Risk evaluation and type of treatment of multiple dental trauma episodes to permanent teeth

Abstract – Studies have shown that some children and adolescents are effected only once with a dental trauma, while others seem to be accident‐prone and suffer from multiple dental trauma episodes (MDTE). Studies have also shown that dental traumas mostly affect upper permanent and medial incisors. Less is known about treatment consequences related to teeth with repeated dental trauma episodes. The aim was therefore to evaluate the risk of MDTE to permanent teeth among children and adolescents by age and gender and to compare types of dental treatment modalities used for patients with one episode and those with MDTE and with single and repeated traumatized teeth. The study was based on a random sample of 83 Danish 6–18‐year‐old children and adolescents born in 1970 who suffered from dental trauma episodes. All patients were followed during a 12‐year period (1976–1988). Forty‐one of the patients were registered with MDTE with a range of 2–7 episodes and a mean of 2.9 episodes/patient (SD=1.1). The mean age at single and MDTE was 11.4 years (SD=3.6) and 8.6 years (SD=2.1), respectively. No significant differences were found between age at first episode and the number of MDTE per patient. The number of patients with MDTE was significantly higher among those who suffered their first trauma episode in the age interval 6–10 years than in the age interval 11–18 years (P<0.001). A survival analysis showed that the risk of sustaining another trauma episode increased by 14.9–30.3% when the first trauma occurred before the age of 11, compared to 0–7.4% after the age of 10. The risk of sustaining multiple injuries was 8.4 times higher when the first trauma episode occurred at 9 years of age, compared with those occurring at age 12. The survival analysis also showed that for every new trauma episode, the interval between them became closer. Forty‐five per cent of the MDTE affected teeth had already sustained an injury. With an increased number of trauma episodes per patient followed an increase in the number of follow‐ups, filling therapy, information and prosthetics, whereas the rates of endodontics, surgery, and consultations were unchanged or even decreased.     

Combined technique with glass‐fibre‐reinforced composite post and original fragment in restoration of traumatized anterior teeth – a case report

Abstract – Dentoalveolar trauma is frequently encountered by dental practitioners. In some instances, saving a child’s traumatized permanent teeth can create difficulties for the child, the parents and the dentist. Reattachment of a crown fragment is a conservative treatment that should be considered for crown fractures of anterior teeth. This case describes the clinical reattachment of an original tooth fragment. A 10‐year‐old male presented at the Department of Pediatric Dentistry with a complex crown fracture of the left maxillary central incisor 1 day after the trauma occurred. Following endodontic treatment, a glass‐fibre‐reinforced composite root canal post (FRC Postec^®; Ivoclar Vivadent AG, Schaan, Liechtenstein) was inserted to increase retention and distribute stress along the root. The dental restoration was completed using the original fragment and a dual‐cured resin composite (Variolink^® II; Ivoclar Vivadent AG). Clinical and radiographic examinations at 1‐year recall showed the glass‐fibre‐reinforced composite root canal post and restoration to be in place, indicating the success of the treatment in maintaining the fractured tooth. Thus, we conclude that reattachment of a tooth fragment using a dual‐cured resin composite and a glass‐fibre‐reinforced composite root canal post is an alternative method for the rehabilitation of fractured teeth that offers satisfactory aesthetic and functional outcomes.     

Clinical management of a fractured anterior tooth with reattachment technique: a case report with an 8‐year follow up

Abstract – Fracture of anterior teeth is a relatively common outcome of trauma to the teeth. If the fractured teeth fragments are recovered by the patient and brought to the dental office within reasonable time, the fragments may be reattached to the remaining tooth structure. This article presents a case of a 15‐year‐old male patient with fractured left maxillary lateral incisor. The fragment reattachment was performed using dual‐cured composite resin cement and the treatment outcomes of an 8‐year follow up were presented. The technique described in this case report for reattachment of the fractured fragments is simple, while restoring providing long‐lasting esthetics and improved function with a very conservative approach.     

Crestal Bone Changes at Teeth and Implants in Periodontally Healthy and Periodontally Compromised Patients. A 10‐Year Comparative Case‐Series Study

Background: Limited data exist on the longitudinal crestal bone changes around teeth compared with implants in partially edentulous patients. This study sought to compare the 10‐year radiographic crestal bone changes (bone level [BL]) around teeth and implants in periodontally compromised (PCPs) and periodontally healthy (PHPs) patients. Methods: A total of 120 patients were evaluated for the radiographic crestal BL around dental implants and adjacent teeth at time of implant crown insertion and at the 10‐year follow‐up. Sixty patients had a previous history of periodontitis (PCPs), and the remaining 60 were PHPs. In each category (PCP and PHP), two different implant systems were used. The mean BL change at the implant and at the adjacent tooth at the interproximal area was calculated by subtracting the radiographic crestal BL at the time of crown cementation from the radiographic crestal BL at the 10‐year follow‐up. Results: At 10 years after therapy, the survival rate ranged from 80% to 95% for subgroups for implants, whereas it was 100% for the adjacent teeth. In all eight different patient categories evaluated, teeth demonstrated a significantly more stable radiographic BL compared with adjacent dental implants (teeth BL, 0.44 ± 0.23 mm; implant BL, 2.28 ± 0.72 mm; P <0.05). Radiographic BL changes around teeth seemed not to be influenced by the presence or absence of advanced bone loss (≥3 mm) at the adjacent implants. Conclusions: Natural teeth yielded better long‐term results with respect to survival rate and marginal BL changes compared with dental implants. Moreover, these findings also extend to teeth with an initial reduced periodontal attachment level, provided adequate periodontal treatment and maintenance are performed. As a consequence, the decision of tooth extraction attributable to periodontal reasons in favor of a dental implant should be carefully considered in partially edentulous patients.     

The importance of soft tissue examination in post‐traumatic decision‐making: A case report

Dental and facial traumas involving teeth and supporting tissues are common sports‐related injuries. In this case report treatment of a 23‐year‐old student who had been elbowed by an opponent player during a basketball game, which caused oblique fractures on both maxillary incisor teeth is presented. The patient presented 17 days following trauma having completed full recovery of soft tissues. A fragment of upper incisor tooth had been embedded in lower lip at the time of trauma, which was covered by healing tissues. At the 1 month control the patient complained of a hard structure in his lower lip. The elusive broken fragment was revealed by a radiograph and then removed surgically. This case report is a good example of the importance of the training of general dentists about sports‐related traumatic injuries as well as emphasising the importance of the use of mouthguards during contact sports.     

Maxillary implant‐supported overdentures opposed by (partial) natural dentitions: a 5‐year prospective case series study

The aim of this study was to assess the 5‐year treatment outcome of maxillary implant‐retained overdentures opposed by natural antagonistic teeth. Fifty consecutive patients received maxillary overdentures supported by six dental implants. Implants were placed in the anterior region, if enough bone was present (n = 25 patients) Implant were placed in the posterior region if implant placement in the anterior region was not possible (n = 25 patients). Variables assessed included survival of implants, condition of hard and soft peri‐implant tissues and patients' satisfaction. The five‐year implant survival rate was 97·0% and 99·3%, and mean radiographic bone loss was 0·23 and 0·69 mm in the anterior and posterior group, respectively. Median scores for plaque, calculus, gingiva, bleeding and mean scores for pocket probing depth were low and stayed low. Patients' satisfaction after treatment was high in both groups. Within the limits of this 5‐year study, it is concluded that six dental implants (placed in the anterior or posterior region) connected with a bar and opposed to natural antagonistic teeth result in acceptable results for clinical parameters and good outcomes for marginal bone level changes and patient satisfaction.     

General anesthesia for dental care management of a patient with epidermolysis bullosa: 24‐month follow‐up

Epidermolysis bullosa comprises a group of uncommon skin‐related diseases, characterized by the formation of blisters on mucocutaneous regions occurring spontaneously, following a trauma, exposure to heat, or as a result of minimal mechanical trauma. The dental treatment of the patient with epidermolysis bullosa raises many questions and discussions, due to the difficulty of carrying out the procedures. This report aimed to detail the clinical considerations of the treatment under general anesthesia of a patient with epidermolysis bullosa. The extraction of all deciduous teeth under general anesthesia was recommended based on the clinical and radiographic examinations. At 24‐month follow‐up, the patient had great improvement in oral hygiene without new caries lesions. The patient has been followed‐up at every month for caries lesion prevention and permanent tooth development. The treatment under general anesthesia provided the ideal safe conditions and was beneficial for the patient.     

Six‐Year Survival of a Mini Dental Implant‐Retained Overdenture in a Child with Ectodermal Dysplasia

Patients with ectodermal dysplasia (ED) experience several problems caused by abnormal development and functioning of the head and neck region. In addition to developmental nasal cartilage abnormalities and absence of sweat glands, hair, and eyebrows, edentulism or developmental disorders of teeth (cone‐shaped teeth) are commonly observed in these types of patients. ED is also characterized by underdeveloped alveolar ridges, a decreased occlusal vertical dimension, reduced salivary secretion, and dry oral mucosa, which make prosthetic rehabilitation difficult. Few studies of intraosseous dental implant‐retained prostheses have described adverse effects on craniofacial growth and esthetic and functional disadvantages, while some researchers have described the advantages of this treatment option as an alternative option in these cases. Due to the associated alveolar bone deficiency, dental mini‐implant therapy may be a treatment option for these patients; however, there are isolated cases in the literature regarding the rehabilitation of ED patients with mini‐implant‐supported overdentures. This clinical report describes the rehabilitation of a 6‐year‐old child with ED using a maxillary removable partial prosthesis and a mini‐implant‐retained mandibular overdenture. The clinical and radiographic findings of this prosthetic rehabilitation during the 6‐year follow‐up are also presented.     

Immediate self‐replantation of an avulsed permanent mandibular incisor – a case report

Abstract – Background: Approximately 50% of children under the age of 15 years are subjected to various kinds of injuries in the orofacial region. In the permanent dentition, the most severe dental injury affects the surrounding alveolar bone structure and leads to loss of the tooth. The current literature emphasizes that the awareness of appropriate triage procedures following dental trauma is unsatisfactory and that delay in treatment is the single most influential factor affecting prognosis. Results: This case report presents the immediate self‐replantation of a right lateral mandibular incisor of a 12‐year‐old male patient following a traumatic avulsion. The same patient had earlier, aged 10 years, experienced a trauma leading to the loss of all four maxillary incisors. The missing incisors were replaced by a removable acrylic denture. Having the requisite experience from the earlier accident, the child performed on himself an immediate replantation of the tooth at the site of the accident. After avulsion, the tooth was not splinted timely nor was an endodontic procedure carried out and no antibiotics were prescribed. The first dental examination after the trauma was performed 6 months later and since then, radiographic follow‐up has been introduced. One year after the trauma, following the late endodontic treatment performed 6 months after reimplantation, the tooth is asymptomatic and stable. Conclusions: Immediate self‐replantation of an avulsed tooth is the best treatment choice, even without any other proceeding treatment. However, the healing process should be followed up to allow for the treatment of the early signs of pulpal necrosis and/or root resorption.     

Management of a 9‐year‐old boy experiencing severe dental injury – a 21‐year follow‐up of three autotransplants: a case report

Abstract – The replacement of missing anterior teeth is a particular challenge in children and adolescents. This report describes the management of a 9‐year‐old boy suffering a severe dental injury. The treatment included three autotransplantations and orthodontic space closure to replace four maxillary teeth. A follow‐up period of 21 years demonstrated a successful outcome. Autotransplantation of premolars in growing individuals is a predictable method for replacement of missing teeth and for re‐establishment of the alveolar process after traumatic bone loss. This case report shows that a multidisciplinary approach is essential for the management and outcome of severe dental injuries in children.     

Oral habits,dental trauma,and occlusal characteristics among 4‐ to 12‐year‐old institutionalized orphan children in Riyadh,Saudi Arabia

The aim of this study was to assess the oral habit practices, dental trauma, and occlusal characteristics of 4‐ to 12‐year‐old orphans living in governmental orphanages in Riyadh. This cross‐sectional study was conducted in three government orphanages and three ordinary schools. All 90 orphans, residing in the orphanage, were included. Ninety schoolchildren were selected to serve as the controls. Demographic data, oral habit history, and dental trauma history were obtained through a questionnaire. All children were examined to confirm the presence of signs of oral habits, dental trauma, and associated occlusal characteristics. Pearson chi‐square was used for statistical analysis. Orphans were found to have more digit sucking and oral self‐mutilation habits; however, the control children were found to have more nail biting habit. Nearly 21% of the orphans had dental trauma compared to 10% of the control group. About 70% of the dental trauma affected permanent teeth among orphans, whereas, 85% affected primary teeth in the control children. Dental trauma increased as the orphans got older; however, it decreased significantly as the control children got older. Orphans were found to have more cross‐bite, increased over‐jet, and open‐bite. Digit sucking habit was positively associated with class II molar relation, presence of posterior cross‐bite, and open‐bite. Orphans had increased prevalence of digit sucking habit, self‐mutilation, dental trauma, and malocclusion.     

Dental trauma in an Australian rural centre

Abstract – Background/Aim: There is little epidemiological research regarding dental trauma in Australia. Previous research has largely focused on specific sub‐populations with data not necessarily applicable to a general rural Australian population. Studies from other countries have presented variable data and the relevance of their findings to the Australian setting is questionable. The aim of this study was to investigate the prevalence, causes and presentation of dental trauma in a large rural centre in Australia. Materials and methods: A retrospective analysis was performed of the dental records of 323 consecutive patients who had attended a private general dental practice in Bunbury, Western Australia following an injury to their teeth and/or mouths during the period from May 2000 to December 2005 (inclusive). Injuries were classified using the Andreasen system (1994). Data analysis was carried out using spss software and Chi‐Square tests were performed with the level of significance set at 5%. Results: There were 528 teeth injured and eight patients had only soft tissue injuries. Males (68.1%) significantly outnumbered females (31.9%) and the ages ranged from 10 months to 78 years. The highest number of injuries occurred in children and adolescents, specifically the 0‐ to 4‐year age group followed by the 5‐ to 9‐year age and 10‐ to 14‐year age groups. Trauma was most frequently the result of falls, accidents while playing and participating in sports activities. Conclusions: The maxillary central incisors were the most commonly injured teeth in both the primary and permanent dentitions. Uncomplicated crown fractures were the most common injury followed by luxations and subluxations. No significant differences in frequency were reported for the different days of the week, the different months or seasons of the year. Only one‐third of the patients presented for dental treatment within 24 h of the injury while the remainder delayed seeking treatment for varying times up to 1 year.     

Dental injuries among children and adolescents aged 1–15 years attending to public hospital in Temuco,Chile

Abstract –  A cross‐sectional study was carried out in children and adolescents of both sexes, aged 1–15 years that sought dental emergency attention to the Regional Hospital between 2004 and 2007 in Temuco, Chile. The purpose of this study was to identify the aetiology, types of traumatic dental injuries in primary and permanent dentitions, sex and age distributions, accident location; and time elapsed before emergency treatment in children and adolescents. The sample consisted of 359 patients with 145 primary teeth and 525 permanent teeth affected by dental trauma. The results showed a 2:1 male:female ratio distribution (242/117) with a mean age of 8.4 years. The 7‐ to 12‐year‐old group had the highest frequency of dental injuries (66.6%). Unspecific accidental falls were the main cause of injury to primary and permanent dentition (51.8%), followed by striking teeth against objects (15.6%) and bike accidents (13.9%). In primary dentition the most common diagnosis were subluxation (38.6%) and avulsion (16.6%), whereas in permanent dentition was uncomplicated crown fracture (32.9%). A high proportion of the patients received their first emergency attention 24 h after the accident (32.6%). This study revealed a high frequency (37.9%) in 1–15 aged population that sought emergency attention by dental trauma in the period of time study. A large proportion of children with dental trauma received delayed first emergency care, even 24 h after the accident. Considering the high frequency of traumatic dental injuries in 1–15 aged population and the high percentage of delayed emergency attention is necessary to develop effective educational campaigns in regard to causes, prevention and emergency management of traumatic dental injuries, especially in deprived areas. In conclusion, traumatic dental injury may be considered as a serious dental public health problem especially in children of deprived areas.     

Dental auto‐transplantation to anterior maxillary sites

Abstract – 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.     

Dental status and self‐assessed chewing ability in 70‐ and 80‐year‐old subjects in Sweden

The objective was to compare two cohorts of elderly people, 70 and 80 years old, with respect to dental status and self‐assessed chewing ability. The hypotheses were as follows: (i) dental status is associated with self‐assessed chewing ability; (ii) chewing ability is poorer among the 80‐ than the 70‐year‐old subjects. Identical questionnaires were in 2012 sent to all subjects born in 1942 and 1932, living in two Swedish counties. The response rate was 70·1% resulting in samples of 5697 70‐ and 2922 80‐year‐old subjects. Answers to questions on self‐assessed chewing ability, dental status and some other factors have been analysed. Dental status varied but was in general good; 72% of the 70‐ and 60% of the 80‐year‐old subjects reported that they had all or only few missing teeth. Rate of edentulism was 3% and 7%, respectively. Removable partial dentures were reported by 6% and 10%, respectively, implant treatment by 13% in both cohorts. Self‐assessed chewing ability was mostly good and correlated with the number of teeth (Spearman rho = 0·46). A majority of the edentulous subjects assessed their chewing ability as very or fairly good. Logistic regression showed that self‐assessed chewing ability was significantly associated with a number of dental variables but also with general health. In conclusion, dental status was relatively good at both ages but somewhat poorer in the older cohort. Dental status, some other dental variables and being healthy were in both age groups significantly associated with self‐assessed chewing ability.     

Occurrence of tooth injuries in patients treated in hospital environment in the region of Araçatuba,Brazil during a 6‐year period

Abstract – Dental trauma has been considered as a public health problem that affects mainly children and youngsters and due to its impact on the patient’s quality of life. This study presents the results of a 6‐year survey of the occurrence and characteristics of dental trauma in patients admitted to the Service of Surgery and Oral and Maxillofacial Traumatology of the School of Dentistry of Araçatuba (UNESP, Brazil) after emergency care in hospital facilities in the region of Araçatuba, SP, Brazil. For such purpose, the clinical files of patients treated at the Service between 1999 and 2005 were reviewed. Information regarding gender, age, number of traumatized teeth, etiology and diagnosis of the trauma was collected from the files of patients with tooth injuries and recorded in case report forms specifically designed for this purpose. The results showed that from a total of 4112 patients admitted to the Service within the surveyed period, 266 (6.5%) had tooth injuries (172 males – 64.7%; 94 females – 35.3%). The total number of traumatized teeth was 496. Most patients belonged to the 16–20 year‐old age group (20.3%) and the most frequent causes of tooth injuries were bicycle accidents (28.6%), motorcycle accidents (19.2%) and falls (18.8%). Injuries to the periodontal tissues were the most frequent type of tooth injuries (408 teeth; 82.26%), occurring in 118 primary and 290 permanent teeth. Among the injuries to the periodontal tissues, avulsion was the most common (32.86%) (29.41% for primary and 34.0% for permanent teeth), followed by extrusive luxation (19.15%) (25.21% for primary and 17.24% for permanent teeth). In conclusion, in the surveyed population, cases of tooth injuries were more frequent in males aged 16–20 years old due to cyclist accidents with predominance of injuries to the periodontal tissues, in particular, avulsions.     

Incisor Trauma and the Planning of Orthodontic Treatment

Because of the frequency of dental injuries during infancy and adolescence, traumatized teeth with variable long-term prognoses present a problem for orthodontic treatment planning. Orthodontic therapy can remain unaffected, or be complicated, by traumatized teeth. In some cases, following dental injury, orthodontics can also be used to enhance (prosthetic and) restorative treatment results. The orthodontic challenges involved in treating patients with a history of dental trauma are complicated by the consequences of trauma on dentition development and the different treatment options that must be considered. In this paper, we provide actual examples of the effects dental trauma can have on orthodontic treatment planning.     

Subjective Aspects of Patients with Traumatized Teeth A 15-Year Follow-Up Study

Robertson A, Norén JG. Subjective aspects of patients with traumatized teeth. A 15-year follow-up study.

The aim of this study was to obtain detailed information about adults who suffered trauma to the teeth as children. A total of 102 patients took part. The patients answered a questionnaire and were interviewed before the oral examination. Thirty-nine per cent of the patients reported dissatisfaction either with the color and/or anatomic form of the traumatized teeth or reconstruction. Most of the individuals did not remember having received any information about prognosis for the traumatized teeth. Twenty-one per cent of the patients remembered pain during treatment, and 25% remembered only the behavior and attitudes of the dental team. It can be concluded that all dental treatment in children with traumatized teeth must be carried out as painlessly as possible, and the dental team should minimize discomfort during the treatment. Good knowledge about traumatology and management can reduce stress and anxiety for both the patient and the dental team.     

Treatment of multiple traumatized anterior teeth associated with an alveolar bone fracture in a 15‐year‐old schoolboy: a 2.5‐year follow up

Abstract – We report a case of multiple dental traumas in a 15‐year‐old schoolboy who was hit by a stone. Clinical examinations revealed the avulsion of teeth 21, 22, and 23, an uncomplicated crown fracture of tooth 41, and a complicated crown fracture (CCF) of teeth 11, 31, and 33. An alveolar bone fracture and a root fracture in the apical third of tooth 23 were as well noted on radiographs. The avulsed teeth were replanted and rigidly splinted after an extraoral dry time of 90 min. Endodontic treatments were performed on teeth with CCFs. The dental morphology was restored using polyethylene fiber‐reinforced composite resin. Endodontic obturations were performed on replanted teeth after the arrest of external root resorptions by a long‐term calcium hydroxide dressing. Esthetics and function were recovered with a 2.5‐year follow‐up period.