compare them with the traditionally used materials using a patient specific cone beam computed tomography (CBCT) based finite element model (FEM). To conduct this research, two different implant groups i.e., traditional implant and composite implant were designed using Titanium grade 4, zirconium oxide-reinforced lithium silicate (ZLS), and Zirconia (ZrO2). Six dental implants were designed namely Ti implant, ZLS implant, ZrO2implant, Ti-ZrO2composite, Ti-ZLS composite, and ZLS-ZrO2composite using 3D modelling software. Detailed full-scale 3D models of patient specific dental implant were developed and traumatic loading conditions were applied to the enamel of central incisor teeth or crown of dental implant, and maxilla was constrained in all directions. It was found that the use of composite materials for dental implants can reduce the stresses over the surface of abutment and implant as compared to traditional implants. The detailed models developed as a part of this study can advance the research on dental implants, and with further experimental validation allow the use of composite materials for fabrication of more stable dental implants.

Quality analysis of the clinical practice guidelines for management of impacted maxillary central incisors: a systematic review.

PURPOSE: To assess the quality of clinical practice guidelines (CPG) for management of impacted central incisors. METHODS: Search was performed in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane databases, and guideline-focused databases/repositories on 15-09-2022 without any limitations and was updated on 15-07-2023. Grey literature search was also performed. Two independent reviewers were involved in the study selection and data extraction. Quality assessment of the included CPG was performed by four independent appraisers using the AGREE-II instrument. The degree of agreement among the appraisers was calculated using the intraclass correlation coefficient (ICC). RESULTS: Five CPG were included in the review. The Ministry of Health, Malaysia (MHM) guideline obtained the highest scores in all six domains of AGREE-II and an overall score of 73% demonstrating the "highest" quality. The remaining four guidelines obtained overall "low-quality" scores ranging from 34.57-37.52%. The ICC scores ranged from 0.530 to 0.990 for various domains of AGREE-II. CONCLUSION: MHM guidelines demonstrated high-quality scores in domains of 'scope and purpose', 'clarity of presentation', 'applicability domain', and 'editorial independence', while others were found to have moderate or low quality. This review identified areas that can be addressed by future guideline developers to avoid these discrepancies.

Methods and applications of finite element analysis in dental trauma research: A scoping review.

Finite Element Analysis (FEA) is vital for understanding dental traumatology (DT) biomechanics, aiding diagnosis, treatment planning, and outcome prediction. This review explores FEA applications in DT research, evaluates their quality and outcomes, and assesses methodological aspects. Accordingly, recommendations for future researchers are provided. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews and registered in Open Science framework. A comprehensive search using relevant text-words and MeSH terms was performed in established databases. The inclusion criteria encompassed all Finite element analysis (FEA)-based Dental traumatology (DT) studies without language or publication year restrictions. Risk of bias was assessed with the Risk of bias tool for the use of finite element analysis in dentistry (ROBFEAD) tool. Forty-six studies published from 2001 to 2023 were included in the qualitative synthesis. The studies were categorized into five domains and six subdomains based on objectives. Maxillary central incisors and surrounding structures were commonly modelled (n = 27). Most studies utilized Computed tomography (CT), Cone Beam CT, or micro CT. Traumatic injury forces ranged from 100 N to 2000 N, and occlusal forces ranged from 150 N to 350 N. All studies were rated as high risk of bias. Fory-six studies were categorized, with most focusing on stress distribution and fracture patterns in dento-alveolar structures under various conditions, while few assessed displacements. Methodological quality lacked robustness in model development and substructure properties. Future studies should address these limitations and enhance reporting practices.

Effect of wire diameter and extent of wire composite splint on the mobility of luxated and anchor primary teeth: A typodont study.

BACKGROUND/AIMS: The recommendations for splinting are well established for the injuries of permanent dentition; however, ambiguity still exists for the injuries in primary dentition. Hence, this study aimed to determine the most appropriate dimensions of stainless steel wire and its extent, for achieving the physiologic mobility in primary dentition. MATERIAL AND METHODS: This study was designed as an in vitro experiment by using a typodont model of primary dentition. The baseline mobility of primary maxillary incisors was calibrated to the physiologic mobility of natural primary incisors by using a Teflon tape wrapped around the roots of resin teeth. Splinting was done using a stainless steel wire of 0.2 mm (Group I), 0.3 mm (Group II), and 0.4 mm (Group III). These groups were subdivided (a, b, and c) on the basis of the extent of the splint, and pre splint mobility (Pre-PV) and post-splint mobility (Post-PV) were tested by Periotest M. The splint effect was calculated by subtracting Post-PVs and Pre-PVs. RESULTS: The normal values of mobility in healthy human volunteers ranged from 10.5 to 13. The overall splint effect was higher in Group III irrespective of the extent of the splint, whereas it was found to be the lowest in Group I (b and c). The splint effect increased with the extent of the splint in all the groups. Among all the groups, the splint effect on the anchor teeth was observed to increase with the extent of the splint and the diameter of the wire. CONCLUSION: The mobility of the injured and anchor teeth splinted with 0.2-mm stainless steel wire was similar to the pre-splint and physiologic mobility. The most favorable extension was one tooth adjacent to the injured tooth on each side for both 0.2- and 0.3-mm wires.

Risk factors associated with traumatic dental injuries in individuals with special healthcare needs-A systematic review and meta-analysis.

BACKGROUND/AIM: Individuals with special healthcare needs (SHCN) are more likely to sustain traumatic dental injuries (TDIs) due to distinct risk factors. The aim of this review was to assess various risk factors associated with TDIs in individuals with SHCN. MATERIALS AND METHODS: The protocol was designed according to the recommendations of the Cochrane-handbook, Joanna Briggs Institute, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42022357422). A comprehensive search was performed in PubMed, LILACS, Web of Science, EMBASE and Scopus using a pre-defined strategy without any limitation of language and year of publication. It was last updated on 25 April 2023. Studies addressing the TDIs in individuals with SHCN were included. Data extraction and analyses were performed, risk of bias (ROB) assessment was done using the Joanna Briggs Institute's critical appraisal tool, and a meta-analysis was performed using random-effects model. RESULTS: A total of 21 studies were included in the review. They were categorized according to the target disease/condition: cerebral palsy (n = 5), ADHD and autism spectrum disorders (n = 5), visually impaired (n = 4), and multiple disorders (n = 7). The studies showed variability in the design and methods; however, 17 out of 21 studies showed moderate to low ROB. Increased overjet and lip incompetence were the main risk factors reported in the studies. The commonest injuries were observed to be enamel and enamel and dentine fractures. CONCLUSION: The overall pooled prevalence of TDI in individuals with special healthcare needs was 23.16% with 20.98% in males and 27.06% in females. Overjet >3 mm and inadequate lip coverage were found to be associated with a higher risk of TDI in all the categories of individuals with special healthcare needs except ADHD and ASD. Falls at home in cerebral palsy, falls while walking and self-harm in ADHD and ASD, falls at home and collision in visual impairment, and unspecified falls in multiple disorders could be identified as the most common cause of TDI.

Comparative evaluation of three materials used for fragment reattachment in uncomplicated crown fracture-An in vitro study using bovine teeth.

BACKGROUND/AIMS: The recommended treatment for uncomplicated crown fractures is bonding the fractured fragment or the fragment reattachment. A paucity was identified regarding the studies comparing the efficacy of micro-hybrid and nanohybrid composites in fragment reattachment. Hence, the present study aimed to evaluate and compare three materials for bonding of fragments rehydrated by humidification in teeth with uncomplicated crown fractures. MATERIAL AND METHODS: Eighty mandibular bovine incisors with similar dimensions and free of any structural deformities were fractured similar to the technique followed in previous studies. Fracture was simulated, fragments, and stumps were coded, stumps were stored in artificial saliva and the fragments were dehydrated at room temperature and pressure. They were randomly assigned to Group-1 (no rehydration), Group-2 (rehydrated and bonded by flowable nanohybrid composite-3M Filtek Supreme Syringe Flowable Composite Resin-A2, Sao Paulo, Brazil), Group-3 (rehydrated and bonded by flowable micro-hybrid composite- Ruby Flow, InciDental, England, United Kingdom), and Group-4 (rehydrated and bonded by light-cured Glass-Ionomer-Cement-Voco Ionoseal, Cuxhaven, Germany). The samples were subjected to a universal testing machine to evaluate the force required to fracture the bonded fragments. RESULTS: The highest median value of the force required to fracture was recorded for Group 2 (208.4 N) followed by Group 3 (195.2). The force required to fracture the bonded fragments was lowest in Group 4 (67.2 N) which was lower than the negative control (131.4 N). The differences between the observations in Groups 2 and 3 were not found to be statistically significant. CONCLUSION: The nano and micro-hybrid composites showed greater force required to fracture than fragments bonded by LC-GIC. Dehydrated fragments bonded using nanocomposites performed better than rehydrated fragments bonded by using LC-GIC.

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.