[Dental accidents. Accidents to the permanent teeth in the youthful dentition].
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A case of successful replantation of a traumatically exarticulated tooth is presented. Avulsed teeth should be replanted immediately after the accident. If this is not possible, the periodontal tissue of the tooth should be protected from drying. Milk has been demonstrated to be a good medium in which the periodontal tissue can survive for as long as six hours whereas teeth stored in the buccal cavity must be replanted in the course of one, or at the latest two hours. Antibiotic treatment should be instituted immediately after replantation, and tetanus prophylaxis should be administered after the usual guidelines. Endodontic treatment should be performed after 10-14 days.
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A significant percentage of people suffer dental traumatims along his life. In view of aesthetic and functional importance of dental traumatisms we carry out a aethiological and epidemiological revision, with a study of classification and localization of these lesions.
With the use of calcium hydroxide, apexification and apexogenesis will result in the formation of an apical barrier (osteo-cementum or similar hard tissue) or in the apical closure of the traumatised tooth, in order to realise later on, a hermetic and permanent root canal obturation.
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As figures stand now, dental trauma will in the forseeable future probably surpass dental caries and periodontal disease as the most significant threat to dental health among youth, affecting approximately 50% of schoolchildren before they reach school leaving age. This threat will also be accompanied by just as significant economic consequences. Despite the frequency and severity of dental trauma, little has been done in the dental academic world to examine the cause and effect relationship between, e.g. trauma and later healing complications or acute treatment and the same. Moreover, knowledge about long-term prognosis after trauma is fragmentary. 1989 has been declared by the European Community as children's safety year. Perhaps this year will bring the traumatized child into focus and trigger the research needed to understand the etiology of trauma, its treatment and its consequences.
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The value of autotransplantation of premolars to the anterior region is demonstrated in three cases where respectively one, two and four maxillary incisors were lost due to trauma. It is stressed that a careful analysis should precede this treatment approach.
In the world stomatological literature many more or less extensive clinical classification of posttraumatic damage to teeth are available. In the Polish stomatological school Ellis classification is used most frequently. However, this classification comprising nine classes of traumatic teeth damage is not sufficiently precise in the descriptions qualifying various classes. Moreover, the successive classes are not always logically arranged depending on the degree of damage. In view of this, the author has evolved another clinical classification of traumatic dental damage based on own clinical material and other classifications. The new classification is used in the Department of Developmental Age Stomatology in Zabrze. The base of the classification is the degree of damage to the dental tissues and the used therapeutic methods. Two-year experience with the classification showed that it is simple, sufficiently precise and easy for application by students and stomatologists.
In this study Ca(OH)2 + distilled water was applied to the traumatized necrotic incisor teeth with immature root development. After necessary mechanical and chemical root canal disinfection the paste was applied to 13 teeth of 9 patients. Periodontologic problems in vestibule gingiva of the teeth prior to the treatment doubted if the primary lesion was the necrotic pulp or periodontal infection. After control periods (6 weeks, 3 months, 6,9,12,18,24 months) the cases were evaluated roentgenographically whether the apical closure was obtained. After observation of calcified tissue in the apex the canals were filled with sectioned warm gutta percha with vertical condensation. All the cases were successful except one and after treatment restorations were performed. In case all the patients experienced periodontologic problems from the teeth prior to treatment, after endodontic treatments and application of Ca(OH)2 to the canal, healing of periodontal tissues were also observed. This finding shows the importance of differential diagnose of periodontal problems caused by pulpal necrosis.
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