Orthodontic management of traumatic dental injuries in Norway and orthodontists' perceptions of referral routines: A quality assurance survey.

BACKGROUND/AIM: Orthodontic treatment of patients with traumatic dental injuries is challenging, with limited evidence of routines and outcomes. The aims of this study were: (i) to describe how orthodontists perceive the information on traumatic dental injuries received by referral from the Public Dental Health Service before orthodontic treatment and (ii) to assess orthodontists' knowledge and working routines in managing traumatic dental injuries. MATERIALS AND METHODS: Data were obtained through a survey of all practicing orthodontists registered as members of the Norwegian Association of Orthodontists (n = 203). RESULTS: Eighty-three orthodontists were enrolled, most of whom had received their dental degree (73.0%) and specialist orthodontic training (88.5%) in Norway. They reported examining patients with a history of traumatic dental injury at weekly (34.2%) or monthly (38.0%) basis. In 85.5% of cases, they obtained a history of traumatic dental injury from patients. Half of the respondents (51.3%) favoured two-phase early orthodontic treatment for patients with an overjet ≥6 mm. The observation time and treatment strategy showed considerable discrepancies across traumatic dental injury diagnoses. Most (59.1%) orthodontists considered the information on previous traumatic dental injuries provided by the Public Dental Health Services referral 'inadequate', more commonly in cases of mild (83.5%) than severe (57.5%) traumatic dental injuries. CONCLUSIONS: Orthodontic management of patients with traumatic dental injuries was characterised by lack of uniformity in both recommended observation time before orthodontic treatment and management strategy. The referral routines by the Public Dental Health Services for patients with traumatic dental injuries were perceived as 'inadequate' in terms of frequency and quality. The results indicate the requirement of standardisation of routines related to orthodontic management of traumatic dental injuries and referral routines by the Public Dental Health Services.

Influence of dental education on adoption and integration of technological aids in the delivery of endodontic care by dental practitioners: a survey.

OBJECTIVE: To investigate adoption and integration of technological aids during endodontic treatment and where dental practitioners (DPs) learnt to use this technology. MATERIALS AND METHODS: An electronic questionnaire was distributed to all 459 dentists who graduated from University of Bergen between 2008 and 2018. The respondents were divided into two cohorts, older graduates (2008-2013) and newer graduates(2014-2018). RESULTS: A total of 314(68.4%) DPs answered the questionnaire. Magnification in the form of dental operating microscopes (DOM) and dental loupes was used by 180 (59.6%), electronic apex locators (EAL) by 271(89.7%) and motor-driven files by 281 (93.4%) DPs. The most frequent response, as to where they learnt to use them was: during undergraduate dental (UG) education. Significantly more newer graduates (90.7%) performed instrumentation based on what they learnt during UG education (p < .001). Older graduates based their instrumentation method equally on what they learnt during UG education (51.9%) and continuing dental education(42.6%). Rubber dam was used during all treatment procedures by 93% of the DPs. CONCLUSIONS: UG education is a communication channel with long-lasting importance for adoption and integration of technology by DPs. Exposure to innovations (awareness) during UG education is adequate for integration of technology. Continuing dental education is as valuable as UG education for adoption of technology for older graduates.

Traumatic dental injuries and pulp sequelae in an adolescent population.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) occur frequently and may result in pulp sequelae. This includes pulp necrosis with infection, pulp canal obliteration and root resorption. The aim of this study was to assess the prevalence and risk factors of pulp sequelae after TDI among Norwegian adolescents. MATERIAL AND METHODS: A retrospective longitudinal study, including historical clinical data, was conducted with 16-year-old pupils in western Norway. All first-grade pupils, born in 1997 (n = 5184), attending public high schools, were invited to participate and to respond to an electronically administered closed-ended questionnaire (response rate 39.6%, n = 2055). Consent was given to access the dental records in the Public Dental Health Service in Hordaland, where information regarding TDI (diagnosis and treatment) and radiographs were interpreted. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible). Outcome variables of TDI were registered and analysed using logistic regression, Kaplan-Meier survival estimates and log-rank test. RESULTS: The prevalence of TDI in the sample population was 16.4% (338 pupils), with a total of 637 teeth involved. The number of included teeth for analysis was 571 (90.5%). The prevalence of pulp necrosis with infection was 7.5%. Moderate and severe TDI was associated with a higher frequency of pulp necrosis with infection. Pulp canal obliteration and root resorption were found in 2.8% and 2.3% of teeth with TDI, respectively. Dental hard tissue injuries were more prone to the development of pulp necrosis than luxation injuries and combination injuries. The relationship between root development stage and development of pulp necrosis with infection was not statistically significant. CONCLUSIONS: Occurrence of different pulp sequelae among teeth affected with TDI was low. Moderate and severe TDI were more at risk of developing pulpal complications and hard tissue injuries were at higher risk of developing pulp necrosis with infection.

Differential Responses of Human Dental Pulp Stromal Cells to Bioceramic Materials: A Comparative In Vitro Study.

AIM: The aim of this study was to compare the effects of white MTA-Angelus (wMTA), Biodentine® (Biodentine) and TotalFill® BC Root Repair MaterialTM putty (TotalFill) on human dental pulp stromal cells (hDPSCs) in vitro. MATERIALS AND METHODS: hDPSCs were isolated from third molars of healthy young adults. Material elutes at different concentrations were prepared. Cells were exposed to the eluates for 1, 3, and 7 days. Cell proliferation was evaluated using 3-(4,5-dimethyl-thiazoyl)-2, 5-diphenyl-tetrazolium bromide assay. The expression of alkaline phosphatase (ALP), osteoprotegerin (OPG), osteocalcin (OC), collagen1A (Col1A), runt-related transcription factor 2 (RUNX2), vascular endothelial growth factor-A (VEGF-A), fibroblast growth factor-1 (FGF-1), interleukin 6 (IL6), tumor necrosis factor alpha (TNFα), and interleukin-1-beta (IL1ß) was determined by reverse transcription-polymerase chain reaction (RT-PCR). VEGF-A protein levels and ALP activity were quantified in the culture supernatant. Data were analyzed by two-way analysis of variance (ANOVA). p values <0.05 were considered statistically significant. RESULTS: hDPSC proliferation was decreased in a dose-related manner for all materials on day 3. The same effect was observed with wMTA and TotalFill on day 7. RT-PCR showed that Biodentine increased the expression of the osteogenic markers ALP, OPG, and OC. TotalFill decreased the ALP expression and activity, enhanced the production of angiogenic VEGF-A, and downregulated the inflammatory IL6 on day 7. CONCLUSION: Although the tested materials are used interchangeably in vital pulp therapy, the findings showed varied hDPSC responses. Biodentine did not affect cell proliferation and increased the expression of osteo-/odontogenic markers compared to wMTA and TotalFill, whereas TotalFill decreased cell proliferation and exhibited enhanced angiogenic and anti-inflammatory effects over time. CLINICAL SIGNIFICANCE: The clinical significance of the results needs further investigation in an attempt to provide recommendations on the selection of bioceramic pulp capping material under different scenarios of pulpal pathosis.

Influence of the coronal restoration on the outcome of endodontically treated teeth.

Objective: The tooth weakens due to removal of hard tissue during an endodontic procedure. Many dentists find it difficult to choose between different coronal restorations after root canal treatment (RCT). Studies show that the coronal restoration may affect the endodontic prognosis. This student-based study had three aims. (1) Examine the choice of coronal restoration of endodontically treated teeth at a Scandinavian dental school, (2) examine the survival of these restorations and (3) evaluate the influence of the coronal restoration on the outcome of the RCT. Material and methods: Radiographic and clinical examination was performed on 127 posterior teeth. The quality of the root canal treatment and the periapical status (PAI-index) were evaluated. Results: 43.8% of the teeth were restored with an indirect coronal restoration and 47.2% with a direct coronal restoration. The period from finished root canal treatment until placement of a permanent coronal restoration was significantly longer for an indirect restoration than a direct restoration. The teeth treated with a PAI score of 1 and 2 following pulpectomy, necrotic pulp treatment and endodontic retreatment was 93.8%, 82.6% and 69.4%, respectively.Conclusion: There was no significant association between choice of coronal restoration and PAI-score.

Traumatic dental injuries and experiences along the life course - a study among 16-yr-old pupils in western Norway.

The study assessed risk factors for traumatic dental injuries (TDI) using experiences along the life course. A retrospective longitudinal study, including historical clinical data, was conducted on 16-yr-old pupils in western Norway. All first-grade pupils born in 1997 and attending public high schools were invited to participate (n = 5,184). Participants responded to an electronically administered closed-ended questionnaire (39.6%, n = 2,055). Information on the occurrence of TDI and events during the life course (categorized as socio-economic, biological, psychosocial, and behavioural indicators) was collected. Variables with a significant bivariate association with three different dependent variables (TDI, severity of TDI, and multiple episodes of TDI) were tested in a hierarchical logistic regression analysis. Traumatic dental injuries were more frequent among boys, adolescents of higher socio-economic status, and adolescents with adverse psychosocial and behavioural scores. Moderate and severe TDIs were more frequent among adolescents with adverse psychosocial and behavioural scores and among adolescents participating in the sport of wrestling. Multiple episodes of TDI were more frequent among adolescents with adverse psychosocial and behavioural scores and among adolescents participating in sports activities. Incorporation of different life-course indicators is important in evaluating TDI severity and repeated incidents.

Tricalcium silicate cements: osteogenic and angiogenic responses of human bone marrow stem cells.

Tricalcium silicate cements (TSCs) are used in endodontic procedures to promote wound healing and hard tissue formation. The aim of this study was to evaluate and compare the effect of commonly used TSCs [mineral trioxide aggregate (MTA), Biodentine, and TotalFill] on cellular metabolism and osteogenic/angiogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs) in vitro. We tested the null hypothesis of no difference between MTA, Biodentine, and TotalFill in stem cell responses. Cells were subjected to eluates of the tested materials for up to 14 d. Cell viability was evaluated using the 3-(4,5-dimethyl-thiazoyl)-2,5-diphenyl-tetrazolium bromide (MTT) assay. Real-time PCR was used to determine the levels of expression of the osteogenic factors alkaline phosphatase (ALP), osteoprotegerin (OPG), osteocalcin (OC), and collagen 1A (COL1A1), and the angiogenic factors vascular endothelial growth factor A (VEGFA) and fibroblast growth factor 1 (FGF1). ELISAs were used to measure the levels of VEGFA and ALP in culture supernatants. Mineralization in vitro of hBMSCs was assessed using Alizarin Red staining. The hBMSCs tolerated exposure to TSCs well, with Biodentine showing the most favorable effect on cell viability. Expression of ALP, COL1A1, OPG, and VEGFA were differentially affected by the materials, with Biodentine and TotalFill inducing earlier changes at gene level. Increased mineralization was observed with time, after exposure to all TSCs tested, with MTA showing the greatest effect. The results revealed different responses of hBMSCs to TSCs in vitro.

Traumatic dental injuries-Prevalence and severity among 16-year-old pupils in western Norway.

BACKGROUND/AIMS: Published data on prevalence and severity of traumatic dental injuries (TDI) in Norway are limited. The aims of this study were to assess prevalence, distribution and severity of TDI in the permanent dentition of 16-year-old pupils in western Norway. MATERIAL AND METHODS: A retrospective longitudinal study, including historical clinical data, was conducted among 16-year-old high school pupils in the County of Hordaland, western Norway. First-grade pupils attending high school, born in 1997, were invited to participate (n = 5184). Consent was given to access their dental records in the Public Dental Health Service in Hordaland, where information regarding TDI (diagnosis and treatment) and radiographs was interpreted. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible) and classified using a modified version of the WHO's classification. RESULTS: A total of 2055 participants were included (response rate 40%). TDI prevalence was 16.4% (338 pupils), with the maxillary central incisors most affected (64.7%). A total of 637 teeth were involved. Boys were more prone to injury than girls (P < 0.05). Severity of TDI was divided into 3 groups (mild, moderate and severe), with the following distribution: 563 mild (88.4%), 39 moderate (6.1%) and 35 severe (5.5%). Peak age for TDI was 8-10 years (50.9%). CONCLUSIONS: Prevalence of TDI among Norwegian adolescents was moderate. Milder injuries were more frequent than moderate and severe injuries. Age and gender were risk factors with regard to TDI. Seasonal influence on the occurrence of TDI was not statistically significant.

Traumatic dental injuries as reported during school hours in Bergen.

AIMS: To identify existing guidelines for managing traumatic dental injuries (TDIs) in the schools of Bergen, to ascertain the frequency of occurrence of such injuries, and to estimate the need for further information among teachers and school administrators. MATERIAL AND METHODS: The study, undertaken among teachers and school administrators of elementary and lower secondary schools in Bergen municipality, was questionnaire-based and included a cross section of staff. The structured short questionnaire included items registering TDIs during 2009, existence of routines or guidelines for managing TDIs, previous relevant training, and request for TDI education or information. The statistical methods included frequency tables and logistic regression analysis. RESULTS: The response rate was 73%. The incidence proportion of TDIs was measured to 0.74% of children at risk, varying according to children's classes (peak at third class: 1.68% of children in the population). No schools had adequate written guidelines for handling TDIs. Previous education on the subject was scarce. In 20 schools, there was no perceived need for TDI-related education or information. The schools' routines for TDI reporting, who was in charge of the reporting, acquired TDI education and expressed need for TDI information or education, did not influence the number of reported TDI cases. CONCLUSION: This study has produced reliable information that schools in the municipality of Bergen could improve ways of reporting and managing TDIs. As teachers with skills in handling TDIs could help to improve the prognosis for injured teeth, some types of educational intervention in schools should be launched.

Impact of low birthweight on early childhood caries in 6-36 months old infants in Uganda: A cross-sectional study.

OBJECTIVE: Focusing on 6-36 months old infants, this study assessed (1) whether socio-economic status, current anthropometric status, presence of enamel hypoplasia, number of erupted teeth, oral hygiene and consumption of sugared snacks varied between children with normal birthweight (NBW) and low birthweight (LBW) and (2) the association between ECC and birthweight whilst adjusting for covariates of ECC, such as current anthropometric status. METHOD: A cross-sectional study was conducted in Kampala in 2007, involving 816 child/caretaker pairs. All caretakers completed face-to-face interviews. Children were examined for ECC and enamel defects using WHO (1997) criteria and the developmental defects of enamel (DDE) index. Weight at birth was obtained from hospital records and current anthropometric status was assessed using z-scores for weight-for-length (WLZ), length-for-age (LAZ) and weight-for-age (WAZ). RESULTS: Prevalence of LBW (< 2500 g) and ECC were estimated to 11.5% and 18.1%, respectively. Children with LBW and those with ECC presented with more visible plaque, higher sugar consumption and more current underweight (WAZ < -2) than children with normal birth weight (NBW) and no caries; 26.7% of LBW vs 17.3% (p < 0.001) of NBW children presented with ECC. Enamel defects (OR = 2.8, 95% CI = 1.6-4.8) and presence of visible plaque (OR = 2.4, 95% CI = 1.3-4.1), but not LBW, were associated with ECC in multiple variable logistic regression analyses. CONCLUSION: Both LBW and ECC were associated with poor oral hygiene, high intake of sugars and current underweight. Enamel defects were associated with ECC. Adjusting for covariates there were no clear association between LBW and ECC. Studies using a prospective study design are needed for further investigation.

Biological properties versus solubility of endodontic sealers and cements.

Endodontic sealers and cements used in root canal treatment have different compositions and properties. Common to all materials is that their primary goal is to fill gaps and voids, making a permanent seal of the root canal system. Furthermore, aspects such as antibacterial properties, cytotoxicity, setting time, solubility and biocompatibility are also crucial and ought to be considered. Over the years, a shift in the view on the importance of these aspects has ocurred. Whereas the antibacterial properties were considered important when the technical factors in endodontics were less developed, the sealing ability and biocompatibility have later been considered the most critical factors. The introduction of tricalcium silicate cements and sealers has led to a renewed interest in material properties, as these cements seem to have good sealing ability and at the same time combine favourable antimicrobial effects with excellent biocompatibility. This review discusses how the various properties of root canal sealers and cements may conflict with the primary aim of providing a permanent seal of the root canal system.

Feeding practice among 6-36 months old in Tanzania and Uganda: reliability and relationship with early childhood caries, ECC.

OBJECTIVE: To assess the reproducibility of caregivers' responses to dietary recall from birth and 24-h dietary recall with respect to infants' intake of sugared snacks and to assess whether those assessment methods provide comparable results for groups of infants. Re-test reliability and clinical covariates of time to first exposure of sugared snacks and time to termination of breastfeeding were also examined. It was hypothesized that time to first exposure/termination would vary according to socio-demographic profile and ECC. METHOD: Interviews and clinical oral examinations were carried out in Kampala and Manyara, including 1221 and 816 child-caregiver pairs. Reproducibility was assessed using Cohen's kappa and Intra Class Correlation Coefficient, ICC. Adjusted Cox regression was used to model time to first exposure of sugared snacks and time to termination of breastfeeding. RESULTS: Cohen's kappa for intake of sugar items ranged from 0.40-1.0, with no differences observed between average intakes at test-re-test. Mean sugar score based on 24-h recall increased significantly by increasing quartiles of the sugar score based on recall from birth. Cox regression revealed that the odds ratio, OR, for early exposure to various sugared snacks and the ORs for early termination of breastfeeding were significantly smaller in infants with than without ECC. CONCLUSION: Fair-to-good reproducibility was established. Infant's sugar consumption emerge as early as 6 months of age. Survival of any breastfeeding and non-exposure to sugared snacks was most prolonged among infants with ECC. This has implications for interventions needed to improve feeding habits of infants and toddlers.

Radiological evaluation of single implants in maxillary anterior sites with special emphasis on their relation to adjacent teeth: a 3-year follow-up study.

AIM: The aim of this study was to measure, in adults, changes in crest bone level around single dental implants in the anterior maxilla and continuous eruption of adjacent teeth. MATERIAL AND METHODS: In this prospective study, 50 patients received single-implant-supported crowns in the maxillary anterior region. Enrolled patients lacked maxillary anterior teeth as a sequel to trauma or agenesis in the maxillary anterior region. Participants were followed during a 3-year period. Baseline radiographs were taken at the time of loading and then repeated at one- and 3-year recalls. Radiographic parameters were recorded to assess changes in the skeletal bone structure and crest bone level. RESULTS: Twenty-six patients attended for all recalls. Three patients were excluded owing to difficulties related to identifying the same radiographic landmark on the radiographs throughout the recall period. All implants were successfully integrated with no sign of peri-implantitis. The mean crest bone loss was 0.45 mm at the mesial aspect of the implant and 0.56 mm at the distal aspect. In smokers, there was significant bone loss on the distal aspect. Mean change between reference points on implant and adjacent tooth (continuous eruption of adjacent tooth) over the 3-year period was 0.67 mm. In women, mean change (0.79 mm) was statistically insignificantly higher, compared with men (0.59 mm). CONCLUSIONS: Radiographic evaluation of crest bone level showed slight bone loss after 3 years of functional loading. Some changes in the eruption of neighbouring teeth were seen. Being a smoker was associated with significant negative changes related to the crest bone level.

Developmental defects of enamel in primary teeth and association with early life course events: a study of 6-36 month old children in Manyara, Tanzania.

BACKGROUND: Children with low birth weight show an increased prevalence of developmental defects of enamel in the primary dentition that subsequently may predispose to early childhood caries (ECC).Focusing 6-36 months old, the purpose of this study was to assess the frequency of enamel defects in the primary dentition and identify influences of early life course factors; socio-demographics, birth weight, child's early illness episodes and mothers' perceived size of the child at birth, whilst controlling for more recent life course events in terms of current breastfeeding and oral hygiene. METHODS: A cross-sectional study was conducted in the high fluoride area of Manyara, northern Tanzania including 1221 child-mother pairs who attended Reproductive and Child Health (RCH) clinics for immunization and/or growth monitoring. After the primary caregivers had completed face to face interviews at the health care facility, children underwent oral clinical examination whereby ECC and developmental defects of enamel were recorded using field criteria. All erupted teeth were examined and the enamel defects were assessed on buccal surfaces according to the modified DDE Index. RESULTS: The prevalence of enamel defects was 33.3%. Diffuse opacities were the most common defects identified (23.1%), followed by hypoplasia (7.6%) and demarcated opacities (5.0%). The most frequently affected teeth were the upper central incisors (29.0% - 30.5%), whereas lower central incisors (4.3% to 4.5%) were least frequently affected. Multiple logistic regression analysis, adjusting for confounding the factors revealed that having normal birth weight (equal or more than 2500 g) associated with lower odds of having enamel hypoplasia [OR 0.2 (95% CI 0.1-0.7)]. No statistically significant association occurred between birth weight and diffuse opacities, demarcated opacities or combined DDE. CONCLUSION: Children with the history of low birth weight were more likely than their normal birth weight counterparts to present with enamel hypoplasia. In view of the frequent occurrence of enamel defects and the fact that hypoplasia may constitute a risk factor for future ECC, enamel defects should be included as a dental health indicator in epidemiological studies of children in northern Tanzania.

Impact of Case Difficulty, Endodontic Mishaps, and Instrumentation Method on Endodontic Treatment Outcome and Quality of Life: A Four-Year Follow-up Study.

INTRODUCTION: Root canal treatment (RCT) is often considered a difficult procedure for both the patient and treatment provider. The American Association of Endodontists case difficulty assessment form categorizes cases as minimal, moderate, and high difficulty level. We recently showed that endodontic mishaps occur frequently during treatment of teeth in high difficulty category. The aims were to investigate the clinical and radiographic outcome at least 4 years after RCT and to evaluate patients' perceived oral health-related quality of life (OHRQoL). METHODS: Two hundred thirty-four patients (257 endodontically treated teeth) who were previously included in a quality assurance study were offered a recall appointment at the Department of Clinical Dentistry, University of Bergen, Norway. Patients were given a thorough clinical, radiographic examination and asked to fill out the Oral Health Impact Profile-14 questionnaire. RESULTS: A total of 149 patients (160 teeth) attended the 4-year (range, 4-6 years) recall appointment. An unchanged or lower Periapical Index (PAI) score at recall visit was registered on 153 teeth (95.6%) (P < .001). Radiographic success rate (PAI score ≤ 2) was 87.5%, and clinical success (absence of clinical signs and symptoms) was 88.8%. Both radiographic and clinical success was observed in 78.8% of teeth. Teeth in high difficulty category, instrumented with engine-driven files, and molars presented with significantly more clinical signs and symptoms but not high PAI score (PAI score ≥ 3) (P < .05). Endodontic mishaps such as overinstrumentation and overfill with gutta-percha resulted in significantly high PAI score (P < .05). Patients with no clinical signs and symptoms after RCT and elderly had a significantly better OHRQoL (P < .05). CONCLUSIONS: Presence of clinical signs and symptoms rather than PAI score affected patients' OHRQoL.

Prevalence and socio-behavioral influence of early childhood caries, ECC, and feeding habits among 6-36 months old children in Uganda and Tanzania.

BACKGROUND: Early childhood caries (ECC) is a serious problem that has remained unexplored in sub-Saharan Africa. This study aimed to identify possible socio-behavioral correlates of ECC focusing 6-36 months old children and their caretakers. METHODS: Cross sectional studies were conducted in a high fluoride rural area, Manyara, Tanzania and a low fluoride urban area, Kampala, Uganda. Totals of 1221 and 816 child - caretaker pairs attending health care facilities for growth monitoring were recruited in Manyara and Kampala, respectively. All caretakers completed face to face interviews at the health care facility. Children underwent oral clinical examination whereby ECC and Enamel hypoplasia were recorded using the dmft (WHO 1997) and the DDE index (FDI 1992). RESULTS: The prevalence of ECC was 3.7% in Manyara and 17.6% in Kampala. According to multiple logistic regression analyses, received oral health information from health worker was the strongest determinant of ECC in Manyara, adjusted OR 0.3, 95% CI 0.09 - 0.93. In Kampala, visible plaque, high sugar intake and presence of enamel hypoplasia associated with ECC, adjusted ORs 2.8 (95% CI 1.61- 4.95), 3.0 (95% CI 1.39 - 6.34) and 2.3 (95% CI 1.36 - 3.95). CONCLUSION: Oral health education aimed at caretakers of 6-36 months, including health care workers' information regarding the detrimental consequences for oral health of frequent sugar consumption and poor oral hygiene is important for prevention of ECC in Tanzania and Uganda.

Aesthetics of implant-supported single anterior maxillary crowns evaluated by objective indices and participants' perceptions.

AIM: The objective of this study was to evaluate the aesthetics of implant-supported single crowns in the anterior maxilla using objective indices and patients' perception. METHODS: Fifty participants, former patients (mean age 31.3 years) at the Dental Hospital, University of Bergen, or at Haukeland University Hospital in Bergen, Norway, who had implant-supported single crowns replacing upper anterior teeth lost due to trauma or agenesis during 2006, were included. One year after placement of the crown, an evaluation was carried out using the Pink Aesthetic Score (PES), the Implant Crown Aesthetics Index (ICAI), a modified version of the ICAI (mod-ICAI), and the index of the Californian Dental Association (CDA). The participants rated their satisfaction with the crowns and adjacent soft tissue. RESULTS: The form of the crown was satisfactory for 88% and the colour for 84% of participants, while 72% were satisfied with the adjacent mucosa. A statistically significant bivariate correlation was found between the PES and the ICAI and mod-ICAI. A weaker association was found between the CDA and the ICAI, mod-ICAI and PES. A positive correlation was found between the mod-ICAI index and satisfaction with the form and colour of the crowns and with the sum of ratings of responses to the questions about the form and colour of the crowns and the form and colour of the adjacent mucosa (P<0.05). Although most participants were satisfied, objective evaluation showed that a good aesthetic outcome for single implants was related to the quantity of the peri-implant mucosa. CONCLUSION: The mod-ICAI index correlated with responses to questions about the form and colour of the mucosa. Other significant correlations were found between the participants' aesthetic perceptions and the ICAI and the mod-ICAI. The mod-ICAI combined best objective and subjective assessment of aesthetics related to implant-supported crowns.

Impact of traumatic dental injuries with unmet treatment need on daily life among Albanian adolescents: a case-control study.

BACKGROUND: Traumatic dental injuries (TDI) are common in children and adolescences. Neglected or inadequate treatment may lead to psychosocial distress during late adolescence. AIM: To investigate the potential impact of traumatic dental injuries (TDI) with unmet treatment need, on the quality of life of 16-19 year-olds in Tirana, Albania. MATERIAL AND METHODS: A case-control survey (1:2) was conducted in public high schools in Albania, comprising 95 subjects affected by TDI with unmet treatment need based on objective clinical signs. Controls (n = 190) with no history of TDI were matched by age, sex and belonging to the same school class and group of friends as the respective case. The Oral Impact on Daily Performances (OIDP) index was used to measure the impacts. DMFT, Community Periodontal Index and the Aesthetic Component of the Index of Orthodontic Treatment Need as well as social parameters were recorded. RESULTS: The response rate was 98%. Overall, the impact prevalence of OIDP was 88.4% among the cases, and 58.9% among the controls (P < 0.001). The most prevalent OIDP impact was 'smiling and showing teeth without embarrassment': cases had significantly higher values than controls (78.9% vs 31.6%). Multiple conditional logistic regression analysis was used to disclose the effect of TDI with unmet treatment need on quality of life by adjusting for possible confounders. Compared to the control group, TDI cases with unmet treatment need are at greater overall risk of impacts measured as OIDP, with an odds ratio of 3.9 (95% CI: 1.6-9.1). CONCLUSION: TDI with unmet treatment need in this sample of adolescents is associated with reduced OHRQoL. Compared to adolescents with no history of TDI, those affected by TDI with unmet treatment need are at greater risk of suffering impacts on OHRQoL in the form of OIDP.

Dental auto-transplantation to anterior maxillary sites.

AIM: To investigate the indications for, and the outcome of auto-transplantation of teeth to the anterior maxillary region. MATERIAL AND METHODS: From 1978 to 1994, 41 teeth in 31 subjects were transplanted to anterior maxillary sites at the Department of Oral Surgery, Stavanger University Hospital, Norway. All transplantations were performed by one oral surgeon (B.G.). Relevant information was collected from patients' files, including radiographs of the tooth graft, the recipient site and follow-up radiographs. RESULTS: The mean observation period was 55.1 months (range 1-158 months). The age of the patients at the time of the auto-transplantation ranged from 10 to 30 years (mean 14.8 year). The most common indications for auto-transplantation were aplasia (41.5%), sequelae of trauma (36.6%) and impacted or ectopic teeth (17.1%). Eight teeth were judged to be failures; five had been extracted because of severe root resorptions and periodontal infection and three were judged as failures owing to severe ongoing root resorption but remained in the alveolus. CONCLUSION: Trauma is as common indication as aplasia for transplantation. From a biological point of view, dental auto-transplantation to the anterior maxillary region has a high success rate. Hence, auto-transplantation is an important treatment option for missing or lost maxillary anterior teeth where preservation of the alveolar bone is important during growth and development in adolescents. The major reason for failure was various types of root resorptions, some of which were detected late.

Applicability of an Albanian version of the OIDP in an adolescent population.

BACKGROUND: The impact of oral conditions on quality of life of adolescents has not been thoroughly investigated. AIM: The purpose of this study was to assess the reliability and validity of an Albanian version of the oral impact of daily performance (OIDP) questionnaire. DESIGN: A total of 493 adolescents attending secondary public schools in Albania attended clinical examination and completed a questionnaire that included an Albanian version of the OIDP inventory. The psychometric properties of the OIDP were evaluated in terms of reliability and validity. RESULTS: The validity and reliability of the Albanian version of OIDP were good. Cohen's Kappa ranged from 0.72 to 0.79. In terms of internal consistency, Cronbach's alpha was 0.77. Construct and criterion validity were demonstrated in that the OIDP frequency scores were statistically significant with global measures of self-rated and self-perceived oral health status variables and some of the clinical variables used in this study. A total 60.9% of participants reported having at least one oral impact. The most prevalent impact was difficulty in smiling, whereas difficulty in speaking was less prevalent impact. CONCLUSION: The Albanian version of OIDP seems to be a reliable and valid scale for use in an urban adolescent population.