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Angle's device with orthodontic crowns for the [formula: see text] teeth was used as a splinting device in a patient aged 11 with a complete dislocation of four frontal teeth [formula: see text] The dental formula was as follows: [formula: see text] Use of traditional splinting methods was impossible in this case.
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The accidental loss of maxillary teeth, without replacement, led to an overeruption of the opposing mandibular teeth. The resulting reduction of interarch space created a severe prosthetic problem that was resolved by orthodontic management.
Discoloration of teeth is common sequel of dental trauma and is often taken as a sign of irreversible pulpal degeneration, particularly if the crown becomes gray or blue-gray in appearance. If a viable blood supply remains or revascularization occurs following trauma to teeth, removal of blood pigments by normal biologic processes can occur. The assessment of blood flow with laser Doppler flowmetry is an additional diagnostic aid following dental injuries. This technology has been used to monitor the clinical progress of two central incisors that had been palatally luxated in a sporting accident. Color changes were observed and were correlated with symptomatic and radiographic evaluation, sensibility tests, and laser Doppler readings. The results of these examinations indicated that the blood pigment within a discolored tooth crown interfered with laser light transmission. The limitation of this new technology in the assessment of teeth discolored following trauma is significant. Visual radiographic and symptomatic assessment remain as the principal diagnostic criteria at the present time.
Young patients often require fixed bridgework or orthodontic therapy in cases of traumatic tooth loss or congenitally missing teeth. Dental implants represent an alternative to the more conventional treatment methods. We report positive experience over a seven-year period with 42 titanium Ha-Ti implants in 34 patients aged 9 to 18 years. Fourteen implants were placed into prepared tooth sockets immediately after traumatic luxation of anterior teeth in 12 patients aged 9 to 18 years (median age 16). An additional 22 patients (median age 15.5, range 11 to 18) also received implants (N = 28), but these were placed only after healing of extraction sites, or as substitutes for congenitally missing teeth. Implants remained in situ for an average of 7.7 months before loading. During the healing period, three implants were lost due to additional trauma and one became infected. The 38 remaining implants osseointegrated and since have been loaded for five to 79 months in successful function. There was no difference between immediate and delayed implants in clinical success. These experiences demonstrate that appropriate, versatile, osseointegrated implants can provide a successful treatment method for young patients, without damaging adjacent teeth.
The dental management of traumatic injuries in the preschool child demands a careful and methodical approach to the clinical patient care. Insurance claims and litigation possibilities require detailed documentation of the accident, the nature and extent of the injury and all treatment rendered, follow-up care, and verbal instructions given to the parent. The prognosis of the treatment and the damage to the permanent teeth depend upon the nature and extent of the injury and, in part, upon the treatment rendered and the follow-up care received by the patient. The dental records must be retained until the permanent teeth erupt to fully assess the extent of the damage to the developing dentition.
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Fifty-seven patients were followed for 2 years and 34 patients for 3 years in a study of the CeraOne system. One implant was lost, resulting in a cumulative success rate of 97.3% at the 3-year examination. All-ceramic crowns were seated for 95% of the subjects, and only four of the crowns were classified as failures. Two all-ceramic crowns fractured following trauma, but no crown was fractured when exposed to common bite forces. The bone loss around implants and adjacent teeth was small, and few problems were observed. It was proven that the system achieves good esthetic results and avoids the complications of screw loosening and fistula formation.
This study investigated the epidemiology, sequelae, and prognosis of subluxation injuries to the maxillary primary anterior dentition. Data were collected from dental records at the Montreal Children's Hospital, Montreal, Canada, of patients sustaining trauma between 1982 and 1993. The study group consisted of 207 teeth in 134 patients, 81 males and 53 females. The age of the patients ranged from 0.8 years to 7.5 years, with a mean of 3.5 years. The highest incidence of trauma was in males between the ages of 3 and 4 years, and in females between 1 and 3 years. The highest incidence of trauma (66.2%) involved the primary central incisors. The most common cause of trauma (52%) was simple falls indoors. Occlusal or periapical radiographs were the radiographic view of choice unless an anterior nasal spine fracture was suspected, in which case a lateral projection was exposed. Approximately 64% of the study teeth had a mobility ranging from 0.6 to 1.5 mm. Treatment varied from no treatment (80% of teeth) to extraction. Post-traumatic evaluations were distributed into six common time intervals used by dentists for follow up. The results indicated that patient discomfort and occlusal interference were not common. Discoloration and pulpal calcification increased with time. Mobility decreased with time, with the majority of teeth returning to a normal physiologic range. External resorption may have been present, but was rare. Treatment or antibiotics were rarely needed at follow-up visits. Overall, these teeth responded positively, and there was a low morbidity associated with subluxation injuries.
The study reports the total incidence as well as the incidence of different types of traumatic tooth injuries in a Swedish county in the age interval 0-19 years during 1989/90. The incidence of individuals experiencing tooth injuries was 13 per 1000 per year. Boys were more frequently injured in the age-groups 3-4 years and 7-9 years and girls, in the age-group 5-6 years. A method is presented defining uncomplicated and complicated tooth injuries as a basis for estimating the economic consequences of these injuries in the community. Boys more often suffered uncomplicated injuries to permanent teeth and girls, to primary teeth (p < 0.05). The same distribution was found for uncomplicated multiple tooth injuries. Boys sustained more uncomplicated hard tissue injuries and girls, more uncomplicated luxation injuries (p < 0.01). Using a classification according to the most serious tooth injury in each episode, 33% of the episodes had resulted in complicated injuries in which the pulpal tissue and/or periodontal membrane was severely damaged.
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The objectives of this study were to investigate the occurrence, causes, types and severity of trauma to primary teeth in a hospital population, and to evaluate the interval between injury and treatment. The records of 1809 children treated in a two year period at the Ibadan University College Hospital were reviewed. There were 122 children aged one to seven years, with the highest frequency of trauma in the four and five year age groups, with no significant difference between boys and girls. Falls (88 per cent) were the commonest cause, and 57 children (47 per cent) had two injuries per episode of trauma. The majority (94 per cent) were luxation injuries and 6 per cent were fractures. Eighty-nine per cent of the injuries affected the maxilla, and the maxillary central incisors were the most frequently affected teeth, accounting for 68 per cent of all injuries. Only 11 per cent of the injuries presented for treatment on the day of trauma, while 10 per cent presented later than one year after trauma. The results suggest that the parents of these children with dental trauma do not bring the children for early treatment. The findings underscore a need to improve oral health awareness in general, but more importantly they emphasise that parents should obtain treatment for their children as soon as possible following any episode of dental trauma.
In three Scandinavian dental facilities, a series of 334 permanent incisors with fractures of the crown or crown and root was treated by reattachment of the fragment with a resin composite. Two centers (Oslo and Stockholm) employed acid etching of enamel alone for fragment bonding (n = 146), while the third center (Copenhagen) used a combination of enamel etching and dentinal bonding (n = 188). Although the final retention rate of fragment bonding was similar in the two groups, it took the dentinal bonding group almost three times as long to drop to 50% fragment retention. This difference could be attributed to greater bonding strength in the dentinal bonding group, greater risk of second injury in the younger acid-etching group, or difficulty in maintaining a dry operative field in the younger age group. The good fragment retention, acceptable esthetics, and pulpal vitality observed in the present series indicate that reattachment of the coronal fragment is a realistic alternative to placement of conventional resin-composite restorations.
This study was undertaken to investigate the outcomes in 20 children and adolescents who had undergone an intracoronal nonvital bleaching technique. Twenty-one discolored central incisor teeth were treated by the walking bleaching method and reviewed at intervals for 18 months following completion of bleaching. All teeth bleached lightened to varying degrees, and 62% of patients expressed satisfaction with the result. When a porcelain shade guide was used as a reference before bleaching, the percentage of teeth deemed off the shade guide, gray or reddish gray, was 97%. Immediately postbleaching, the percentage had been reduced to 57%, and relatively more teeth were at the lighter end of the scale for each color band. At 18 months, three teeth (17%) had been veneered, and 33% of the remainder were found to be off the shade guide, gray or red-gray. Radiographically, 81% of teeth were classified as healthy at 18 months, with no evidence of cervical or progressive apical resorption.
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