Factors that cause endodontic failures in general practices in Japan.

BACKGROUND: Bacterial biofilms that develop on root surfaces outside apical foramens have been found to be associated with refractory periapical periodontitis. However, several other factors cause endodontic failures apart from extraradicular biofilms. The aim of this study was to identify the factors causing endodontic failures in general practices in Japan. METHODS: Patients diagnosed as having refractory periapical periodontitis by general practitioners and who requested endodontic treatment at Osaka University Dental Hospital were selected by checking medical records from April 2009 to March 2013. Factors causing endodontic failures were identified. RESULTS: A total of 103 teeth were selected, and 76 teeth completed root-canal treatment. Tooth extractions were required for 18 teeth after or without endodontic treatment. Six teeth required apicoectomy after endodontic treatment. One tooth needed hemisection. One tooth needed intentional replantation. One tooth needed adhesion and replantation. The main causes of treatment failure were open apices (24 teeth), perforation (18 teeth), and root fracture (13 teeth). In six teeth with open apices that required apicoectomy or extraction, extraradicular biofilms may have been related to endodontic failure. CONCLUSIONS: Most endodontic cases diagnosed with refractory periapical periodontitis by general practitioners were compromised by any other factors rather than extraradicular biofilms.

Retention and Healing Outcomes after Intentional Replantation.

INTRODUCTION: Intentional replantation is an alternative to tooth extraction and prosthetic replacement when conventional endodontic treatment modalities are unfeasible or contraindicated. This study assessed tooth retention and healing after intentional replantation and explored predictors of these outcomes. METHODS: Data of intentional replantation procedures performed between March 2000 and December 2010 were collected prospectively, excluding teeth with preoperative periodontal and root defects. A cohort of 159 teeth was followed up for 0.5-12 years. Retention and healed status without complications (periapical radiolucency, external root resorption, ankylosis, signs/symptoms, probing ≥6 mm) was recorded and analyzed with Kaplan-Meier survival analysis and Cox proportional hazard regression model (P < .05). RESULTS: Complications leading to extraction occurred in 8 of 159 teeth (5%). Kaplan-Meier survival function suggested 93% cumulative 12-year retention. Cumulative healed rates declined from 91% at 6 months to 77% at 3 years. The healed rate was significantly lower for maxillary teeth without preoperative periapical radiolucency, replanted in more than 15 minutes, and root-end filled with ProRoot MTA. Cox regression identified extraoral time ≤15 minutes as predictor of complication-free healing (P < .04; hazard ratio, 2.767; 95% confidence interval, 1.053-7.272). CONCLUSIONS: This prospective cohort study of contemporary intentional replantation suggested a cumulative 12-year retention rate of 93% and healed rate of 77% after 3 years. Healing occurred 1.7 times more frequently in teeth replanted within 15 minutes. Although most complications occurred within 1 year after replantation, follow-up should extend for at least 3 years to capture late complications.

Prevalence and prevention of dental injuries in young taekwondo athletes in Croatia.

AIM: The aim of this study was to evaluate the occurrence of dental and facial injuries, the habit of wearing mouthguard and the awareness regarding injury prevention and first aid after tooth avulsion among young taekwondo athletes in Croatia. MATERIALS AND METHODS: A survey on a sample of 484 taekwondo athletes was conducted, which included 271 male (56%) and 213 female (44%) athletes aged between 8 and 28 years. The questionnaire submitted to the athletes contained 15 questions about dental trauma, use of mouthguard, dental trauma prevention, level of awareness about tooth avulsion and replantation and disturbances associated with mouthguard use. Collected data were evaluated according to gender, age groups and duration of actively engagement in taekwondo. Descriptive statistics and Chi-square tests were used for comparisons between groups. RESULTS: From the survey 300 (62%) of 484 athletes had sustained one serious injury and 103 (21%) had sustained an orofacial injury, while 194 (40%) had observed another player sustaining a dental injury. Higher number of orofacial injuries was observed in males (24%) than in females (18%). Furthermore, 98 (20%) athletes have experienced one or more dental injuries, and out of these 98 suffering dental injury 60 were male (61%) and 38 were female (39%). The frequency of orofacial injuries in the older group (42%) is higher than in three younger groups (younger cadets 25%; cadets 13%; juniors 20%) (p<0.05). Mouthguard wearing was recorded in 465 athletes (96%), 47.1% of them wear stock mouthguard, 47.6% wear boil and bite mouthguard, but only 5.3% were custom-made mouthguards. Most of them (96%) consider that mouthguards are useful for injury prevention in taekwondo. CONCLUSION: The results of this survey show that dental and orofacial injuries occur in taekwondo in all age groups but mostly in the senior group. Taekwondo players know the importance of mouthguard use, but only 5% use custom made mouthguards. This is not adequate for dental injury prevention and highlights the important role of dental professional in education of athletes for advocating the use of custom made mouthguards.

Replantation of avulsed primary incisors: a critical review of a controversial treatment.

Compared with the abundant literature on the replantation of avulsed permanent teeth, the literature on replantation of avulsed primary teeth is significantly more limited. A search of PubMed, using the terms: primary teeth, primary incisors, avulsion, exarticulation, replantation and reposition, and search in the reference list of the relevant articles, revealed 16 case reports of replantation of 31 primary incisors in 24 children. This article is a critical review of the arguments against replantation that have been presented in textbooks, review articles, and clinical guidelines.

Early prognostic indicators and outcome prediction model for replanted avulsed teeth.

AIM: To identify early clinical variables that are most predictive of treatment outcome and to develop a model that will allow prediction of treatment outcomes based on these variables. STUDY DESIGN AND METHODS: A dental trauma database was used to randomly identify patients who had received treatment for avulsed teeth between 1998 and 2007. A data extraction form was designed and completed for each tooth. Demographic, diagnostic and treatment information recorded in the patient's records, in addition to radiographs, were viewed retrospectively. STATISTICS: The significance and the predictive power for each early clinical variable were assessed using a univariate logistic regression model. Only significant variables (p<0.05) were considered eligible for the prediction model and a c-index was then constructed for their respective predictive power (0.5 = no predictive power, 1.0 = perfect prediction). RESULTS: Of the original sample of 213 patients who had received treatment for avulsed teeth between 1998-2007 only 105 fulfilled the criteria for evaluation. Two models ('At first visit' and 'at initial treatment visits') were produced with a total of five variables that were significant and holding the greatest predictive power (high c-index): patient age (p=0.001, c=0.80); stage of root formation (p=0.001, c=0.76); storage medium (p=0.047, c=0.58); tooth mobility after dressing (p=0.001, c=0.70); and tooth mobility after splinting (p=0.003, c=0.70). These variables underwent multi-variate analysis and the final models had good predictive abilities (c-index of 0.80 and 0.74). CONCLUSION: These predictive models based on patient age, stage of root formation, storage medium, tooth mobility after dressing and tooth mobility after splinting were shown to have high predictive value and will enable a clinician to estimate the long term prognosis of avulsed and replanted teeth. It will enable planning for further treatment with a realistic view of outcome at an early stage.

Orofacial trauma in Brazilian basketball players and level of information concerning trauma and mouthguards.

Orofacial injuries are increasingly considered a public health problem in high impact sports. The purposes of this study were: to assess orofacial trauma (OT) history in basketball players, in relation to wearing mouthguards (MG), facial types, presence of mouth breathing and player's position in the game, also to check athletes' level of knowledge about trauma and MGs. Questionnaires were given to category A-1 adult athletes registered in 2006/07 in the State of São Paulo and Brazilian Basketball Confederation Championships, and National Team members. Of the total sample (n=388), 50% of athletes sustained orofacial injuries; dental trauma accounted for 69.7%, with emphasis on maxillary central incisors, followed by soft tissue (60.8%), in which lip injuries were the most prevalent. No relationship was found between trauma history and player's position (P=0.19), facial type (P=0.97), presence of mouth breathing (P=0.98), but there was statistically significant association between the prevalence of OT and lack of MG use (P≤0.0001). Of all the athletes affected, only 1% wore a MG at the time of the trauma, 26.5% did not know about the MGs and 10.6% did not know their functions. When trauma occurred, 79.6% replied one must look for the tooth at the accident site, 50% knew it must be stored in liquid, as replantation was possible (62.3%) and 75.8% believed elapsed time could influence prognosis. Basketball is a high impact sport with high prevalence of OT, particularly maxillary central incisor and lip injuries, but athletes did not use MGs. There should be more educational campaigns to inform players about orofacial injuries and their prevention in Brazilian basketball.

Clinical audit of children with permanent tooth injuries treated at a dental hospital in Ireland.

AIM: To audit key demographic and clinical factors relating to treatment of trauma to the permanent dentition at the Paediatric Dental Department, Cork University Dental School and Hospital, Ireland and to compare clinical management with guideline recommendations. STUDY DESIGN: Clinical audit. METHODS: Consecutive clinical records for children attending for treatment of dental trauma were audited with regard to age, gender and distance travelled. The number of teeth per patient, the cause, type and prevalence of injury were examined. Splinting of mobilisation injuries and the prevalence of pulp extirpation were compared with published guidelines. RESULTS: Records were available for 94 children (65 male, 29 female) with a mean age at time of injury of 10.1 (SD±2.64) years. There were 82% of children living within 50 km of the Hospital. A total of 168 teeth were involved. Dental injuries comprised 39 uncomplicated crown fractures, 18 complicated crown fractures, 37 subluxations, 9 root fractures, 10 extrusions, 14 lateral luxations, 7 intrusions, 30 avulsions and 4 were unclassified. Sport injuries accounted for 23.2% of injuries to teeth, falls for 22.6%, bicycles were involved in 15.5%, other domestic accidents 6.5%, assault 4.2%, vehicles 3.0%, swimming 0.6%. and the remaining 24.4% were unclassified. In some instances of avulsion, lateral luxation, subluxation and extrusion injuries, a tendency to splint for durations longer than that recommended in guidelines was observed. Prevalence of pulpal extirpation for replanted teeth was in keeping with recommendations. CONCLUSION: General adherence to guidelines in respect of splinting and prevalence of pulp extirpation was demonstrated. Utilising a standardised recording system would facilitate the clinical audit process.

A retrospective study of 889 injured permanent teeth.

The aim of this study was to investigate pre-injury factors, causes of dental injuries and healing complications after traumatic injuries to permanent teeth. The analysed sample comprised 889 permanent teeth of 384 patients, who were treated in the Dentistry Department in Faculty Hospital in Pilsen. Enamel-dentin fractures [233 teeth (26.2%)] and lateral luxations [207 teeth (23.3%)] were the most frequent injuries. The age of the patients at the time of injury varied between 7 and 65 years. Predominantly, children were affected [587 injured teeth (66.0%)]. The most frequent causes of injuries in patients older than 11 years were various sport activities, predominantly bicycling. Pulp necrosis was observed in 239 teeth (26.9%). It was the most frequent post-traumatic complication in all types of dental traumas. Teeth with a completed root formation demonstrated a higher prevalence of pulp necrosis than teeth with an incomplete root formation in all types of luxation injuries. External root resorption was observed in 144 teeth. The rate of inflammatory resorption differed between the various types of luxation injuries (extrusive luxation 5.6%, lateral luxation 11.6%, intrusive luxation 33.3%). Following avulsion and replantation, active inflammatory resorptions were diagnosed in 13 (26.5%) of 49 replanted teeth and ankylosis/replacement resorptions were observed in 21 (42.9%) of 49 replanted teeth. After avulsion, primarily, immature teeth were affected by these complications. Within the observation period of 5 years, 39 teeth (4.4%) had to be removed (16 teeth with root fractures, 19 avulsed and replanted teeth, 3 luxated teeth, 1 tooth with crown-root fracture).

Retrospective clinical study of 90 avulsed permanent teeth in 58 children.

The aim of this study was to find out the causes that lead to dental avulsion in children, to analyze the effectiveness of our treatment and the response of the adults when such incidents occur and finally to determine the occurrence of posttraumatic complications some time after the injury, especially the resorption of the affected teeth root. We analyzed the documentations of a sample of patients containing 57 children who had a total of 90 avulsed teeth and were treated in Dentistry Department of Medical Faculty in Pilsen, Czech Republic, in the years between 1995 and 2005. We discovered that most frequently the children experience dental avulsion in the age between 8 and 11 years old, the most affected teeth are the upper central incisors and the most frequent causes are sports and games which are very common in these ages, in various environments, like schools, sport fields and home. The majority of the children were transferred to the Dentistry Department either quite long after the avulsion incident and without the avulsed teeth, or with the avulsed teeth which were carried in an inappropriate transport medium, indicating that there is insufficient knowledge of adult people, especially the ones who are in daily contact with children, on how to provide first aid in cases of dental avulsion.

An investigation into dentists' management methods of dental trauma to maxillary permanent incisors in Victoria, Australia.

Trauma to anterior teeth in children could become a long-term problem to dental health. To a large extent, the management actions of the dentists involved will determine the clinical outcome and, in turn, these actions will be related to their levels of knowledge. The aim of this study was to investigate dentists' knowledge of managing traumatic injuries to maxillary permanent incisors in children. A self-completion questionnaire containing 19 questions on management methods of treating dental trauma was mailed to 693 dentists in Victoria, Australia. The response rate achieved was 61%. This survey found that some of the respondents had adequate management knowledge for the different types of traumatic injuries, while others did not have the correct information. Approximately half the dentists considered milk as the preferred extraoral storage medium of choice for avulsed teeth and a period of 7-10 days splinting after replantation. A large proportion of dentists showed inadequate knowledge with regard to understanding the biological mechanisms causing replacement root resorption (61%) and external inflammatory root resorption (74%). Overall, the respondents to this survey demonstrated only a moderate level of knowledge in management of traumatic injuries to maxillary permanent incisors in children. Continuing professional development programmes may be a means of improving this deficient knowledge base.

Dental trauma that require fixation in a children's hospital.

Children and adolescents who suffer traumatic injuries often seek emergency treatment at a Children's Hospital. Complex injuries to permanent teeth and their periodontium require immediate repositioning and stabilization. Many of these emergencies are treated by pediatric dental residents at the Women and Children's Hospital of Buffalo, Buffalo, New York. The purpose of this study was to characterize these complex injuries of permanent teeth that require emergency treatment in a Children's Hospital. All of the cases of dental trauma which had involved permanent teeth and which had been treated with a splint in 2001 and 2002 were reviewed. There were 79 patients that were between 5 and 19 years of age with twice as many males (54) as females (25). The number of males increased from childhood (5-10 years) to early adolescence (11-15 years) and then decreased rapidly in late adolescence (16-19 years), whereas the number of females decreased steadily with age. Most of the incidents occurred during the summer months (72%), particularly in June and July (42%), and Fridays and Saturdays were the busiest days of the week. Most of the injuries were caused by organized and recreational sporting activities (39%) and accidental falls (33%), followed by interpersonal violence (15%) and a few motor vehicle accidents (7%). The 173 permanent tooth injuries were mostly luxations (62%) or avulsions (20%), with only a few fractures of the alveolar bone (5%) or tooth root (1%). Most of the displacements were lateral luxations (40%) or extrusions (18%) with only a few intrusions (3%). These injuries most commonly afflicted the maxillary central incisors (54%), followed by the maxillary laterals (18%) and mandibular centrals (17%). The emergency treatment that was provided at the Children's Hospital included replantation and repositioning, and the placement of a semi-rigid or flexible splint.

Dental injuries in inline skating - level of information and prevention.

Inline skating belongs like ice hockey, rugby, and boxing to sporting activities with high-risk of suffering tooth accidents. Because of high velocity and loss of balance, especially on uneven ground, the injury potential in inline skating is higher. The objective of this work was to conduct a comparative study between Switzerland and Germany. The questions focussed on the frequency of tooth accidents, their prevention by mouthguard and the level of information about emergency measures after dental trauma and the resulting consequences for athletes. Using a standardized questionnaire totally 612 individuals, 324 men and 288 women, in two countries belonging to three different divisions (fun, fitness and speed) were surveyed. Fifty-six (9.2%) of these 612 interviewees have already experienced a tooth injury while inline skating. More than half of all interviewed players (68.3%) were aware of the possibility of replanting avulsed teeth. Only 32.4% were familiar with the tooth rescue kit. Just 65.4% knew mouthguard and only 1.9% of those athletes (n = 12) wore a mouthguard while inline skating. The results show that the area of inline skating requires more information about preventing dental trauma through sports associations and dentists.

[Tooth replantation after traumatic exarticulation. Present therapeutic orientations and future perspectives]. / Reimpianto dentale dopo exarticolazione traumatica. Orientamenti terapeutici attuali e prospettive future.

Replantation is a method in which an avulsed dental element is replaced into its alveolar socket. The dental traumatic exarticulation occurs in any age, but most frequently in the juvenile population. The aim of this paper is to rewiew the risks and benefits of tooth replantation and to discuss the present therapeutic orientations and future perspectives for avulsion management.

Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisors.

OBJECTIVE: The purpose of this study was to assess the knowledge of physicians in hospital emergency room care on their possible role in cases of traumatic loss of permanent incisors. METHODS: A questionnaire was sent to directors of emergency room facilities in hospitals in Israel regarding the medical team at the emergency room in the hospital, availability of an in-house dental service and existence of a protocol for management of avulsed teeth. Another questionnaire, completed by physicians in the emergency room, contained demographic questions and questions regarding their knowledge of management of avulsed permanent teeth. RESULTS: The findings of the study showed that only 4% (12 of 335 physicians) would provide an appropriate initial treatment that, if followed by treatment by a dentist as recommended, could save the avulsed tooth. No correlation was found between knowledge of appropriate treatment of avulsed teeth and type of specialty, years of experience, previous exposure to information on trauma to the teeth and gender. The only significant association was found between physicians' knowledge and having a dentist spouse. Most of the physicians had never attended any formal seminar or lecture or received printed instructions on the management of avulsed teeth. CONCLUSIONS: Medical students and physicians in hospitals' emergency rooms should be made aware of their possible role in cases of avulsion of permanent teeth, in order to minimize late complications associated with such injuries. One possible way to achieve this goal is through education during and after training and introduction of a formal protocol for treatment of avulsed permanent teeth and other dental injuries.

Estudo clínico e radiográfico de dentes avulsionados acidentalmente e reimplantados: retrospectiva de 18 anos / Clinical and radiographic evaluation of accidentally avulsed and replanted teeth: 18-year retrospective

O objetivo deste trabalho, foi analisar os prontuários de pacientes acidentados, que tiveram dentes avulsionados e reimplantados no período de 1983 a 2000, atendidos no Serviço de Urgência Odontológica da Faculdade de Odontologia de Bauru da Universidade de São Paulo. Foram coletados dados sobre: o tempo de permanência extra-alveolar, o meio usado na conservação do dente avulsionado e o tipo de contenção empregado, assim como a proservação instituída, correlacionando-os com a situação atual do dente reimplantado. Esta análise foi complementada pelos seguintes dados epidemiológicos: elementos dentais mais atingidos, idade do paciente na época da reimplantação, sexo, raça, tipo de acidente, ambiente de ocorrência, época do ano de maior incidência e o número de dentes avulsionados por paciente. Desse modo os dados obtidos foram os seguintes: - Foram atendidos 87 pacientes, totalizando 116 dentes avulsionados. - O tempo de permanência extra-alveolar variou de 30 minutos (13,8 %) até 96 horas (1,1 %). - O meio mais utilizado para conservação do elemento dental avulsionado foi o leite (43,5 %). - O tipo de contenção mais empregado foi a esplintagem com resina composta (50,0 %). - Os dentes mais atingidos foram os incisivos centrais superiores (72,4%). - A avulsão ocorreu com mais freqüência na faixa etária compreendida entre 8 e 12 anos. - Predominância do sexo masculino (60,9 %) em relação ao sexo feminino (39,1 %). - 81,6% dos pacientes são da raça branca, 17,2 % negros e 1,2 % amarelos. - Os acidentes ocorreram com maior freqüência no outono. - 21,9 % dos acidentados tiveram mais que 1 dente avulsionado. Confrontando essas informações com a literatura pertinente pode-se observar que os nossos dados são semelhantes àqueles contidos nos estudos sobre avulsão e reimplantação e concluir que nos últimos 5 anos o grau de conhecimento do público leigo em relação à conservação de dentes avulsionados evoluiu muito, porém, ainda predomina entre os profissionais...

The objective os this project was to analyze the records of patients who suffered accidents and had avulsed and replanted teeth in the period between 1983 and 2000, attended to by the Dental Urgency Service of the School of Dentistry at Bauru of the University of São paulo. Data regarding: the time of extra-alveolar permanence, the means used in the conservation of the avulsed tooth and the type of splint employed, as well as instituted preservation, correlating them to the current situation of the replanted dental element, was collected. This analysis was complemented by the following epidemiological data: the most affected dental, the age of the patients at the time of the replantation, gender, race, kind of accident, environment of the incident, the time of year with the highest incidence, and the number of avulsed teeth per patient. In such a way, the data obtained was de following: - 87 patients were attended to, making a total of 116 avulsed teeth; - The time of extra-alveolar permanence ranged from 30 minutes (13,8 %) to 96 hours (1,1 %); - The most utilized means for the conservation of the avulsed dental elements was milk (43,5 %); - The kind of splint most used was a variety with compound resin (50,0 %); - The teeth most affected were the upper central incisors (72,4 %); - Avulsion occurred most frequently in the age range between 8 and 10; - Predominance of the male sex (60,9 %) in relation to that of the female (39,1 %); Abstract 1 0 7 - 81,6 % of the patients were white, and 17,2 % were black, while 1,2 % were Asiatic; - The accidents occurred most frequently in the fall; - 21,9 % of the accidents had more than 1 avulsed tooth. Confronting this information with the pertinent literature, one can observe that our data is similar to that which is contained in the studies on avulsion and replantation, and conclude that in he last 5 years, the extent of the layman publics knowledge in relation to the conservation of avulsed teeth has...

Treatment of traumatic dental injuries in a cohort of 16-year-olds in northern Sweden.

The prevalence and yearly incidence of traumatic tooth injury between 1 and 16 years of age have been studied in a cohort of 16-year-olds, born in 1975, and residing in the County of Västerbotten. The study material comprised 3007 dental records from the Public Dental Health Service. Of these, 1040 contained information on dental injuries. Out of 1000 injured primary teeth, 32% were lost, either avulsed at the time of the accident or extracted due to complications. A majority (92%) of the extractions was performed at the first or second follow-up. A total of 690 tooth injury episodes had occurred in the permanent dentition, involving 981 teeth. In 10% of the teeth more than one diagnosis was recorded for the same tooth. 416 restorations were performed due to crown fractures, the majority at the emergency visit. 44% of the patients had to come back one or more times to revise the composite restoration. Complicated fractures or serious luxation injuries constituted only 5% of the total number of injuries in the permanent dentition. 77 (8%) of the traumatised teeth were treated endodontically. Two percent of the teeth with uncomplicated crown fractures required endodontic treatment due to pulp necrosis, while 28% of teeth with a combination of crown fractures and luxation injury were endodontically treated. Out of 6 avulsed incisors, 4 survived after endodontic treatment. A total of 7 incisors were lost as a consequence of the injuries. A specialist treated 4% of the patients.

Reimplantes intencional para tratamento de fratura radicular longitudinal: caso clínico / Intentional replantation and reattachment for treatment of vertical root fracture: case report

Um elemento dental com fratura radicular longitudinal frequentemente está condenado à extraçäo. Entretanto, o reimplante intencional realizado com o objetivo de possibilitar o acesso a toda a extensäo da fratura e permitir a colagem dos fragmentos dentais com materiais adequados é uma alternativa terapêutica viável e com prognóstico favorável

[Preliminary research on the prognosis of late reimplants with prior conditioning with a fluoridated solution]. / Ricerca preliminare sulla prognosi con reimpianti tardivi previo condizionamento con soluzione fluorurata.

The principal factors that affect the prognosis of a posttraumatic reimplantation are the length of the extra-alveolar persistence and the manner in which the extracted tooth is preserved. Both are fundamental for the maintenance of the fiber vitality of the periodontal ligament. The necrosis of these fibers cause ankylosis. It is observed that the conditioning of the radicular surface with fluoride solutions before the reimplantation is likely to slow down the evolution of radicular resorption. To evaluate the effectiveness of such methodology six cases of traumatic extractions, characterized by a length of extra-alveolar persistency (not longer than 24 hours), and unfavorable conditions of the preserved tooth have been treated by conditioning the radicular surface with the Na-fluoride solution before the reimplantation. Another group of reimplantation cases with the same characteristics have been examined without proceeding first to the radicular conditioning. The results of the study, although preliminary, verified the positive influence of the Na fluoride upon the radicular resorption.

[20-years experience with tooth reimplantation]. / 20 év replantációs tapasztalatai.

Tooth reimplantation experiences through 20 years are reported on. On basis of his results the tooth maintaining method is suggested to be employed by practicing dentists.