Survival analysis of endodontically treated traumatized primary teeth

The present study aimed to verify the factors that interfere with the success of endodontic treatment of traumatized primary teeth as well as to determine the success level of the proposed treatment, through survival analysis. The research was conducted through the analysis of dental traumatism records and attached radiological exams of patients assisted by the Assistance Program for the Traumatized Patient at UFSC (Universidade Federal de Santa Catarina). Fifty-one dental records of patients aged between 10 and 60 months were analyzed. These patients had their traumatized teeth endodontically treated (n = 51), according to the indications of the UFSC protocol. In order to evaluate possible interference factors affecting the success of the endodontic treatment, the following items were analyzed: age of the child at the beginning of the endodontic treatment (over or below 36 months), trauma type (mild or severe) pathological root resorption type (replacement or inflammatory), localization of the pathological root resorption (in the apical third or in the middle third), bone resorption (absent or present), alteration of the soft tissue (absent or present), condition of the pulp tissue (vitality or necrosis) and trauma recurrence (absent or present). Through the chi-squared test (chi(2) = 9.594, P < 0.05) and survival analysis, it was verified that trauma recurrence in the same tooth is a factor that interferes in the success of endodontic treatment. It was also observed, through survival analysis, that levels of success of endodontic treatments are stabilized in the 19th month. A period of 48 months of follow up was observed. It was also verified that most failures occurred between the 7th and 12th months counting from the beginning of the endodontic treatment. It was concluded that endodontic treatment of traumatized primary teeth, performed according to the UFSC protocol, enables the maintenance of the traumatized tooth in acceptable conditions in the buccal cavity up to its physiological resorption, and that trauma recurrence is a factor that leads to treatment failure.     

Treatment of a severe dental lateral luxation associated with extrusion in an 8-month-old baby: a conservative approach

Abstract –  This case report documents the trauma and follow-up care of lateral luxation associated with extrusion of the lower central incisors in an 8-month-old patient. The teeth were repositioned by digital pressure and stabilized using proximal sutures. Clinical and radiographic follow-up 40 months after the injury showed alterations in both incisors, but both remained functional and free of pathology.     

Trauma to primary teeth of South African pre-school children

Abstract— A clinical survey of 1466 children of typical South African communities showed a prevalence rate of primary tooth trauma of 15%. Trauma was least common at age 1–2 years (10.7%) and most common at 4–5 years (20.6%). The commonest trauma seen was fracture of enamel only (71.8%) followed by fracture of dentine (11.2%), tooth loss (8.2%) and discolouration without other sign of injury (5.6%).     

Histological evaluation of dog permanent teeth after traumatic intrusion of their primary predecessors

Abstract –  The aims of this study were to analyze the histomorphology of developing permanent teeth whose primary teeth had suffered traumatic intrusion, as well as to compare the influence of immediate extraction of the intruded tooth to passive re-eruption. Nine dogs from 45 to 50 days old were submitted to the intrusion of the maxillary central and lateral primary incisors using a force applicator adapted to the teeth incisal cuspids. The right side intruded teeth were kept in their sockets and the ones on the left side were extracted 30 min later. After a postoperatory periods of 30 and 60 days, four (group 1) and five (group 2) dogs, respectively, were killed by perfusion. The histological evaluations showed that, in group 1, alterations had occurred in the odontoblastic layer and deposition of the enamel matrix had taken place in some specimens while in group 2, a portion of non-mineralized matrix was observed. We concluded that the morphological changes were because of the immediate trauma of intrusion. No differences were found between the groups where the primary tooth was immediately extracted or left to passively re-erupt.     

Federal University of Santa Catarina follow-up management routine for traumatized primary teeth – part 1

Abstract –  The objective of this study was to verify if the follow-up management routine of traumatized primary teeth set up by Federal University of Santa Catarina, which performs clinical and radiographic assessments (15 and 45 days; 4, 8 and 12 months) after the oral trauma, enabled an early diagnosis of sequelae which would indicate the need for endodontic intervention, as well as the influence a type of trauma and the child's age could have in the severity of the sequelae. In this study 52 sets of records were used of patients being seen in the last 6 months, with a total of 70 teeth that were receiving follow-up treatment. Patients returned for regular visits set up by the management routine, where clinical and radiographic examinations were performed to check for sequelae, which justified endodontic intervention. Mobility (51.2%) and crown discoloration (25.6%) were the most common sequelae found in the patient's first appointment. In the follow-up visits, replacement root resorption (22.5%) was the second most common sequela found, suggesting endodontic intervention. No significant association was found between severe sequelae, types of trauma and a child's age ( χ ² = 0.3, P  = 0,8613). During the intervals of the follow-up visits, it was noticed that between 46 days and 8 months a higher number of sequelae were diagnosed ( P  < 0.05). The diagnosis of sequelae such inflammatory and replacement root resorption, which can lead to an early loss of a primary tooth, are frequent and that the interval between the follow-up visits has to be changed, suggesting the setting up of management routine 2. The study also concluded that the type of trauma and the child's age are not fundamental factors in the diagnosis of severe sequelae.     

Avulsion of primary teeth and sequelae on the permanent successors

Abstract –  The purpose of the present study was to determine the frequency of avulsion of primary teeth and the location of the avulsed tooth in a representative population of Danish children. Also, the frequency and the type of developmental disturbances in the permanent successors were assessed and related to age at the time of injury. The material included dental records of 4238 children from three clinics in Municipal Dental Health Services near Copenhagen, Denmark. The children were born between 1 January 1983 and 31 December 2000. Thirty-five children (0.8%) were identified as having avulsed in all 44 primary teeth most frequently the maxillary incisors (89%). Thirty-three fully erupted permanent successors were included in the study, the prevalence of developmental disturbances was 30% (10 teeth). The results showed the risk of developmental disturbances in the permanent successors to be more frequent the younger the age at the time of injury ( P  = 0.04). Discolouration affected all 10 permanent teeth, but also hypoplasia and horizontal enamel hypoplasia were found.     

Healing and prognosis of teeth with intra-alveolar fractures involving the cervical part of the root

Healing and long-term prognosis of 94 cervical root fractures were evaluated. The teeth were divided into two groups according to type of fracture: transverse fractures limited to the cervical third of the root (51 incisors) and oblique fractures involving both the cervical and middle parts of the root (43 incisors). Neither the frequency nor the type of fracture healing differed significantly between the two groups. In the material as a whole, healing of the fracture with hard tissue formation was observed in 17 teeth (18%), and healing with interposition of periodontal ligament (PDL) and, in some cases, hard tissue between the fragments in 62 teeth (66%). Fifteen teeth (16%) showed no healing and a radiolucency adjacent to the fracture. Statistical analyses revealed that incomplete root formation and a positive sensibility test at the time of injury were significantly related to both healing and hard tissue repair. The same applied to concussion or subluxation compared with dislocation of coronal fragment, as well as optimal compared with suboptimal reposition of displaced coronal fragments. The type and duration of splinting (or no splinting) appeared to be of no significance for frequency or type of healing of cervical root fractures. During the observation time (mean = 75 months), 19 (44%) of the teeth with transverse fractures and 3 (8%) of those with oblique fractures were lost after healing. In conclusion, fractures in the cervical part of the root had a healing potential and the predictive parameters identified for fractures in other parts of the root seemed to be valid for the healing of cervical root fractures. Transverse fractures appeared to have a significantly poorer long-term prognosis compared to oblique fractures, apparently due to a marked post-treatment mobility, which often led to new luxation caused by even minor impacts.     

Trauma in primary teeth and its effect on the development of permanent successors: a controlled study

Objective: This controlled study investigated the occurrence of sequelae to permanent successors (SPS) following traumatic dental injury in primary teeth (TDIp). Additionally, this study evaluated whether TDIp is a risk factor for SPS, with a focus on an association between SPS and the child's age and type of trauma. Materials and methods: The trauma group (TG) consisted of permanent teeth, whose antecessors had suffered TDIp, in a population of children with complete eruption of permanent teeth. The control group (CG) consisted of permanent teeth from the same individuals, whose antecessors had not suffered TDIp. There were 214 cases of TDIp with their respective permanent teeth. In the CG 247 permanent teeth, whose antecessor had not suffered TDIp, were included. Data concerning such teeth and when TDIp occurred (in terms of the child’s age) and types of SPS were collected. The chi-square test, regression logistic with generalized estimating equations (GEE) test, and risk analyses were applied to investigate the associations. Results: Overall, 29% of the permanent teeth in the TG presented SPS. This was compared to the development disturbances in the CG, which was 7%. The TG demonstrated the highest risk for SPS (OR, 5.388; p?=?.0001). The discolouration of enamel (37%) was the most common type of SPS found. SPS was more prone to occur in permanent teeth whose antecessors had been intruded (39%; p?<?.001). TDIp when the child was 1-year old was associated with SPS (p?<?.001). Moreover, children who had TDIp had a 4.1 times higher risk of presenting SPS. Conclusions: TDIp is a risk factor for the development of SPS. All types of TDIp caused SPS in this research. Additionally, the younger ages at the time of the injury and intrusions were related to SPS.     

同一个体乳牙列龋与恒牙列龋的相关性研究

目的：探讨同一个体乳牙龋与其年轻恒牙龋之间是否具有相关性，是否可以通过乳牙龋预见其恒牙龋的发生。方法：对293名5～6岁替牙期的儿童进行4年的跟踪调查，记录其在1999年和2003年时的乳、恒牙患龋情况，并进行统计学分析。结果：乳牙列龋与恒牙列龋之间相关性存在统计学意义。结论：乳牙列患龋严重的儿童，其恒牙患龋的可能性相对增高，可达乳牙列无龋者的4倍。特别是乳磨牙龋对其恒牙龋更具有预见价值。     

A dental caries severity index for primary teeth

Criteria for scoring the caries attack on each surface of an affected primary tooth are described. The score for each carious surface ranges from 1 to 3. The score per tooth is a sum of the surface scores. The caries severity index (csi) is the mean of the scores of all carious teeth in the population examined. Three groups of children aged 5-6.5 yr were examined. In Jerusalem, with a water fluoride concentration of 0.4 ppm, 54 children had a csi of 2.99 and a defs of 10.19. In a semirural African town, Soshanguva, with a 0.2 ppm fluoride concentration, 103 children had a csi of 3.10 and a defs of 5.75. In a nearby rural African area with a water fluoride concentration well above the optimum, 86 children had a csi of 1.93 and a defs of 1.99. Interexaminer and intraexaminer reproducibility of the csi were good. The csi expresses the severity of the caries attack on affected teeth and gives additional information to that of the def indices.     

Dental caries indices for primary teeth: the need to comply with international recommendations

This paper illustrates inconsistent use of abbreviations in indices employed to assess caries prevalence and incidence in the primary dentition. Possible consequences of this practice are discussed and it is suggested that authors, editoris and referees for dental journals should accept and adhere to internationally agreed upon definitions of these indices. As long as there is disagreement on the use of the dmf and def indices these initials should be defined under "methods".     

Tube-like mineralization in the dental pulp of traumatized primary incisors

Abstract— Mineralization in the pulp is a common finding in permanent as well as primary teeth and is associated with caries, aging, traumatic injuries and systemic conditions. This article describes an unusual pattern of pulpal calcification. A tube-like calcified structure formed in the dental pulp of primary incisors following mild traumatic injuries. It was studied by clinical, radiographic and histologic evaluation and by scanning electron microscopy.
The tube-like structure was found to estend along the entire length of the pulp canal. Generally it was separated from the root dentin by normal pulp tissue, but was connected to the dentin in some sites. It had the histologic appearance of osteodentin with cell inclusions in a ring-like formation that was incomplete in places. The scanning electron microscope study showed rough inner and outer surfaces of a tube-like structure with openings that seemed to be dentinal tubules.     

Traumatic injuries to primary teeth in Mexico City children

Abstract The purpose of this retrospective study was to analyse traumatic injuries to primary teeth in children attending an emergency dental service in a pediatric hospital in Mexico City. A total of 563 children 6-mo to 7 yrs-old were treated during the period from January 1981 to December 1987. The 563 children presented 936 traumatic dental injuries. The most common type of trauma was soft tissue injury, followed by luxation and avulsion. More males presented with traumatic injuries (61.8%) than females (38.2%). In both sexes, maxillary teeth received more traumatic injuries than mandibular teeth. Children 2-3 yrs old presented the highest number of injuries (195) followed by the 4-5 and 6-7 year-olds. The largest number of injuries were seen during winter (36%) followed by summer (25%), spring (21%) and fall (18%).     

The ultrastructure of black stain on human primary teeth

abstract — Primary teeth with typical black stain were obtained from 10 children and processed for electron microscopy. The deposit consisted of microorganisms in an intermicrobial matrix of varying density. The majority of the bacteria were Gram-positive cocci or rods. Calcification of the black stain was observed. The results indicate that this deposit is a special type of dental plaque. It differs from regular dental plaque in that Gram-positive rods constitute the majority of the bacterial population, and it resembles plaque in its ability to provide a matrix for calcification.     

The risk of healing complications in primary teeth with root fractures: A retrospective cohort study

Background/Aim

Primary teeth are frequently affected by traumatic dental injuries. Root fractures are rare and have a reported incidence of 2% in the primary dentition. Hence, there is limited evidence on this topic. This study aims to evaluate the risk of healing complications in primary teeth with root fracture and to identify possible sequelae in the permanent dentition following root fracture in the primary dentition.

Materials and methods

A retrospective analysis of a cohort of 53 patients with 74 root fractured primary teeth. The standard follow-up program included clinical and radiographic examination after 4 weeks, 8 weeks, 6 months, and 1 year after the trauma and when the patient was 6 years of age. The following complications were registered: pulp necrosis (PN), pulp canal obliteration (PCO), ankylosis with replacement root resorption (ARR), infection-related root resorption (IRR), premature tooth loss (PTL), and repair-related resorption (RRR). Statistics: The Kaplan–Meier and Aalen-Johansen estimators were employed. The level of significance was 5%.

Results

A total of 74 teeth were included. 42 teeth were extracted at the initial examination. Risks estimated after 3 years: PTL 45.9% [95% CI: 28.8–63.0], PCO 12.9% [95% CI: 2.3–23.4], PN 14.9% [95% CI: 3.9–25.9], RRR 2.6% [95% CI: 0.0–7.5]. No teeth showed ARR or IRR. All complications were diagnosed within the first year. Most common sequelae in the permanent dentition was demarcated opacities, with an estimated risk of 20% [95% CI: 8.2–41.3].

Conclusions

There is a low risk of healing complications following a root fracture in the primary dentition. Root fractures often result in early extraction of the coronal fragment. The remaining apical fragment will undergo a physiological resorption. Aside from opacities, there is a low risk of sequelae in the permanent dentition.     

上海市789名5岁儿童乳牙患龋状况观察

目的评价1995-2005年上海市儿童乳牙患龋10年变化情况,为政府制订相关政策提供依据。方法采用多阶段、分层、等容量、整群抽样方法,按照2005年第三次全国口腔健康流行病学调查方案和技术要求,对上海市789名5岁儿童的乳牙患龋率、龋均和龋失补构成比进行调查,并与1995年儿童的乳牙患龋情况进行比较。结果2005年上海市5岁儿童的乳牙患龋率、龋均、龋齿充填构成比分别是71.74%、4.17、7.70%,与1995年相比分别下降了6.54%、0.59、1.12%,其差异有统计学意义（P<0.01）。结论上海市5岁儿童乳牙患龋率和龋均呈现下降趋势,儿童口腔健康状况有了明显改善,但是乳牙龋齿充填构成比的下降,提示对儿童口腔卫生防治服务应引起足够的重视。     

An alternative method for splinting of traumatized teeth: case reports

Abstract –  Injuries to the dentoalveolar complex are fairly common and can be caused by a number of reasons. There are many techniques for repositioning and stabilizing traumatically luxated or avulsed teeth. Many of the splinting techniques previously advocated were time-consuming. Not only were the splints difficult to fabricate and difficult to remove, they also contributed to injury of the soft and hard supporting tissues. Ribbond (Ribbond Inc., Seattle, Wash) is basically a reinforced ribbon which is made from ultrahigh molecular weight polyethylene fiber having an ultrahigh modulus. It is used in dentistry for various purposes. The use of Ribbond appears to be an adequate and easy method for stabilization and fixation. It can be used in the treatment of dental injuries. In this article the use of Ribbond for the treatment of dentoalveolar injuries is described.