Space maintainer using fiber‐reinforced composite and natural tooth – a non‐invasive technique

Abstract – Dental traumatic injuries are widespread in the population and are a frequent pathology among children and teenagers. Dentists and especially pediatric dentists are commonly confronted with managing dental crown root fractures on a regular basis. Fiber‐reinforced composite (FRC) have been used as an alternative to conventional space maintainers in pediatric dentistry. We present here a case of a 11‐year‐old boy with oblique crown root fracture, treated by placing extracted natural crown with FRC as space maintainer.     

Adhesive tooth fragment reattachment with intentional replantation: 36‐month follow‐up

Crown‐root fracture is one of the most challenging fracture types in dental traumatology literature. Aesthetic and functional rehabilitation is the primary goal of the treatment of crown‐root‐fractured tooth. For this purpose, reattachment of the fragment to its original position is a good choice. This paper reports a case of an adhesive fragment reattachment of a complicated crown‐root fracture with intentional replantation in a 9‐year‐old girl patient and 36‐month follow‐up.     

A 22‐year follow‐up of an endodontic implant

Root fractures in the middle and apical thirds of the root are treated by repositioning and for approximately 6 weeks of immobilization while those in the cervical third are immobilized for 3 months. Even though the results are good, some root‐fractured teeth are lost and replaced by dental implants or fixed partial dentures. One historic but effective treatment option for those root fractures with unfavorable crown to root ratios is an endodontic implant in middle and apical third root fractures. This method offers immediate stable fixation of a crown and its coronal root segment to the underlying alveolar bone. This report documents the long‐term survival of a tooth treated with an endodontic implant. A 25‐year‐old male patient presented following a bicycle accident with a dislocated unfavorable root fracture in the middle third. The crown with the coronal root segment was secured to the bone using a commercially available endodontic implant. The apical part of the root was removed. Although the clinical and radiological follow‐up results of the endodontic implant demonstrated a good clinical function and little bone loss, the implant ultimately had to be removed after 22 years of service due to pain and increasing mobility.     

Recurrent trauma histories of two ‘unlucky teeth’: 42‐month follow‐up

Abstract – The root fractures occur relatively rarely and account for 0.5–2.5% of all dental injuries. The fracture type, severity of dislocation, mobility of fragments and diastasis have negative influence on the healing process. The aim of this study was to describe the treatment and the 42‐month follow‐up period of three trauma histories in a 12‐year‐old patient in 1 year and to emphasize the negative effects of recurrent traumas on the healing pattern and prognosis of root fractures.     

Comparison between intraoral indirect and conventional film‐based imaging for the detection of dental root fractures: an ex vivo study

Digital intraoral radiographic systems have been rapidly replacing conventional dental X‐ray films for diagnosis of dental diseases. Current scientific literature supports the use of these digital systems for the detection of dental caries, periodontal bone loss, and periapical pathologies. However, relatively few studies have been published addressing the detection of dental root fractures. The purpose of this study was to compare the intraoral F‐speed film (Insight) with two photostimulable phosphor (PSP) indirect digital systems (ScanX and Digora Optime) for the detection of simulated dental root fractures. Ten raters evaluated images acquired from 10 dry human cadaver mandibles under optimal viewing conditions. These data were analyzed by a 5‐point receiver operating characteristic curve analysis for statistical differences. Sensitivity and specificity of these systems were also assessed. Since statistically significant difference between the systems was not observed, the results of this study agreeably support indirect digital PSP plates as an alternative to the evaluated conventional film for the detection of dental root fractures.     

Dental students’ part‐time jobs in dental practices in the Netherlands

Objective: In the Netherlands, the Individual Health Care Professions Act (IHCP Act) allows dental students, amongst other non‐qualified individuals, to work under certain conditions in a dental practice. The aim of the study was to determine how many dental students have part‐time employment in dental practice and which professional tasks they carry out. We also asked the dental students their opinion about the IHCP Act. Material and methods: All the enrolled dental students at the Academic Centre for Dentistry Amsterdam (ACTA) in the Netherlands received a questionnaire by e‐mail. Within 1 month, two reminders were sent. Results: The response was 44% (427 students). Of the responding students, 71% had paid employment in addition to their study. Twenty‐five per cent of all students worked in a dental practice, usually 8 h a week. Study year and age were positively related to working part‐time in dental practice. Activities frequently performed were providing chair side assistance, giving oral hygiene instruction, fluoride applications, scaling and root planning. The self‐reported knowledge about the IHCP Act was positively related to study year and working in a dental practice. Hardly any information about the requirements of the IHCP Act with regard to delegation of tasks was provided by the employer. Conclusion: Many Dutch dental students work in a dental practice, taking over a variety of tasks. Although the self‐reported knowledge about the IHCP Act was relatively high, many dental students expressed the need for more detailed information about the legal aspects of their tasks.     

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.     

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.     

Intraradicular splinting with endodontic instrument of horizontal root fracture – case report

Abstract – This case report describes the treatment of a horizontal mid‐root‐fractured incisor with an alternative fixation technique. As a result of clinical signs of pulpal necrosis, both the coronal and the apical root fragments were endodontically treated and obturated at single visit, and the fragments were stabilized internally through insertion of a stainless‐steel endodontic file into the root canal. Four‐year follow‐up examination revealed satisfactory clinical and radiographic findings with hard tissue repair of the fracture line. This technique can be a quick remedy for patients with root‐fractured tooth, especially for those who cannot make a second visit to the dental clinic.     

Management of cervical root fracture injury in a patient with epilepsy: Case report with 5‐year follow‐up

The difficulty in providing stability to the coronal segment makes cervical root fracture one of the most challenging dental traumatic injury. This type of injury is less frequent in children. However, due to their serious consequences and poor prognosis, tooth loss may occur. This report presents the management of a case of cervical root fracture in an 11‐year‐old patient with epilepsy. The stabilization of the root‐fractured tooth with a splint failed due to the recurrent seizures the patient had. Coronal fragment was removed and vital root submergence was performed in order to support the alveolar growth. The natural tooth crown was incorporated into a modified Nance appliance to meet the esthetic and functional requirements of the patient. After 5‐year follow‐up, this treatment approach has seemed to offer a long‐term provisional and satisfactory solution to the consequences of a cervical root fracture injury.     

Management of trauma‐induced inflammatory root resorption using mineral trioxide aggregate obturation: two‐year follow up

Abstract – Inflammatory root resorption is a serious complication of dental trauma, which leads to progressive loss of the root structure. This report describes the treatment a previously traumatized young maxillary lateral incisor, severely affected by inflammatory root resorption. An 11‐year‐old boy presented with pain and mobility in his maxillary incisors which experienced fall trauma 2 years earlier. Radiographic examination revealed incomplete root development of the right central incisor, associated with advanced inflammatory root resorption and a periapical lesion. Following removal of a prior long‐term calcium hydroxide dressing, the root canal was submitted to a 2‐week irrigation regimen involving 1.25% sodium hypochlorite and 2% chlorhexidine gluconate. Thereafter, the entire root was filled with mineral trioxide aggregate. The radiographic follow up at 6 months showed arrest of root resorption and initiation of periapical healing in the absence of clinical symptoms and mobility. This was followed by advanced osseous regeneration and re‐establishment of the periodontal space at 12 and 24 months. From the present case, it can be concluded that mineral trioxide aggregate obturation can be a viable option that can improve the healing outcomes in cases of severe inflammatory root resorption in young permanent teeth.     

Age‐related morphological,histological and functional changes in teeth

Throughout lifetime, the teeth are continuously exposed to numerous chemical and physical impacts, which cause the wear of the dental hard tissues, gingival recession and other oral changes with sometimes subsequent problems. Age‐related wear of tooth surfaces reduces the dental enamel thickness and exposes deeper layers of enamel, which have different physical and chemical properties than the surface enamel. Gingival recession is the main causal factor of root caries and dentine hypersensitivity. Age‐related changes in dentine include the formation of secondary dentine and the reduction in tubular lumen diameter (dentine sclerosis), which lead to a reduction in the volume of the pulp chamber. In addition to the reduction in the volume of pulp chamber, changes to the dental pulp also include dental pulp calcifications. The age‐related physiological changes to the teeth should be carefully distinguished from pathological changes, especially when they induce pain or a negative impact on the oral health‐related quality of life (OHRQoL) of the older individuals. Therefore, regular oral examinations coupled with early preventive measures should aim at maintaining oral health until old age.     

Management of root dilaceration of an impacted maxillary central incisor following orthodontic treatment: an unusual therapeutic outcome

Abstract – There are rare cases of impacted permanent central incisors with dilaceration, a dental deformity characterized by pronounced angulation of the longitudinal tooth axis. This paper presents the orthodontic alignment of a permanent maxillary left central incisor in a 7.5‐year‐old boy, which appeared impacted radiologically and displayed root dilaceration. Following surgical exposure with the closed‐eruption technique and appropriate orthodontic traction, the tooth was successfully aligned into the dental arch and the root was radiologically shown to be straightened and relatively well developed.     

Dental hygiene students’ part‐time jobs in dental practices in the Netherlands

To cite this article:
Int J Dent Hygiene
DOI: 10.1111/j.1601‐5037.2009.00415.x
Poorterman JHG, Dikkes BT, Brand HS. Dental hygiene students’ part‐time jobs in dental practices in the Netherlands. Abstract: Objective: Many students have paid employment while studying. In the Netherlands, the Individual Health Care Professions Act (IHCP Act) allows dental hygiene students to work under certain conditions in a dental practice. The aim of the study was to determine how many dental hygiene students have part‐time job employment in dental practice and which professional tasks they carry out. We also asked the dental hygiene students their opinion of the IHCP Act. Methods: All the enrolled dental hygiene students (n = 341) at a School of Health in the Netherlands received a questionnaire by email. Results: The response was 52% (176 students). Of the responding students, 75% had paid employment in addition to their study. A proportion of the students (35%) worked in a dental practice. The median number of hours worked per week was eight. Study year, age and prior education were positively related to working part‐time in dental practice. Activities frequently performed were giving oral hygiene instruction, fluoride applications, scaling and root planning, providing chair side assistance and giving local anaesthesia. Although the self‐reported knowledge about the IHCP Act was high, almost half of the students expressed the need for more detailed legal information. Conclusions: Many dental hygiene students work in a dental practice, taking over a number of tasks usually performed by the dentist. More information in the dental hygiene curriculum about the requirements of the IHCP Act seems desirable.     

Development of a Basic Root canal Treatment (BRT) for primary oral health care — evaluation after one year

Objectives : Atraumatic Restorative Treatment (ART) was a major step forward in community dentistry but treatment options for deep carious lesions or pulp involvement still focus on tooth extraction in under‐served areas worldwide. To bridge the gap between ART and extraction this pilot study aimed to develop and follow‐up a basic root canal treatment for rural dental health facilities in the Republic of The Gambia (West Africa), faced with an environment lacking technical equipment and developing primary oral health care. Methods : 25 single rooted teeth with acute irreversible pulpitis were root canal treated with a standardised endodontic instrument kit and a specific procedure. A step‐back technique was used with intermittent chlorhexidine 0.2% and saline irrigation. Root canal obturation was performed using a single‐cone technique with gutta‐percha using Grossman's root canal cement. Coronal filling was carried out by using ART. Clinical examinations were documented before treatment, one day, five days, six months and twelve months postoperatively. Results : None of the root canal fillings had to be revised due to postoperative complications. In 9 out of 25 teeth, transitory apical pain disappeared after a few days. After six months, all ART fillings appeared clinically acceptable, two fillings had to be corrected. Four class II restorations and three class IV restorations needed replacement after 12 months. Patients' assessment of health related quality of life improved significantly, especially concerning dental pain, chewing ability and fitness for work. Conclusions : Preliminary clinical follow‐ups showed encouraging results for the basic root canal treatment approach. Longitudinal clinical studies with greater populations are required to substantiate these results. Modifications in the coronal filling technique are preferable to improve the clinical performance of extended ART cavity restorations.     

An unusual lateral luxation of an upper incisor owing to long‐term boxing without protection

Abstract – This case report describes a lateral luxation of an upper incisor in a 19‐year‐old non‐professional boxer. The tooth displacement gradually worsened over several months because the boxer received repeated blows to the head without using a mouthguard. Being a chronic dental trauma, rather than an acute lateral luxation, this case had several unique features: the labial plate of the alveolar bone was penetrated, the root apex was free in the vestibulum, the tooth was mobile (second degree) and radiographs revealed bone resorption. This case emphasized the need for a mouthguard to be used even with amateur boxing. The dental practitioner should educate his sportsmen–patients of the risk of sport‐related dental trauma and the benefit of a mouthguard.     

Comprehensive and sequential management of an impacted maxillary central incisor with severe crown–root dilacerations

Abstract – Tooth dilaceration refers to a dental anomaly characterized by an abrupt deviation in the longitudinal axis of tooth. Crown–root dilaceration is diagnosed in teeth with sharp angles at the cement–enamel junction. The greater the bending degree is, the less chance there is for successful teeth preservation and relocation. In this report, a clinical case of an impacted maxillary central incisor with severe crown–root dilacerations was described by means of an operative evaluation using three‐dimensional dental computed tomography and a multidisciplinary approach that included surgical, orthodontic, endodontic, prosthetic and periodontal therapy.     

The concepts of evidence‐based periodontal plastic surgery: Application of the principles of evidence‐based dentistry for the treatment of recession‐type defects

The decision‐making process for the treatment of recession‐type defects is based on translation of the outcomes from randomized controlled trials and systematic reviews to clinical practice. Such an approach is capable of assisting researchers, clinicians, and patients to understand the mechanisms and effects of the treatment of different root‐coverage procedures, as well as turning treatment options into usable and predictable tools to be applied in dental practice. This review explores: (a) the aspects related to the etiology of gingival recession; (b) the history of periodontal plastic surgery procedures used to achieve root coverage; (c) the main findings, implications of research, and practice of root‐coverage procedures described from the current base of systematic reviews; (d) the role of the evidence produced in Latin American research centers; and (e) the outcomes of an individual patient data meta‐analysis of randomized controlled trials evaluating the role of root coverage and restorative procedures in achieving complete root coverage of noncarious cervical lesions. The findings of the current base of evidence clearly indicate that all of the main periodontal plastic surgery procedures lead to improvements in initial clinical parameters, but subepithelial connective tissue grafts, either alone or associated with coronally advanced flaps, result in superior complete root coverage, long‐term stability, and greater increase of keratinized tissue. Nonetheless, coronally advanced flaps, either associated with biomaterials (acellular dermal matrix grafts, enamel derivative proteins and xenogeneic collagen matrix) or used alone, provide satisfactory results and are suitable for use as secondary/alternative procedures to subepithelial connective tissue grafts.     

Factors associated with pain and analgesic consumption following non‐surgical periodontal therapy under local anaesthesia and carried out by dental students

Aim

Evaluate factors associated with pain and analgesic consumption following non‐surgical periodontal therapy.

Materials and methods

The sample consisted of 218 patients with chronic periodontitis, submitted to non‐surgical scaling and root planing under local anaesthesia at a public dental service in southern Brazil. The data collection instruments included a demographic questionnaire, as well as State‐Trait Anxiety Inventory, Corah?s Dental Anxiety Scale, Visual Analogue Scale, Numerical Rating Scale and Verbal Rating Scale. The presence and intensity of pain were evaluated at 2, 6, 12, 24 and 48 hr after scaling and root planing.

Results

A total of 52.3% of the patients reported mild intensity pain at some point during the 48 hr after scaling and root planing with local anaesthesia. Smoking (PR = 1.47; 95% CI = 1.16–1.65), severe periodontal inflammation (PR = 1.31; 95% CI = 1.09–1.58) and dental anxiety (PR = 1.24; 95% CI = 1.03–1.49) were associated with postoperative pain after adjusting for age, gender and state and trait anxiety scores. Moreover, 46.8% of the subjects used analgesics at some time during the 48‐hr follow‐up period and dental anxiety was the only factor associated with postoperative analgesic use.

Conclusions

Smoking, severe periodontal inflammation and dental anxiety were identified as factors associated with pain after non‐surgical scaling and root planing with local anaesthesia. Dental anxiety was also a factor associated with postoperative analgesic use.