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.

Long-term prognosis after decoronation of avulsed teeth with replacement resorption: a report of three cases.

The complications of replacement resorption following tooth injury in growing children include infrapositioning of the tooth, tilting of the adjacent teeth, and alveolar ridge deformity. Decoronation is a conservative treatment method that facilitates bone preservation. The current case report focuses on the long-term preservation of alveolar ridge dimension following decoronation in three patients. Decoronation was performed prior to occurrence of the pubertal growth spurt, and the patients' ridge width and vertical apposition were monitored for at least 4 years. Timely intervention and regular monitoring are essential for maximization of the benefits of decoronation, a simple procedure that preserves esthetics and minimizes the need for further treatments. The importance of space management for prosthetic treatment has also been highlighted. The findings of this study show that infrapositioned teeth in growing children can be treated successfully using decoronation.

The consequences of orthodontic extrusion on previously intruded permanent incisors-A retrospective study.

AIM: The aim of this study is to compare the adverse effects that occur after orthodontic extrusion of teeth that have been traumatically intruded with those of similar teeth that have not experienced any trauma. BACKGROUND: The outcome of incisors intrusion can be affected by the patient's age, extent of injury, root development, and malocclusion. Orthodontic extrusion is a potential solution, but it may also cause complications. MATERIALS AND METHODS: A retrospective study of the effects of extrusion of traumatically intruded teeth was carried out. The study group included 21 teeth in 14 patients. The control group included 32 teeth in 10 patients that underwent orthodontic extrusion with no history of trauma. Patients' age, gender, and stage of root development were recorded. The severity of the intrusion was classified as mild (<3 mm), moderate (3-6 mm), and severe (≥7 mm). A comparison of signs of pulp necrosis and root resorptions between the groups was made. RESULTS: The central incisor is the tooth that is most injured in 80.9% of cases. A majority of these incidents involve severe intrusion, which was found in 42.9% of cases. 90% of the traumatized teeth had already lost their vitality prior to orthodontic treatment. Various forms of root resorption were observed in the study group. In the control group, 31.2% of teeth showed signs of external root resorption, but no endodontic intervention was carried out during the follow-up period, as these teeth remained vital. CONCLUSIONS: Following intrusion, there is a high risk for root resorption and pulp necrosis. Orthodontic repositioning should be carried out with caution and mild force to prevent complications. Long-term follow-ups are required to ensure the best possible outcome.

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.

The risk of healing complications in primary teeth with root fractures: A retrospective cohort study.

BACKGROUND/AIM: Primary teeth are frequently affected by traumatic dental injuries. Root fractures are rare and have a reported incidence of 2% in the primary dentition. Hence, there is limited evidence on this topic. This study aims to evaluate the risk of healing complications in primary teeth with root fracture and to identify possible sequelae in the permanent dentition following root fracture in the primary dentition. MATERIALS AND METHODS: A retrospective analysis of a cohort of 53 patients with 74 root fractured primary teeth. The standard follow-up program included clinical and radiographic examination after 4 weeks, 8 weeks, 6 months, and 1 year after the trauma and when the patient was 6 years of age. The following complications were registered: pulp necrosis (PN), pulp canal obliteration (PCO), ankylosis with replacement root resorption (ARR), infection-related root resorption (IRR), premature tooth loss (PTL), and repair-related resorption (RRR). STATISTICS: The Kaplan-Meier and Aalen-Johansen estimators were employed. The level of significance was 5%. RESULTS: A total of 74 teeth were included. 42 teeth were extracted at the initial examination. Risks estimated after 3 years: PTL 45.9% [95% CI: 28.8-63.0], PCO 12.9% [95% CI: 2.3-23.4], PN 14.9% [95% CI: 3.9-25.9], RRR 2.6% [95% CI: 0.0-7.5]. No teeth showed ARR or IRR. All complications were diagnosed within the first year. Most common sequelae in the permanent dentition was demarcated opacities, with an estimated risk of 20% [95% CI: 8.2-41.3]. CONCLUSIONS: There is a low risk of healing complications following a root fracture in the primary dentition. Root fractures often result in early extraction of the coronal fragment. The remaining apical fragment will undergo a physiological resorption. Aside from opacities, there is a low risk of sequelae in the permanent dentition.

Young Hemophilia Patient Presenting with Avulsed Maxillary Permanent Incisor.

A 7-year-old girl came to the Emergency Department following an avulsion of the maxillary central incisor. The tooth was replanted and splinted. The patient was referred to a hematologist for follow-up and maintenance of adequate levels of Factor VIII.

Intentional replantation and management of avulsion related ankylosis and external cervical resorption. A 10-year follow up case report.

Replantation is the treatment of choice for avulsed permanent teeth; ankylosis and cervical root resorption are among survival complications. A 9.5-year-old boy presented with an avulsed maxillary permanent central incisor with an open root apex following a school accident. The tooth was kept in milk, after a dry time of 15-20 min. Its replantation was performed 60 min after the accident. At 8 months, apexification with apical plug was attempted upon radiographic evidence of apical periodontitis. Ankylosis sound with infraocclusion and radiographic evidence of external cervical root resorption (ECR) were evident at 3 years and 3 months. At the patient's return one year later with esthetic concerns (2 mm infraocclusion) there was a 5 mm diameter ECR cavity. After intentional atraumatic extraction the resorptive cavity was debrided and restored with Biodentine; subsequently the tooth was reimplanted and splinted at an extruded position. At the 10-year follow up since the first avulsion the tooth remains esthetically pleasing, asymptomatic, non-ankylotic and functional. The present case supports intentional replantation as an option in managing infraoccluded teeth with advanced ECR.

Management of transverse root fractures in dental trauma.

The management of complex dental trauma can be modulated according to the emergencies that may arise over time. Clinical management of transverse root fractures may require different therapies based on situations, such as delay and error in the treatment of an avulsion trauma associated with apical third root fracture, patient's poor compliance, or external and internal root resorption. The primary aim of this article was to review studies regarding root fractures in the permanent dentition and root fracture management. The secondary aim was to present the inflammatory reaction and the complications (i.e., infections) that may occur if the International Association for Dental Traumatology (IADT) guidelines are not followed. In addition, a scenario is devised in which endodontic surgery, despite the baseline patient's conditions and negative prognosis, can help to inhibit the inflammatory root resorption and allow the preservation of soft and hard tissues within a long follow-up from the injury, for the purpose of demonstrating the next possible implant-prosthetic rehabilitation.

Tooth transplantation and replantation: Biological insights towards therapeutic improvements.

Transplantation and replantation of teeth are effective therapeutic approaches for tooth repositioning and avulsion, respectively. Transplantation involves transplanting an extracted tooth from the original site into another site, regenerating tissue including the periodontal ligament (PDL) and alveolar bone, around the transplanted tooth. Replantation places the avulsed tooth back to its original site, regenerating functional periodontal tissue. In clinical settings, transplantation and replantation result in favorable outcomes with regenerated PDL tissue in many cases. However, they often result in poor outcomes with two major complications: tooth ankylosis and root resorption. In tooth ankylosis, the root surface and alveolar bone are fused, reducing the PDL tissue between them. The root is subjected to remodeling processes and is partially replaced by bone. In severe cases, the resorbed root is completely replaced by bone tissue, which is called as "replacement resorption." Resorption is sometimes accompanied by infection-mediated inflammation. The molecular mechanisms of ankylosis and root resorption remain unclear, although some signaling mechanisms have been proposed. In this mini-review, we summarized the biological basis of repair mechanisms of tissues in transplantation and replantation and the pathogenesis of their healing failure. We also discussed possible therapeutic interventions to improve treatment success rates.

Traumatic dental injuries - practical management guide.

Traumatic dental injuries (TDIs) with a prevalence of 25% among school children and 33% among adults are a public health problem and can have a negative influence on the quality of life. The treatment prognosis of some teeth injuries is heavily dependent on the actions taken at the place of injury. The objective was to summarize evidence-based knowledge on the topic of TDIs and present a practical management guide for first aid in an accessible way. The authors searched the PubMed and Google Scholar databases. The review included only papers published in 2013 or later. Tooth injuries are proven to cause physical, social as well as economic consequences. The most frequent type of injury in primary dentition is avulsion, whereas crown fractures are most common in permanent dentition. TDIs occur most often at home and in school. Certain risk factors for TDIs were identified which include, among others, male gender, younger age, obesity. The general community knowledge of correct first aid in case of dental trauma is limited. Guidelines published by the International Association of Dental Traumatology include practical recommendations for first aid after avulsion. Permanent teeth should be replanted immediately at the accident site, whereas primary teeth should not be replanted when avulsed. Broken teeth fragments ought always to be collected if possible. After dental trauma it is vital that the patients seek professional help. Measures preventing TDIs (e.g., mouthguards) should be encouraged. It is of great importance that parents, teachers, guardians or bystanders witnessing a TDI are equipped to assist after a dental trauma or give advice on first aid when needed. Raising public awareness on the topic of dental injuries is a strongly advised general objective.

Ten-year follow up of previously traumatized immature permanent incisors sustaining second and third traumatic injuries after revascularization treatment: Case reports.

The long-term prognosis of previously traumatized immature permanent teeth treated with guided endodontic repair is well documented, but little is known about how these teeth respond to further traumatic injury after treatment. This case report presents the 10-year clinical and radiographic findings of two patients with traumatized maxillary incisors who underwent guided endodontic repair treatment and sustained two further traumatic injuries. Three crown-fractured maxillary central incisors with pulp necrosis were treated with a protocol that used 2.5% NaOCl irrigation, 3-4 weeks medication with calcium hydroxide or ciprofloxacin-metronidazole paste, induction of apical bleeding, and coronal sealing with mineral trioxide aggregate. One tooth sustained subluxation and a crown fracture after 20 months and 7 years, respectively. Two other teeth had a luxation injury at 9 months and subluxation 6.5 years after the repair treatment. One subluxated and one luxated tooth remained free of symptoms for 10 years with radiographic evidence of progressive root canal calcification, while the other luxated incisor required root canal treatment after 7.5 years. Although teeth treated with the so-called "regenerative" endodontic techniques do not possess true pulp tissue, the reparative tissue may respond to traumatic injuries in a similar manner to teeth with normal pulps.

Odontoma malformation and disturbances of eruption subsequent to traumatic dental injuries: A literature review and a case report.

Due to the close proximity of the primary teeth with the developing permanent successors, several developmental alterations in the permanent successors have been reported as consequences of traumatic dental injuries to the primary dentition. When they occur at a very young age such trauma could disturb normal tooth development and cause rare anomalies, including sequestration of the permanent tooth germ and odontoma-like malformations. A literature review of case reports with a history of trauma and odontoma formation is discussed in this paper. This paper also includes a case report of a patient, who was 3-years and 5-months old, when she was seen at the University of California, Los Angeles Children's Dental Center for the first time. The grandmother reported that the child was dropped from the father's lap when she was 2 weeks old and suffered head trauma and multiple skull fractures.

Intrusive luxation of permanent upper central incisor into the nasal cavity: A case report.

This case report outlines a rare complete intrusion of a permanent, maxillary central incisor (tooth 11) into the nasal cavity, with a late diagnosis and treatment. An eight-year-old boy was referred to an oral and maxillofacial surgery service with absence of tooth 11 after an episode of a fall from his own height. Approximately 50 days after the trauma, the patient presented with a complaint of obstruction of the right nostril. The clinical examination and tomographic evaluation showed that the tooth had been intruded into the nasal cavity on the right side. The tooth in question was removed under general anesthesia by direct approach through the right nostril. The patient was followed up for approximately one year without complications. This case demonstrates the importance of a detailed evaluation during the first examination after intrusive luxation, so the correct diagnosis is made and the correct treatment is performed to avoid greater morbidity and complications for the patient.

Deferoxamine Reduces Inflammation and Osteoclastogenesis in Avulsed Teeth.

Replacement and inflammatory resorption are serious complications associated with the delayed replantation of avulsed teeth. In this study, we aimed to assess whether deferoxamine (DFO) can suppress inflammation and osteoclastogenesis in vitro and attenuate inflammation and bone resorption in a replanted rat tooth model. Cell viability and inflammation were evaluated in RAW264.7 cells. Osteoclastogenesis was confirmed by tartrate-resistant acid phosphatase staining, reactive oxygen species (ROS) measurement, and quantitative reverse transcriptase-polymerase chain reaction in teeth exposed to different concentrations of DFO. In vivo, molars of 31 six-week-old male Sprague-Dawley rats were extracted and stored in saline (n = 10) or DFO solution (n = 21) before replantation. Micro-computed tomography (micro-CT) imaging and histological analysis were performed to evaluate inflammation and root and alveolar bone resorption. DFO downregulated the genes related to inflammation and osteoclastogenesis. DFO also reduced ROS production and regulated specific pathways. Furthermore, the results of the micro-CT and histological analyses provided evidence of the decrease in inflammation and hard tissue resorption in the DFO group. Overall, these results suggest that DFO reduces inflammation and osteoclastogenesis in a tooth replantation model, and thus, it has to be further investigated as a root surface treatment option for an avulsed tooth.

Avulsión dental y mantenedor de espacio estético-funcional y correctivo en Odontopediatría / Dental avulsion and esthetic-functional and corrective retainers use in Pediatric Dentistry / Avulsão dentária e mantenedor do espaço estético-funcional e corretivo em Odontopediatria

RESUMEN Se presentó el caso de un niño de 8 años que acudió al Servicio de Estomatología del Policlínico Universitario "Chiqui Gómez Lubián", de Santa Clara, provincia Villa Clara. En el mismo se observó avulsión del incisivo central superior derecho, fractura no complicada de la corona en incisivo central superior izquierdo y una marcada vestibuloversión. Se confeccionó un aparato placa Hawley de acuerdo a las características y necesidades del paciente, con el fin de lograr la recuperación estética, mantener la longitud del arco y corregir la vestibuloversión en el mismo. El aparato permitió obtener un resultado satisfactorio, que ha influido psicológicamente en el paciente al elevar su autoestima y salud bucal.

ABSTRACT A boy of 8 years old was seen in the dental service at the Policlínico Universitario "Chiqui Gómez Lubián", in Santa Clara, Villa Clara. Examination revealed avulsion in the right upper central incisor, uncomplicated crown fracture in left upper central incisor and an improper alignment of the teeth. Taking into account patients´ characteristics and requirements, it was fabricated a Hawley´s retainer in order to achieve a better aesthetic outcome, maintain the length of the dental arch and correct the improper alignment of the teeth. The appliance has achieved a satisfactory outcome, which has had a psychological influence on the patient by improving his self-esteem and oral health.

RESUMO Foi apresentado o caso de um menino de 8 anos que veio ao Serviço de Estomatologia do Policlínico Universitario "Chiqui Gómez Lubián", em Santa Clara, província de Villa Clara. Neste, observou-se avulsão do incisivo central superior direito, fratura não complicada da coroa em incisivo central superior esquerdo e vestibuloversão acentuada. Um dispositivo de placa de Hawley foi confeccionado de acordo com as características e necessidades do paciente, a fim de se obter recuperação estética, manter o comprimento do arco e corrigir a vestibuloversão nele. O dispositivo permitiu obter um resultado satisfatório, o que influenciou psicologicamente o paciente, elevando sua autoestima e saúde bucal.

Conservative treatment in adult patient with reimplanted anterior teeth after traumatic avulsion with extensive bone loss: an 8-year follow-up.

INTRODUCTION: Orthodontic treatment in patients with traumatized teeth is a condition that needs good planning in order to achieve satisfactory results. OBJECTIVE: To discuss approaches to orthodontic treatment of malocclusions associated with trauma followed by avulsion of anterior teeth, reimplanted after a short period of time. CASE REPORT: The treatment started with the distalization of upper posterior teeth, with the aid of mini-implants and sliding jigs, followed by the inclusion of anterior teeth in the arch, followed by intrusion of these teeth. RESULTS: With the treatment, improved mobility of the anterior teeth was achieved, with better insertion into bone tissue. The most important factor for satisfactory treatment and a good prognosis for avulsion is the time the tooth remains outside the socket. Orthodontic treatment in patients with traumatized teeth is not contraindicated; however, clinical and radiographic aspects must be considered. CONCLUSION: Among the feasible orthodontic treatment options, the conservative approach can be a very favorable treatment alternative.

Conservative treatment in adult patient with reimplanted anterior teeth after traumatic avulsion with extensive bone loss: an 8-year follow-up

ABSTRACT Introduction: Orthodontic treatment in patients with traumatized teeth is a condition that needs good planning in order to achieve satisfactory results. Objective: To discuss approaches to orthodontic treatment of malocclusions associated with trauma followed by avulsion of anterior teeth, reimplanted after a short period of time. Case report: The treatment started with the distalization of upper posterior teeth, with the aid of mini-implants and sliding jigs, followed by the inclusion of anterior teeth in the arch, followed by intrusion of these teeth. Results: With the treatment, improved mobility of the anterior teeth was achieved, with better insertion into bone tissue. The most important factor for satisfactory treatment and a good prognosis for avulsion is the time the tooth remains outside the socket. Orthodontic treatment in patients with traumatized teeth is not contraindicated; however, clinical and radiographic aspects must be considered. Conclusion: Among the feasible orthodontic treatment options, the conservative approach can be a very favorable treatment alternative.

RESUMO Introdução: O tratamento ortodôntico em pacientes com dentes traumatizados é uma condição que necessita de um bom planejamento, a fim de se conseguir resultados satisfatórios. Objetivo: Discutir as abordagens de tratamento ortodôntico de más oclusões associadas ao trauma seguido de avulsão de dentes anteriores, reimplantados após curto espaço de tempo. Relato do Caso: O tratamento realizado iniciou-se com a distalização dos dentes posteriores superiores, com auxílio de mini-implantes e sliding jigs, seguida da inclusão dos dentes anteriores na arcada e intrusão desses dentes. Resultados: Com a realização do tratamento, conseguiu-se melhoria na mobilidade dos dentes anteriores, com inserção mais favorável no tecido ósseo. O fator mais importante para o tratamento satisfatório e um bom prognóstico da avulsão é o tempo em que o dente permanece fora do alvéolo. O tratamento ortodôntico em pacientes com dentes traumatizados não é contraindicado; porém, aspectos clínicos e radiográficos devem ser considerados. Conclusão: Entre as opções de tratamento ortodôntico factíveis, a abordagem conservadora pode ser uma opção de tratamento bastante favorável.

Severe Case of Delayed Replantation of Avulsed Permanent Central Incisor: A Case Report with Four-Year Follow-Up.

Avulsion is one of the most serious dental traumatic injuries with a reserved prognosis. This case report describes multiple trauma lesions in permanent central incisors of an eight-year-old girl and a four-year follow-up. The right upper incisor suffered avulsion, remained 16 h extraorally, and was replanted after extraoral endodontic therapy. The left maxillary central incisor suffered a noncomplicated crown fracture with concomitant subluxation. The present case adds to the literature a rare occurrence of success in a severe case with poor prognosis. For this reason, the International Association for Dental Traumatology (IADT) guidelines should be followed and, even in extreme situations, replantation should always be considered.

Consequences of tooth luxation associated with complicated crown fracture: a case report.

The objective of this clinical case report is to describe the late treatment performed in a 10-year-old patient who suffered a complicated crown fracture associated with luxation of the maxillary left central incisor. The patient-s parents reported that the patient fell and was immediately taken to a hospital, where radiographs, splinting, and suturing were performed and an anti-inflammatory prescription was provided, but no treatment was given for the exposed pulp. The parents and patient sought treatment at a pediatric dentistry clinic 16 days post-trauma. The clinical examination revealed the presence of a left central incisor with a fracture of enamel and dentin involving the pulp, which was necrotic, and a splint extending from the right lateral incisor to the left lateral incisor. However, it was not possible to diagnose the type of luxation that had occurred. The fractured incisor was treated with periodic changes of calcium hydroxide dressing for apexification for 10 months, and the root was subsequently obturated with gutta percha and root canal sealer. The tooth fragment was stored in physiologic solution during this time. After obturation, tooth darkening was observed, and LED-assisted tooth bleaching was accomplished prior to reattachment of the fractured fragment. The tooth was reexamined every 6 months. Two years after the traumatic event, the left central incisor was infraoccluded in relation to the right central incisor. A radiograph confirmed ankylosis of the traumatized tooth. When trauma affects the enamel, dentin, pulp, and supporting tissues, the prognosis can be unfavorable even when late treatment is adequate, especially when a tooth in a growing patient has points of ankylosis.

Incidence of root resorption after concussion, subluxation, lateral luxation, intrusion, and extrusion: a systematic review.

OBJECTIVE: Traumatic dental injuries often affect the dental hard tissues, periodontal tissues, and dental pulp. Root resorption (RR) is a significantly concerning phenomenon that could lead to loss of the traumatized tooth. The purpose of this systematic review was to analyze the incidences of different types of RR after concussion, subluxation, lateral luxation, intrusive luxation, and extrusive luxation. MATERIAL AND METHODS: Seven databases were electronically and manually searched for the identification of observational studies that evaluated the incidence of RR after luxation injuries. Following study selection, data extraction, and risk of bias assessment through MAStARI checklist, the GRADE quality of available evidence was assessed. RESULTS: In total, 14 studies were included in the present systematic review. Ten and four studies presented a moderate and low RoB, respectively, and the overall GRADE quality of evidence was "very low" for all outcomes. The highest incidence rates of RR were observed for teeth with intrusive luxation, followed by those with extrusive luxation, lateral luxation, subluxation, and concussion. In general, the most common type of RR documented for all injuries was inflammatory RR, followed by replacement RR, surface RR, and internal RR. CONCLUSIONS: Our findings suggest that RR most commonly occurs in association with intrusive luxation and by inflammatory RR. Awareness regarding the incidence of RR after injuries is useful for clinicians to minimize the risk and severity of its occurrence, because a late diagnosis of RR may limit treatment alternatives and result in tooth loss. CLINICAL RELEVANCE: Knowledge about the incidence of RR in teeth with concussion and different types of luxation injuries can ensure appropriate follow-up protocols and favorable outcomes.