Orthodontic management of traumatized teeth: A national survey of UK orthodontists.

BACKGROUND/AIM: There is a lack of research into orthodontic movement and management strategies of traumatized teeth. The aim of this survey was to assess the knowledge of UK-based orthodontists in the orthodontic management of traumatized teeth. MATERIALS/METHODS: A 24-item questionnaire survey was electronically distributed to all members of the British Orthodontic Society. RESULTS: A total of 213 respondents completed the survey with the majority of these being UK registered specialists in orthodontics. Three responses were excluded as one was not based within the UK and two were orthodontic trainees with <1 year of experience, leaving a total of 210 respondents. The majority had orthodontically treated up to three patients with a history of dental trauma in the preceding 3 months. Obtaining a trauma history was done by the majority of respondents. A wide variation in times waited by respondents before orthodontically treating teeth with different types of traumatic injuries was observed. Similarly, the preferred orthodontic management strategies of traumatized teeth differed substantially among respondents. Almost all respondents were interested in further training in the management of dental trauma. CONCLUSIONS: The study showed a wide variation in the orthodontic management of traumatized teeth among UK-based orthodontists. Further training and national guideline establishment are indicated for orthodontic management of traumatized teeth in the UK.

Timing of implant placement after traumatic dental injury.

Dental implants are reliable to replace teeth lost because of traumatic dental injury. However, dental implants behave like ankylosed teeth and should not be placed in growing individuals because of the risk of infraposition. This risk may be reduced by ensuring arrested skeletal growth and ideal incisal support. The timing of implant placement may be immediate, early, conventional, or late and is determined by the extent of the trauma, remaining growth, and conditions of the hard and soft tissues. Timing should allow an observation period to properly evaluate the prognosis of concomitantly traumatized neighboring teeth. Orthodontic alignment is often necessary after traumatic dental injury in young individuals to provide symmetric dental conditions around the facial midline, to allow implant placement in the correct 3-dimensional position for the later prosthetic reconstruction, and to ensure sufficient mesiodistal space that leaves a minimum of 1.5 mm of healthy alveolar bone between the future implant and neighboring teeth. Space and stable occlusion should be maintained by bonded retainers and a splint used during the night. A partial prosthesis is usually recommended as a temporary replacement. If a fixed provisional prosthesis is required, it is crucial that it does not interfere with the remaining growth and incisal support and allows proper oral hygiene.

Impact of treated and untreated traumatic dental injuries on oral health-related quality of life among 12-year-old schoolchildren in Amman.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) could have negative effects on the physical and psychosocial well-being of children. The aim of this study was to assess the prevalence of TDI and the impact of treated/untreated TDI on the quality of life of children among 12-year-old schoolchildren in Amman. MATERIALS AND METHODS: A cross-sectional study was conducted with 1652 schoolchildren aged 12 years enrolled in schools in Amman. OHRQol was assessed using the Arabic version of the Child Perceptions Questionnaire (CPQ11-14 ). Diagnosis of traumatic dental injury was based on Andreasen's classification. Dental caries and malocclusion were also recorded and analyzed along with social class. Statistical analysis included ANOVA and multiple logistic regression. RESULTS: The prevalence of TDI was 14.6%. There was a statistically significant impact of untreated TDI on all items of CPQ11-14 . When children with treated TDI were compared with those who had not suffered TDI, the only statistically significant impact was difficulty in chewing. Compared to children with treated TDI and those who had not suffered TDI, children with untreated TDI experienced significantly higher impacts related to the overall OHRQol, oral symptoms, the emotional and social well-being domains. Regarding functional limitation domain, children with untreated TDI experienced a significantly higher impact than children who had not suffered TDI, but children with treated TDI still had some limitations. CONCLUSIONS: The prevalence of TDI was 14.6%. Untreated TDI had a negative impact on OHRQol compared to absence of or treated TDI among 12-year-old schoolchildren in Amman.

Access to health care after dental trauma in children: A quantitative and qualitative evaluation.

BACKGROUND/AIMS: The aim of this study was to evaluate the accessibility of proper and on-time treatment after dental trauma in children and to explore the affecting factors via parents' and health professionals' perspectives. The study is important to understand how to improve access to dental treatment after trauma. MATERIALS AND METHOD: The method included quantitative and qualitative parts. For the quantitative method, parents of dental trauma patients who applied to Ege University, Department of Pedodontics during January 2015-June 2016 were the target group. One hundred and forty parents answered the questionnaire on trauma experiences. The participation rate was 62.78%. Questions covered variables such as first admitted health institution, time to go there, access to diagnostics, treatment methods, referral from institution, and sociodemographic characteristics of the family. On-time and proper treatment access was defined using an algorithm for treatment priority of the case, total time to reach treatment, and the correct intervention. For the qualitative method, ten parents and thirty health professionals were interviewed in-depth using a semi-structured question guide. Thematic analysis was applied to the interview texts. RESULTS: The percentage of patients who accessed on-time and proper treatment was 19.29%. Logistic regression analysis showed that admission to the university clinic first increased the access to treatment by 14.135 times. For the qualitative evaluation, treatment access was summarized into three main themes: (a) physical accessibility of dental health services, (b) a quality dental health service as an outcome, and (c) communication among parties. CONCLUSION: The level of accessing proper and on-time treatment was quite inadequate. It is suggested that distribution of dental care centers should be increased and dental centers where competent dentists work should be established. Performance-based payment should be reorganized and cooperation between medical and dental institutions should be encouraged.

Prosthetic, orthodontic and implant-supported rehabilitation of five maxillary anterior teeth with alveolar bone loss.

INTRODUCTION: Treatment of maxillofacial injuries is complex and requires the establishment of a comprehensive and accurate diagnosis and correct treatment planning. OBJECTIVE: The objective of this case report was to describe the re-treatment of a 27-year-old woman who was involved in a severe car accident that resulted in the loss of five anterior teeth and alveolar bone, and whose previous orthodontic and surgical treatments had been unsuccessful. CASE REPORT: In this case, the space for the missing mandibular molar was reopened to allow for rehabilitation. The positions of the mandibular incisors were improved. The right mandibular canine was moved to the mesial, allowing for correction of the Class II canine relationship on that side, and implants were placed to replace the maxillary anterior teeth. CONCLUSION: Anterior aesthetic and functional rehabilitation using a multidisciplinary approach was essential to improve the patient's facial aesthetics, to obtain great improvement in function and to achieve occlusal stability after 2 years of follow-up.

Prosthetic, orthodontic and implant-supported rehabilitation of five maxillary anterior teeth with alveolar bone loss

ABSTRACT Introduction: Treatment of maxillofacial injuries is complex and requires the establishment of a comprehensive and accurate diagnosis and correct treatment planning. Objective: The objective of this case report was to describe the re-treatment of a 27-year-old woman who was involved in a severe car accident that resulted in the loss of five anterior teeth and alveolar bone, and whose previous orthodontic and surgical treatments had been unsuccessful. Case report: In this case, the space for the missing mandibular molar was reopened to allow for rehabilitation. The positions of the mandibular incisors were improved. The right mandibular canine was moved to the mesial, allowing for correction of the Class II canine relationship on that side, and implants were placed to replace the maxillary anterior teeth. Conclusion: Anterior aesthetic and functional rehabilitation using a multidisciplinary approach was essential to improve the patient's facial aesthetics, to obtain great improvement in function and to achieve occlusal stability after 2 years of follow-up.

RESUMO Introdução: o tratamento de danos bucomaxilofaciais é complexo e requer diagnóstico abrangente e preciso, além de um correto plano de tratamento. Objetivo: o objetivo deste relato de caso foi descrever o retratamento de uma paciente do sexo feminino, 27 anos de idade, envolvida em acidente automobilístico grave, que resultou na perda de cinco dentes, além de perda óssea alveolar na região anterior. Relato de caso: a paciente apresentava histórico de insucesso de tratamento ortodôntico e cirúrgico. No caso apresentado, o espaço referente aos molares inferiores ausentes foi reaberto, para possibilitar a reabilitação. Houve melhora no posicionamento dos incisivos inferiores. O canino inferior direito foi deslocado para mesial, possibilitando a correção da relação de Classe II intercaninos do mesmo lado. Implantes foram inseridos a fim de substituir os dentes superiores da região anterior. Conclusão: a reabilitação estética e funcional da região anterior, realizada por meio de uma abordagem multidisciplinar, foi fundamental para valorizar a estética facial da paciente, melhorar a função e promover estabilidade oclusal após dois anos de acompanhamento.

Rehabilitación protésica implanto-soportada en un paciente con epidermolisis ampollar distrófica recesiva. 4 años de seguimiento clínico / Implant-supported dental prostheses in a patient with recessive dystrophic epidermolisis bullosa. Four-year followup

Se describe la evolución de una paciente con diagnóstico molecular de Epidermolisis Ampollar Distrófica Recesiva, quien a los 35 años de edad inicia una rehabilitación bucal mediante prótesis fija implanto-soportada, luego de haber realizado las exodoncias de las piezas remanentes en boca. Todos los implantes se mantuvieron oseointegrados a lo largo de cuatro años de seguimiento clínico y no se encontró flora periodontopática peri-implantar en los controles microbiológicos realizados. Este tipo de rehabilitación es un caso paradigmático para personas con este tipo de genodermatosis, constituyéndose en una posibilidad válida para una mejor calidad de vida frente a las circunstancias adversas que plantea la enfermedad. (AU)

Oral rehabilitation of a 35-years old female patient with Recessive Dystrophic Epidermolisis Bullosa is described. After removal of all remaining teeth, cemented implantasisted prosthesis with shortened arches were installed over three implants in the mandible and four implants in the upper jaw. At the four- year follow up, all the implants conserved osseointegration as well as absence of peri-implantar periodontopatic biofilm was observed. The success achieved in this case becomes a paradigmatic landmark for the oral rehabilitation of patients with such genodermatoses, providing a new resource to improve their quality of life. (AU)

Dental implant treatment following trauma: An investigation into the failure to complete Accident Compensation Corporation funded care.

BACKGROUND AND OBJECTIVES: Among other restorative strategies, the Accident Compensation Corporation (ACC) provides benefits for dental implant treatment to replace teeth lost as a result of trauma. While ACC has funded over 15,000 dental implants since 2002, the outcomes of this treatment and patient perceptions of this treatment have not been investigated. The aim of this study was to investigate the perceptions of the dental implant treatment outcomes and reasons for failure to complete restorative treatment in patients who had undergone trauma-related implant surgery funded by ACC between February 2006 and September 2009, but had not completed the prosthetic component of the treatment. METHODS: A randomly selected sample of 399 patients, who had undergone dental implant surgery but not completed the crown restoration, was identified from the ACC database. These individuals were contacted by mail for expressions of interest and 181 clients were interviewed by telephone. Responses to open-ended questions were entered into an Excel spreadsheet and analysed using a general inductive technique. RESULTS: A common emergent theme was the high level of satisfaction expressed by participants with the implant process, however just under half of those responding felt they had been pushed into having implants and were given the impression that this was the only treatment ACC paid for. The cost of the prosthetic phase of the treatment and surgical complications were identified as the primary reasons why participants failed to complete the restorative phase of treatment, after completing the surgical phase. CONCLUSIONS: The results highlighted the need to better inform patients of their treatment options and to allow time for them to process this information before progressing with care. A patient decision tool may help to give greater ownership of the treatment options. Newly implemented protocols to assist dentists to better assess treatment needs may also assist in achieving improvements in perceived treatment outcomes for patients.

Post-traumatic rehabilitation of anterior teeth with laminates composite veneers in children. Report of two cases.

BACKGROUND: When treating children, a conservative and minimally invasive approach is mandatory. In dental traumas with partial coronal destruction, veneers represent the fastest and most effective method to rehabilitate front teeth of a young patient, since these no- or minimal-preparation restorations were proved to have predictable results without reducing the enamel layer. Indirect additive anterior composite restorations, besides being quick and minimally invasive, have to be considered a good treatment option for rehabilitating children, because they are inexpensive and repairable over time. Current laboratory techniques, associated with a strict clinical protocol, satisfy patients' restorative and aesthetic needs in few appointments and in a short time. CASE REPORT: The cases reported describe the minimally invasive treatment of two lateral incisors with nano-hybrid resin composite veneers after traumatic events. The patient satisfaction and good integration of indirect restorations confirmed the success of this rehabilitation.

The role of dental implants in the management of dento-alveolar trauma. Part 2.

Patients who suffer dento-alveolar trauma present a unique challenge for the dentist. There are numerous options to consider when attempting to restore the dentition. This article reviews the role of dental implants and how thorough planning and execution of such treatment could result in an optimal outcome. Clinical Relevance: Knowledge of the role of dental implants and factors imperative for a successful treatment outcome will assist the clinician in achieving optimal restorative results.

Traumatismo dentario: presentación de un caso / Dental Trauma: a case report

Los traumas dentarios en niños y niñas son frecuentes, razón por la cual el estomatólogo debe estar capacitado para darles solución. En el presente trabajo se expone el diagnóstico, tratamiento y evolución del caso de un niño con resalte de 12 mm, hábito de respiración bucal y cierre bilabial incompetente, que sufrió trauma severo en el diente 11, lo que le causó movilidad de este. Se aplicó una férula al diente afectado y posteriormente se realizó tratamiento pulporadicular, todo ello con una evolución satisfactoria. Aunque estos traumas son comunes, la presentación de este caso es de interés, por su utilidad en el contexto docente(AU)

Dental traumas in children are common; therefore the dentist should be trained to solve them. This paper presents the diagnosis, treatment and outcome of a child with a 12 mm overjet, mouth breathing habit and bilabial incompetence who suffered a severe trauma to tooth number 11, causing its mobility. A splint was applied to the affected tooth and subsequently, a root canal filling was performed, all with a satisfactory outcome. Although these traumas are common, the presentation of this case is important due to its use in the teaching context(AU)

The management of traumatic tooth loss with dental implants: Part 1.

Traumatic dental injuries are relatively common causes of emergency presentation to general dental practitioners. There are well established guidelines for the management of traumatised teeth, which practitioners should be familiar with and able to deliver. Some teeth, however, are either lost at the time of injury or are found to have a hopeless long-term prognosis despite appropriate treatment. The first article in this two-part series covers the important aspects of maintaining teeth where possible, to preserve the supporting hard and soft tissues. It then describes the replacement of a single tooth lost due to trauma and the relative challenges faced. The second article covers more extensive trauma, involving multiple teeth and where significant supporting tissues are lost. It describes the replacement of teeth, including the hard and soft tissues with implant supported restorations, whilst highlighting the need for a multidisciplinary team in severe cases.

Aesthetic preview: a novel approach.

UNLABELLED: Planning the final aesthetic result of restorative treatment is a key skill needed by the clinician to ensure predictable success. This paper aims to review current techniques that may be used by clinicians for an aesthetic preview, whilst also highlighting a simple technique that may be readily utilized in practice. CLINICAL RELEVANCE: It is considered good practice to give patients an aesthetic preview of the end result prior to commencing active treatment. This article demonstrates the different techniques available and those that are easily utilized in general practice. The aesthetic preview is of benefit to both the clinician and technician in defining treatment goals and improving communication.

Tratamento em incisivos centrais superiores após traumatismo dental / Treatment of upper central incisors after trauma

Os traumatismos dentários constituem, na atualidade, uma das principais causas da procura pelo cirurgião-dentista. O objetivo deste artigo é apresentar um caso clínico de traumatismo dental, abordando as diferentes reações pulpares dos dentes afetados e uma proposta de tratamento. Foram identificados dois tipos distintos de respostas pulpares ocorridas em dentes que foram sujeitos a um mesmo traumatismo (dente 21 e 11). Após o exame clínico e radiográfico, foi feito o diagnóstico diferencial entre lesão periapical no dente 21 e a imagem radiolúcida do orifício do nervo nasopalatino. Foi diagnosticado necrose pulpar no dente 21, sem lesão periapical e polpa viva no dente 11, apresentando este reabsorção interna e externa da raiz. Foi realizado o planejamento com indicação de tratamento de canal dos dentes 21 e 11, bem como a restauração estética dos mesmos com recurso de técnicas de clareamento interno e externo. O tratamento seleccionado mostrou um ótimo resultado estético com um custo relativamente baixo. O follow-up de dois anos permitiu confirmar o êxito e a longevidade do tratamento proposto.

Presently, dental trauma is one of the main causes for seeking a dental surgeon. The present paper presents a case report of dental trauma, addressing the different pulp reactions of the affected teeth and a treatment plan. The authors identified two distinct types of pulp reactions in teeth (tooth 21 and 11) subject to the same trauma. After clinical and radiographic examination, the differential diagnosis between periapical lesion on tooth 21 and radiolucency of the nasopalatine foramen was performed. Pulpal necrosis, without periapical lesion, was diagnosed in tooth 21, and live pulp in tooth 11, with internal and external root resorption. A treatment plan was designed, which included root canal treatment of teeth 21 and 11, as well as aesthetical restoration of both using internal and external bleaching techniques. This treatment resulted in optimal aesthetic outcome with relatively low cost. The 2-year follow-up confirmed the success and longevity of the treatment.

Three-dimensionally layered ceramic blocks.

With the aid of an innovatively structured ceramic block, it is possible to achieve results at a high esthetic level with relatively simple means. In the three-dimensionally structured Vitablocs RealLife, translucent enamel ceramic is arranged around a conically structured, opaque dentin core. The virtual restoration can be positioned freely in all three dimensions with the aid of the Cerec/inLab software. The restorations are milled fully anatomically and only minimally glazed or characterized with stains. Results that otherwise can be achieved only with much more complex layering processes are possible.

Bone replacement following dental trauma prior to implant surgery--status.

Dento-alveolar trauma often leads to a need for reconstruction of the alveolar crest before an implant can be placed. Although autogenous bone grafts is considered the 'gold standard', this may be associated with patient morbidity and graft resorption. Consequently, the use of bone substitutes has increased. Today, a substantial number of biomaterials are available on the market, but only a few are well documented. The user should be aware that these biomaterials have different properties: resorbable or non-resorbable, time of resorption and resorption mechanism. The purpose of this review is to describe the function of various bone substitutes and indications for their use in reconstructive implant surgery and to give an overview of the current situation.

An interdisciplinary approach to aesthetic single implant outcomes for young patients.

Clinicians carry a significant obligation to young patients with single missing teeth to ensure that they are prepared for a lifetime of healthy dental function and long-term aesthetic success. Adolescents and young adults in need of implant treatment embody a large and growing patient population that requires distinctly different treatment approaches than those that apply to older patient groups. The primary causes of single missing teeth in young patients are trauma and congenital absence, whereas older populations typically lose teeth due to failure of traditional dental procedures. This article provides an effective approach to meet the challenges that young patients present.