Emergency management of dental avulsion and replantation: knowledge of undergraduate health care students / Manejo emergencial da avulsão dentária e do reimplante: conhecimento dos estudantes degraduação na área de saúde

Dental replantationis a major problem in public health. Its prognosis depends on emergency care, butthere is a lack of knowledge on it. So, this study aims to evaluate the knowledge of undergraduate students of Dentistry, Speech Therapy, Physical Education, Pedagogy,and Technologist in Radiology. One hundred and fifty-onestudents answered tenquestions about emergency replantation care. Then, an educational lecture was performed. The same questions were asked again to the same students to reevaluate their answers. The statisticaltests were employed at a significant level of p<0.05. There wasa significant difference (p<0.05)inthe responsesbefore and after the lecture. The dental students had a higher knowledge ofthe subject (p<0.05). The educational presentation reached its objective, since there was an improvement in the index of all answers of the post-lecture questionnaire, demonstrating thatthe people must be informedand trainedin the emergency management of dental avulsion (AU).

O reimplante dentário é um grande problema de saúde pública. Seu prognóstico depende do atendimento de urgência, mas ainda falta conhecimento.Assim, este estudo tem como objetivo avaliar o conhecimento de graduandos de Odontologia, Fonoaudiologia, Educação Física, Pedagogia e Tecnólogo em Radiologia. Cento e cinquenta e umalunos responderam a 10 perguntas sobre cuidados de reimplante de emergência. Em seguida, foi realizada uma palestra educativa. As mesmas perguntas foram feitas novamente aos mesmos alunos para reavaliar suas respostas. Os testes estatísticos foram empregados em um nível de significância de p <0,05. Houve diferença significativa (p <0,05) nas respostas antes e depois da palestra. Os estudantes de odontologia apresentaram maior conhecimento sobre o assunto (p <0,05). A apresentação educativa atingiu seu objetivo, visto que houve uma melhora no índice de todas as respostas do questionário pós-aula, demonstrando que as pessoas devem ser informadas e treinadas no manejo emergencial da avulsão dentária (AU).

Knowledge of Primary School Teachers Regarding Dental Trauma Management in Hail Region, Saudi Arabia

Abstract Objective: To evaluate the knowledge of elementary school teachers about the management of dental trauma. Material and Methods: An observational study, with the cross-sectional design, was conducted among primary school teachers in Hail, Saudi Arabia during January 2017. The questionnaire distributed among 400 primary school teachers from 18 different schools using convenient sampling. Data were gathered and analyzed using SPSS version 20 Results: 378 (94.5%) respondents to the questionnaire. It was found that only 37.8% of the primary school teachers were able to distinguish between the primary and permanent teeth. Only 59.5% reported starting the management of a child with trauma immediately. Merely 38.4% believed that it is important to search for the missing tooth or the broken pieces, whereas 31% would re-implant the permanent tooth into the socket by themselves. Regarding the storage media, only 16.6% respond correctly. According to school teachers, the best way of learning the management of dental trauma at school is through videos (36.2%) and phone application (33.9%) Conclusion: School teachers lack knowledge regarding the management of dental trauma. We strongly recommend planning for dental trauma educational based on the teacher's perception after pilot testing its effectiveness.

Laminados cerâmicos sobre refratários, beleza em extinção? / Ceramic laminates on refractories, beauty in extinction?

A Odontologia atual está pautada em procedimentos conservadores e, nas últimas décadas, houve uma grande evolução na técnica e nos materiais dentários que favoreceram essa tendência. Hoje em dia, a tecnologia está presente em nosso cotidiano e é difícil de imaginar sobreviver sem ela. Na Odontologia há um grande debate sobre a questão da tecnologia, que pode eliminar até 100% da mão de obra humana (Técnico em Prótese Dental ­ TPD) nos processos de confecção de próteses dentais e se imaginava que esse futuro estaria distante, mas já é realidade. Porém para realizar um tratamento estético de qualidade é necessário investir e ter todos os equipamentos de última geração? Neste artigo será relatado um caso clínico de laminados cerâmicos confeccionados sobre refratários de forma tradicional e artesanal.

The current Dentistry is based on conservative procedures and in the last decades there has been a great evolution in technique and dental materials that favored this tendency. Nowadays, technology is present in our daily lives and it is difficult to imagine surviving without it. In Dentistry there is a great debate on the technology issue, which can eliminate up to 100% of the human workforce (Dental Prosthesis Technician - DPT) in the processes of making dental prosthesis and we have imagined that this future would be distant, but it is already a reality. However to carry out a quality aesthetic treatment is it necessary to invest and have all the latest equipment? In this paper we will report a case of ceramic laminates made from traditional and handmade refractories.

Intentional Replantation Techniques: A Critical Review.

INTRODUCTION: Techniques and armamentarium for intentional replantation have varied throughout the years with no universally accepted clinical treatment guidelines. A wide range of success rates has been reported, and accordingly, this treatment method has often been regarded as a treatment of last resort. However, recent studies have shown more consistent success rates as high as 88% to 95%. In light of these new studies, intentional replantation may now be considered a more commonly accepted treatment modality. The purpose of this review was to critically examine reported techniques for intentional replantation. METHODS: A search of the literature on intentional replantation techniques was performed using electronic databases including PubMed, Medline, and Scopus. A total of 3183 articles were generated and screened for relevance based on defined inclusion and exclusion criteria. Subsequently, 27 studies were included for critical review of technique. RESULTS: There has been an evolution in technique for intentional replantation over the decades. CONCLUSIONS: Numerous aspects of the procedure exhibit variations, whereas other aspects exhibit considerable consistency. Few studies reported techniques consistent with modern endodontic surgical principles.

Maintaining vitality of immediately reimplanted avulsed tooth: two-year follow-up case report.

Management of tooth avulsion in the permanent dentition often presents a challenge. Such injuries should be recognized and treated expeditiously because several studies support a more likely favorable prognosis with timely and appropriate initial management. This article describes the immediate management of an avulsed maxillary permanent incisor with afollow-up of 1 year.

Rigidity of commonly used dental trauma splints.

BACKGROUND/AIMS: The stability of immobilization devices varies from flexible to rigid, depending on the trauma. We evaluated the rigidity of various commonly used splints in vitro MATERIAL AND METHODS: An acrylic resin model was used. The central incisors simulated injured teeth, with increased vertical and horizontal mobility. The lateral incisors and canines stimulated uninjured teeth. Tooth mobility was measured with the Periotest device. Vertical and horizontal measurements were made before and after splinting, and the difference between values was defined as the splint effect. We evaluated 4 composite splints, 3 wire-composite splints, a titanium trauma splint, a titanium ring splint, a bracket splint, and 2 Schuchardt splints RESULTS: For all injured teeth and all splints, there was a significant splint effect for the vertical and horizontal dimensions (P < 0.05). For injured teeth, the composite splints produced the largest changes in vertical tooth mobility; wire-composite splints 1 and 2, using orthodontic wires, produced the smallest vertical splint effects. For uninjured teeth, the Schuchardt 1 splint and the bracket splint produced the largest splint effects; wire-composite splints 1 and 2 produced only a slight change in tooth mobility. Composite splints 2 and 3 produced the largest horizontal splint effects for injured teeth, and the 4 composite splints produced the largest horizontal splint effects for uninjured teeth. The most horizontally flexible splints were the titanium trauma splint and wire-composite splints 1 and 2. CONCLUSIONS: According to the current guidelines and within the limits of an in vitro study, it can be stated that flexible or semirigid splints such as the titanium trauma splint and wire-composite splints 1 and 2 are appropriate for splinting teeth with dislocation injuries and root fractures, whereas rigid splints such as wire-composite splint 3 and the titanium ring splint can be used to treat alveolar process fractures.

Use of a cyanoacrylate ester adhesive for splinting of replanted teeth.

This paper reports a case of tooth replantation in which the splinting was performed with stainless steel orthodontic wire and a widely marketed brand of quick-setting cyanoacrylate ester adhesive (Super Bonder). The long-term clinical and radiographic success of the case reported in this paper indicates that the splinting technique using a quick-setting cyanoacrylate ester adhesive may be a feasible option for making a rapid, simple and efficient contention of replanted teeth in situations where the routinely used materials are not readily available.

Re-inventing intentional replantation: a modification of the technique.

Intentional Replantation (IR) has traditionally been considered a treatment of last resort due to complications during extraction, handling, and replantation. Root resorption and failure often resulted from drying of the root surface during extraoral manipulations. Replantation techniques have been recently modified to prevent desiccation. This article presents a modified IR technique with continuous immersion of the tooth in a tissue culture solution. This allows extension of the extraoral time period to permit inspection of the root surfaces, precise root-end resections and preparations, and placement of root-end fillings.

Comparison of a new dental trauma splint device (TTS) with three commonly used splinting techniques.

Splinting is the standard of care for stabilization of replanted or repositioned permanent teeth following trauma. The present experimental study compared four dental trauma splints in 10 volunteers. The evaluated splints included a wire-composite splint (WCS), a button-bracket splint (BS), a resin splint (RS), and a new device (TTS=Titanium Trauma Splint) specifically developed for splinting traumatized teeth. All splints were bonded to the labial surfaces of the maxillary lateral and central incisors. Splints were left in place for 1 week. After splint removal, the next splint was placed after a 1-week rest period. The sequence of splint application was randomized for each individual. The following parameters were assessed: tooth mobility with horizontal and vertical Periotest values (PTV) before and after splint application and splint removal, respectively; probing depths, plaque and bleeding on probing indices before splint application and removal, and chair time needed for splint application and removal. After splint application, horizontal PTV were significantly lower in central incisors for BS compared to TTS (P=0.04), and for RS compared to TTS (P=0.005) and to WCS (P=0.006). Reduction of lateral tooth mobility (=splint effect) expressed by the difference between horizontal pre- and postoperative PTV was significantly greater in RS compared to TTS and WCS (P<0.05) for central as well as for lateral incisors. However, changes of vertical tooth mobility were not significant across the splinting techniques. Periodontal parameters remained unchanged, reflecting the excellent oral hygiene by the study subjects. The chair time needed for splint application was significantly shorter for TTS (P<0.01). In conclusion, all tested splints appeared to maintain physiologic vertical and horizontal tooth mobility. However, the latter was critically reduced in RS splints.

Periodontal healing after intentional auto-alloplastic reimplantation of injured immature upper front teeth.

BACKGROUND/AIMS: Conventional endodontic treatment results in high complication quota when performed in immature teeth. Intentional reimplantation with extraoral insertion of an endodontic implant (auto-alloplastic reimplantation) is an alternative. METHOD: In a retrospective study, the healing of 40 teeth reimplanted intentionally according to this method in patients aged 7 to 15 years was evaluated. Clinical tests (palpation, percussion sound, periotest values) and radiographical examinations were used to determine the type of periodontal healing (inflammatory resorption/periodontitis apicalis; replacement resorption/ankylosis; normal healing). RESULTS: Mean lifetime of the replanted teeth was 59.2+/-42.5 months, estimated survival time on the basis of the Kaplan-Meier analysis was 99.5 months. 17 teeth (42.5%) were classified as failures, mostly due to inflammatory resorption or periodontitis apicalis. Further investigations demonstrated that success rate and retention period of intentionally replanted teeth depend on the preoperative condition of the pulp. Teeth with preoperative infection suffered frequently from inflammatory resorption or periodontitis apicalis after being replanted (14 of 28 teeth). Estimated survival time according to Kaplan-Meier was 75.5 months. In contrast, inflammations or progressive resorptions were not observed in teeth without preoperative infection of the pulp. All these 12 teeth showed normal periodontal healing and regular tooth mobility. In the absence of any pathology in clinical or radiological findings after an average functional period of 72.3 months, the prognosis can be presumed excellent. Estimated survival time of 148.3 months according to Kaplan-Meier differs significantly from survival time of teeth infected preoperatively. CONCLUSIONS: From the results of this investigation, it may be concluded that an infection of the pulp - due to delay of treatment or attempts at endodontic therapy - should be avoided before intentional replantation of immature front teeth with pulp necrosis. Periodontal healing of the autologous root is not impaired by the insertion of posts made of Al2O3-ceramics or titanium. The inserted posts do not ankylose. Orthodontic movement of auto-alloplastically replanted teeth is possible.

[Semi-rigid bracket splinting of teeth after traumatic luxation]. / Contention semi-rigide par boîtiers des luxations dentaires traumatiques.

We describe a non-rigid procedure using brackets for splinting teeth after traumatic avulsion. This type of appliance preserves alveolodental ligament physiology and enables immediate mastication without occlusal obstruction. Installation is easy, except when severe bleeding or alveolar fracture occurs.

[Complicated tooth replantation]. / Il reimpianto dentario complicato.

The materials and techniques for tooth replantation in presence of complications are discussed on the basis of recent advances in oral medicine and surgery and dentistry. The following complications are examined: mucous and cutaneous wounds, retention of teeth and foreign bodies, bony and radicular fractures with or without tissue loss, root drying, infection. Other problems are also discussed: replantation of deciduous teeth, endodontic therapy, stabilization of replanted teeth, application of orthodontic forces. Some technical principles are presented for a better management of various clinical situations. At last, interesting clinical cases are reported.

Replantation of avulsed primary anterior teeth: treatment and limitations.

In addition to the successful replantation of avulsed permanent teeth, the replantation of primary anterior teeth may also be indicated. The decision is based on age and stage of tooth development, development of dentition, storage of the avulsed tooth and the way it is transported to the treatment site, the appropriate in vitro treatment of the tooth before reinsertion, and the willingness of the child to cooperate. A method involving retrograde filling of the primary tooth root with calcium hydroxide after resecting the root apex has proved successful. Other commercially available root filling materials and pins are not indicated. Calcium hydroxide allows the tooth to heal in place without reaction and prevents the development of apical periodontitis. As regards any surgical intervention, the attending dentist in this case has to weigh the benefits against the risks.

Suture splint: an alternative for luxation injuries of teeth in pediatric patients--a case report.

Stabilization of replanted tooth "splinting" is done to prevent further damage to the pulp and periodontal structure during the healing period. Suture and bonded resin splint is passive, semirigid and functional splint. It is easy to fabricate directly in mouth without lengthy laboratory procedures. A case is presented in which suture and bonded resin splint was performed on laterally luxated maxillary central incisor and avulsed lateral incisor. The splint was removed after one week and sufficient periodontal and gingival healing was observed.

Intra-alveolar transplantation of deeply fractured roots after elongation with titanium roots screws.

Teeth with deep transverse or oblique fractures have posed severe challenges for treatment in the past. Today, such teeth can be saved by transplantation within the alveolus. In this pilot study, a technique is described by means of which roots otherwise determined to be too short can be salvaged. Fourteen fractured short roots were extracted carefully, elongated with titanium screws, and subsequently replanted.