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PubMed1985

Clinical observations regarding the treatment of traumatically avulsed mature teeth. Part 2.

Two documented cases involving avulsions of an incisor and a cuspid are reported. Long-term observations following replantations indicated factors in addition to those reported in Part 1 of this study. Endodontic metallic implants may retard the intrusive process. A fixed-bridge splint also appears to have retarded the ankylosis phenomenon. The three case reports in the two parts of this study indicated that splint time may not be a critical factor in the prognosis of replanted teeth. Calcium hydroxide failed to prevent early root resorption and eventual ankylosis in an early replantation case; the other two cases, with longer replant time, fared better without calcium hydroxide. Endodontic treatment of avulsed teeth soon after replantation is suggested; a time period of several weeks does not appear critical to the prognosis. Removal of the apical root segment prior to replantation does not appear to affect the replacement root resorption process. The reporting of long-term documented cases should be encouraged in order that replantation techniques may be evaluated.

Adult↗
PubMedDate not supplied

Complete intrusion of a maxillary right primary central incisor.

This clinical article presents a rare presentation of complete intrusion of a maxillary right primary central incisor. Routine examination of a 29-month old female patient revealed an intrusion injury where the primary central incisor was displaced through the floor of the nasal cavity. The traumatic impaction was erroneously diagnosed as an avulsion injury by the attending emergency room physician and later discovered by the dental team during routine care. The injury was documented with radiographs. The intruded incisor was removed through the right naris utilizing general anesthesia to manage behavior and surgical access. This article emphasizes the importance of radiographs and demonstrates the need to involve the dental professional in initial assessment of dental trauma.

Child, Preschool↗
PubMed1993

Investigation of the children referred to a dental hospital with avulsed permanent incisor teeth.

The management of children referred to a dental hospital because of avulsed permanent incisor teeth was considered in a retrospective study. The group consisted of 49 children between the ages of 6 and 14 years. Most of the children (60%) had their avulsed teeth stored dry while only 7% had them stored in milk, and 19% in saliva. Following avulsion the majority of the children attended a dental surgeon or general hospital. Twenty-three children contacted health care personnel within 30 minutes but only 13 had their teeth replanted in this time period. Thirty-six children had 46 incisors replanted. No relationship was demonstrated between the place or personnel who replanted the teeth, and a successful outcome.

Adolescent↗
PubMedDate not supplied

Bonded arch bars to manage traumatic injuries to the teeth and alveolar bone.

A simple, rapid, painless, and bloodless method of successfully treating avulsed and partially avulsed teeth with or without associated dentoalveolar fractures is presented for management by the general practitioner in the office. It is a bonding technique with the key elements being a prefabricated malleable mesh backed arch bar in combination with any light curing composite procedure that is standard in the individual's office.

Acid Etching, Dental↗
PubMed2006

The role for 'reminders' in dental traumatology: 1. Current practices in the UK and Ireland.

The aim of this study was to investigate the current method for recording trauma in UK dental hospitals. A standard questionnaire was sent out to all 19 UK and Irish dental hospitals to investigate how trauma was recorded both at initial presentation and at review appointments. Where a standard form was used, a copy was requested. Each form was analysed to assess what information was being recorded and whether prompts were used. For the initial presentation of trauma, nine institutions had a standard trauma form, one used a standard form for avulsions only, seven had no form and two did not respond. For subsequent follow-up visits of trauma cases, six hospitals had a standard form, one used a standard from for avulsions only, 10 had no form and two did not respond. There was considerable variation in the questions that were asked at initial presentation of trauma cases and follow-up reviews in dento-alveolar trauma. Without consistent recording, there is little chance that multi-centred prospective clinical trials can take place in the field of dental trauma.

Forms and Records Control↗
PubMed1980

Technique and rationale for splinting.

Stabilizing teeth after impact injuries is an essential consideration in endodontic therapy. The basic method of treating avulsed, luxated, or fractured teeth should incorporate the orthodontic wire and the acid-etch splinting system. In some particular situations, a simple donut splint, a cross-suture sling, and cemented occlusal acrylic splint have been more useful. All of the splints are economical, efficient, and easy to use in the emergency treatment of injuries.

Acid Etching, Dental↗
PubMed1995

Evaluation of long-term calcium hydroxide treatment in avulsed teeth--an in vivo study.

Calcium hydroxide has been advocated for use in avulsed teeth as a temporary dressing in an attempt to prevent or inhibit external resorption. However, there have been no long-term histological studies that have examined gutta-percha versus calcium hydroxide treatment in avulsed teeth. The purpose of this study was to determine the long-term therapeutic effect of calcium hydroxide therapy in avulsed teeth. Six adult macaca monkeys were anesthetized and all four maxillary incisors were extracted and bench-dried for 25 min. The teeth were replanted and splinted with composite for approximately 2 weeks. Each animal served as its own control and the teeth were accessed, instrumented, and filled with either Ca(OH)2 or gutta-percha and AH26 cement. All access openings were filled with composite. The Ca(OH)2 was replaced twice during the experimental period (approximately every 8 weeks). The animals were killed between 5 and 7.5 months post-avulsion. The teeth were removed, sectioned, and examined histologically by two examiners. The results of the histological evaluation of external resorption indicated that there were no statistically significant differences in resorption indices between the teeth obturated with gutta percha or with calcium hydroxide (P > 0.05). Replacement resorption was the primary cause of root destruction and only a few histological sections exhibited evidence of inflammatory resorption.

Animals↗
PubMed2002

Rehabilitative treatment after unsuccessful teeth replantation: a case report.

A nine-year-old boy suffered a severe facial trauma in a bicycle crash, which resulted in the avulsion and subluxation of upper central incisors. Teeth were repositioned and stabilized, attempting to achieve a successful replantation. Root resorption occurred, teeth were extracted, followed by orthodontic treatment, and esthetic procedures, modifying laterals and canines. This article reports an attempt and failure of replantation, providing alternatives for achieving patient's satisfaction, applying a variety of techniques and areas of dental profession.

Bicycling↗
PubMed1996

Immediate esthetic treatment of an avulsed/replanted permanent incisor with extensive root resorption: a case report.

This article describes the treatment of a 10 year-old patient with complete root resorption of the maxillary permanent incisor following avulsion and replantation 4 years earlier. The remaining natural crown was used to immediately solve the esthetic problem created by its extraction. The crown was attached with an orthodontic wire and composite resin to adjacent teeth. This temporary treatment does not elicit any damage to adjacent teeth, and can be easily removed. Therefore, it does not affect any plans that might be considered in the future as the permanent treatment.

Child↗
PubMed2001

A retrospective study of dento-alveolar injuries of children in Ankara, Turkey.

Information concerning age and sex distribution, etiology, types, place and extent of trauma as well as seasonal variations, time difference between traumatic injury and seeking of dental care and number of traumatic injuries was recorded retrospectively from 150 patients. The study comprised 91 boys and 59 girls representing 246 dental injuries and 332 injured teeth (72 primary and 260 permanent teeth). The most common injuries were uncomplicated crown fracture (23.57%), subluxation (15.85%), avulsion (10.16%), lateral luxation (9.75%), complicated crown fracture and intrusion (8.4% and 8.94%, respectively). The occurrence of uncomplicated crown fractures was significantly higher (P<0.05) in the 10-12 years age group than other age groups. Lateral luxation and intrusion were significantly higher in the 1-6 and 7-9 years age groups (P<0.05, respectively).

Accidental Falls↗
PubMed1992

Traumatic injuries to primary teeth in Mexico City children.

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%).

Age Factors↗
PubMed2005

[Dentoalveolar trauma. Analysis of 4763 patients with 6237 injuries in 10 years].

PURPOSE: The purpose of this study was to evaluate the overall place of dental trauma in facial injuries. This was a retrospective investigation based on the analysis of a large amount of dentoalveolar injuries over a 10-year period. PATIENTS AND METHODS: Between 1991 and 2000, 4763 of 9543 patients suffering from oral and maxillofacial injuries, sustained dentoalveolar trauma. Records of 6237 different dental injury patterns were reviewed according to the five main injury mechanisms: age, sex, type of injury, cause of accident, and frequency of dentoalveolar trauma. They were statistically analyzed using frequency distribution, chi-square test, t-test, Mann-Whitney U test, Kolmogorov-Smirnov test, and logistic regression analysis. RESULTS: Household and play (2117), sports (1533), traffic accidents (438), acts of violence (426), and work-related accidents (201) were noted. A total of 4763 patients had 2988 subluxations, 2356 showed crown fractures, 444 had avulsions, 176 root fractures, 154 intrusions, and 119 patients suffered from concussions. This number of patients accounts for the prevalence of 49.9% for dentoalveolar trauma among all facial injuries. CONCLUSION: Only the analysis of a large number of injuries reveals the risk of suffering from dentoalveolar trauma. Due to this fact, preventive methods can be recommended and demanded more effectively.

Adolescent↗
PubMed1995

Replantation of 400 avulsed permanent incisors. 1. Diagnosis of healing complications.

A material of 322 patients with 400 avulsed and replanted permanent teeth were followed prospectively in the period from 1965 to 1988 (mean observation period = 5.1 yrs). The age of the patients at the time of replantation ranged from 5 to 52 yrs (mean = 13.7 yrs and median = 11.0 yrs). Standardized patient records were used through the entire period in order to obtain valid data concerning the extent of injury and treatment provided. At the follow-up period, pulpal and periodontal healing were monitored by clinical examination, mobility testing and standardized radiographic controls. Thirty-two of the replanted teeth (8%) showed pulpal healing. When related to teeth with incomplete root formation, where pulpal revascularization was anticipated (n = 94) the frequency of pulpal healing was 34%. Periodontal ligament healing (i.e. with no evidence of external root resorption) was found in 96 teeth (24%). Gingival healing was found in 371 teeth (93%). During the observation period, 119 teeth (30%) were extracted. Tooth loss was slightly more frequent in teeth with incomplete root formation at the time of replantation than in teeth with completed root formation.

Adolescent↗
PubMed1975

Some unusual cases of apexification subsequent to trauma.

Three cases are reported in which apexification occurred without the benefit of endodontic treatment. These reports illustrate that immature teeth which are avulsed and replanted, dislocated and repositioned, or traumatized with pulp necrosis supervening, may progress to form complete apices without intracanal therapy. The value of using calcium hydroxide is not in question, but may not be as essential an aid to apical closure as was previously thought. In one case, the appearance of isolated apixes forming, deep in the bone after loss of very immature lateral incisors poses the question of whether this event does not occur more frequently after extraction of newly erupted or young impacted teeth.

Adolescent↗
PubMed1999

Patient and parental awareness of the importance of immediate management of traumatised teeth.

The purpose of this study was to assess patient and parental awareness of the importance of immediate management of traumatised teeth. A three-part questionnaire comprising questions on demographic data, attitude and knowledge was distributed to patients or accompanying parents who presented to the principal author for treatment in an 8-week period. One hundred and fifty-seven respondents with a mean age of 31.1 years participated in the study. Only 30% of the respondents recalled having had previous experience of dental trauma. The majority of the respondents, especially those with a higher educational background, had a positive attitude, expressing enthusiasm for public education on emergency management of dental trauma (85%). The availability of an emergency service during office hours was known by 71% of the respondents while only 26% were aware of the after-office-hour emergency service. Participants generally had a better concept of management of avulsed teeth (63%) compared to that of fractured teeth (35%). Knowledge on some critical aspects of the handling of avulsed teeth was poor (6%). Using multiple logistic regression analysis, it was found that the respondents' attitude tended to be influenced by their educational background (P = 0.08). In addition, subjects with higher education were more knowledgeable regarding the emergency service available during office hours (P = 0.05) and the concept of management of fractured teeth (P = 0.02). Educational background appeared to influence the level of awareness of the importance of immediate management of traumatised teeth.

Adolescent↗
PubMed2004

Incidence of dental trauma associated with facial trauma in Brazil: a 1-year evaluation.

Dental trauma occurs frequently in young people, and mostly occurs in conjunction with facial trauma. In the literature, there are still few reports relating dental trauma, facial trauma, and soft-tissue injuries. This research aimed to evaluate: (i) the overall incidence of dental trauma in 340 patients who presented with facial trauma over a 1-year-period, (ii) the epidemiology of these related diseases, and (iii) the most common dental trauma when a facial trauma was present. Of all facial trauma, 15.29% presented dental trauma, of which luxations and avulsions were the most frequent injuries (40.30% each), occurring mainly on weekends (38.46%) and in October (15.38%), followed by March and June (13.46% each). The sex ratio presented the proportion of 3.3:1 (M:F). Trauma occurred mainly in the second decade (44.23%). These results highlight the high incidence of dental and facial trauma, and suggest the importance of the adoption of appropriate prevention protocols and effective therapeutic methods.

Accidental Falls↗
PubMed2001

Dental trauma management awareness of Singapore pre-school teachers.

The purpose of this study was to assess the awareness of pre-school teachers concerning the management of traumatized teeth. A questionnaire survey of teachers' backgrounds, attitudes/practices and knowledge was distributed to all teachers who attended a dental education program organized by the Singapore Dental Health Foundation. Of a total of 291 teachers surveyed, 29% had received tertiary education, while the rest (71%) had received secondary education. The mean teaching experience was 6.8 +/- 6.9 years. About a quarter had previous experience in handling dental trauma. Sixty-three percent admitted having no knowledge of dental trauma; 79% were unsatisfied with their level of knowledge in this area; 95% were keen to have further education in dental trauma; 65% thought dental trauma emergency should be dealt with as soon as possible. Concerning knowledge, during-office hour emergency services were more familiar (84%) than after-office hour emergency services (15%), as was the concept of management of avulsed teeth (71%) compared to that of fractured teeth (51%). Knowledge about optimal storage media for avulsed permanent teeth was especially poor--being as low as 15%. Using multiple logistic regression analysis, it was found that teaching experience significantly influenced the respondents' self-assessed knowledge and their level of satisfaction with their knowledge (P = 0.012). Teachers with more teaching experience had better knowledge about the replantation of permanent teeth (P = 0.003). It is recommended that public education targeted at teachers should be carried out to increase dental trauma management awareness.

Attitude to Health↗
PubMed1998

[Therapeutic management of traumatic avulsion of permanent teeth].

Management of avulsed permanent teeth requires perfect knowledge of the different parameters influencing the short and mid-term and above all long-term prognosis. Based on a review of the literature and the analysis of 50 cases cared for in our unit enables us to propose, in accordance with the extra oral delay and the degree of dental maturation, a protocol for the different emergency situations. This clarification emphasizes the contribution of new preserving solutions which allow reimplantation delays up to 24 hours without effect on prognosis.

Ankylosis↗