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PubMed1995

A survey of tooth injury experience and attitudes to prevention in a group of Singapore schoolboys.

A survey of 246 boys aged 12-17 years (mean 13.8 years) determined the sports played, dental injury experience, knowledge and usage of and attitudes towards mouthguard wearing. Most played basketball and soccer. Twenty-one suffered 1 injury episode, 7-2 and 10-3 or more tooth injuries. Twenty-six subluxations, 19 fractures and 1 avulsion were reported. The sports with the highest prevalence of dental injury were boxing and wrestling (33%), soccer (20%), and basketball (19%). While 144 (56%) of boys knew about mouthguards, none wore one. Only 64 (25%) would wear a mouthguard if given one. Most dental injuries were minor, but four high-risk sports (> 19% injury prevalence) would justify preventive measures, including education for injury prevention and encouragement of mouthguard use.

Adolescent↗
PubMed2003

Effect of dexamethasone on root resorption after delayed replantation of rat tooth.

The purpose of this study was to evaluate the effect of dexamethasone after delayed tooth replantation with specific regard to root resorption and ankylosis. In addition, the study was planned to elucidate further the usefulness of the model. Fifty-two maxillary first molar teeth were extracted from 26 Sprague-Dawley white female rats fed 0.4% beta-aminoproprionitrile for 3 days to facilitate the extraction. After extraction, the mesiobuccal root canals were endodontically treated under a microscope to prevent subsequent inflammatory resorption of pulpal origin and were assigned to three groups. Teeth in group 1, the dexamethasone group (n = 22), were demineralized in citric acid (1 min), washed, soaked in 1000 nM dexamethasone solution (3 min), air-dried, and replanted in the original sockets. Total extraoral treatment time for each tooth was controlled to 30 min. Teeth in group 2, the dried-only group (n = 22), were air-dried for 30 min after obturation without any surface treatment and replanted. Teeth in group 3, the immediate group (n = 8), were extracted, not root-filled and replanted immediately into their sockets. All experimental animals were killed at 3 weeks after replantation and evaluated histologically. Forty-three of the 52 teeth were available for histological interpretation. They consisted of six immediate, 18 dried-only, and 19 dexamethasone-treated teeth. The degree of progressive root resorption was significantly less in the dexamethasone-treated group than in the dried-only group (p < 0.05). The dexamethasone-treated group exhibited significantly more bone ankylosis than the dried-only group (p < 0.05). These results indicate that the topical use of dexamethasone may be of value in reducing the degree or rate of progressive root resorption secondary to traumatic avulsion and that the rat is a reasonable model for tooth replantation.

Administration, Topical↗
PubMed2002

Emergent axillary artery stent-graft placement for massive hemorrhage from an avulsed subscapular artery.

PURPOSE: To report the successful endovascular repair of an acute axillary artery hemorrhage. CASE REPORT: An 87-year-old woman with Charcot-Marie-Tooth ataxia presented with an enormous shoulder hematoma and clinical signs of exsanguination after a fall. Angiography demonstrated complete avulsion of the right subscapular artery from the axillary artery, and active bleeding into a hematoma of at least 1500 mL. Endovascular repair with a balloon-mounted covered stent-graft was performed percutaneously, which controlled the bleeding and averted surgery. The patient recovered uneventfully and was without signs of recurrent bleeding or ischemia on the 6-month ultrasound examination; she reports no symptoms referable to her upper extremity after 14 months. CONCLUSIONS: Endovascular repair with stent-grafts is effective in controlling arterial bleeding from supra-aortic vessels even under emergency conditions.

Accidental Falls↗
PubMed2004

Intentional dental reimplantation: a case report.

It is well known dental reimplantation is indicated following traumatic avulsion by the preservation of cellular vitality in the periodontal ligament and under conditions of asepsis. The rate of endodontic success at five years reported in the literature ranges between 70% and 91%. However, intentional dental reimplantation is an effective strategy for the treatment of teeth that would be difficult, if not impossible, to treat using traditional root canal therapy. Different prognoses exist for intentional dental reimplantation and trauma-related reimplantation. This is due to such important variables such as the level of cellular vitality in the periodontal ligament; the degree of trauma to surrounding tissues, and the degree of asepsis when a tooth is removed. Surgical extraction is more favorable in this regard compared to a traumatic avulsion scenario. This paper presents a report of an intentional dental reimplantation of a maxillary right first molar.

Humans↗
PubMed2005

Surgical removal of a left lower third molar root after iatrogenic displacement in soft tissue. Case report.

Displacement of a tooth or a portion of it is an unusual but very serious event for the severe consequences it could have. Already Hill and Howe in the half of the past century understood and described the risks associated to this accident particularly frequent during impacted third lower molars avulsion. Displacements can be idiopathic or iatrogenic and the sites of displacements depend on the anatomy of the tooth and the surrounding region. After a complete review of the literature, the authors describe the surgical removal of a left lower third molar root displaced in the soft tissue after a first extraction of the entire tooth. The necessary precautions to limit the frequency of this accident are then discussed.

Adult↗
PubMed2003

Augmentation of the narrow traumatized anterior alveolar ridge to facilitate dental implant placement.

Traumatic tooth loss leads to alveolar resorption especially in sagittal direction. This can be due to avulsion of bone substance during the accident itself or due to resorption of the alveolar crest that takes place afterwards. Shortage of bone can prevent proper positioning of dental implants unless the volume of bone is increased before implantation. In the maxillary anterior area, this is also an esthetic problem. Several treatment modalities have been presented to augment the bone. This report reviews the latest literature on bone grafting, bone substitutes, guided bone regeneration, osteocompression and distraction which are potentially useful in the anterior maxilla. A special emphasis is paid to the versatility of using a crestal split osteotomy, by means of chisels and osteotomes to widen the narrow ridge. Three examples are illustrated showing onlay grafting, preservation of alveolar width with alloplastic coral material and lateral widening of a narrow maxillary alveolar ridge, using the crestal splitting technique.

Adult↗
PubMed1994

[The extraction of the lower third molars: germectomy or late avulsion?].

INTRODUCTION: Lower third molars show the highest incidence of impaction and have been held responsible for pathologies such as pericoronitis, periodontitis, second molars tooth-crown resorption, pain, cysts or odontogenic tumors, primary or secondary crowding of the dentition. Early removal of these teeth to prevent the overmentioned problems is widely acknowledged, as many studies demonstrated a direct correlation between age and incidence of complications. These studies mostly refer to adult patients, while studies about germectomies are few. Because recent contributions showed that the risk of development of these pathologies in presence of impacted third molars is quite low while a certain morbidity associated to this procedure may be expected, a very careful risk to benefit ratio must be considered. The purpose of this study was therefore to compare the incidence of complications and side effects in three age groups, in order to obtain some informations about the choice of the best moment for operation. MATERIALS AND METHODS: The patients, 462 females and 406 males, were divided, according to age, in the following three groups: group A included patients from 9 to 16 years; group B included patients from 17 to 24 years; group C included patients over 24 years. All patients were treated under local anesthesia; surgical procedure and instruments were standardized. RESULTS: In group A, formed by 500 germectomies, the incidence of complications was 2.6% (10 instances of secondary infections, 2 instances of trismus, 1 instance of excessive postoperative bleeding). Group B included 570 procedures and the incidence of complications was 2.8% (3 instances of alveolar osteitis, 7 instances of secondary infections, 2 instances of excessive postoperative bleeding, 2 instances od second molar lesions, 1 instance of inferior alveolar nerve paresthesia, 1 instance of trismus). Group C included 430 procedures and the incidence of complications was 7.4% (2 instances of second molar lesions, 9 instances of alveolar osteitis, 8 instances of secondary infections, 4 instances of excessive postoperative bleeding, 6 instances of inferior alveolar nerve paresthesia, 3 instances of trismus). All complications were transient; in one instance only of mandibular nerve paresthesia in group C symptoms were still present 25 months after the operation. DISCUSSION AND CONCLUSIONS: This study has shown no significant differences between group A and B, while complications significantly increase in group C. Recent researches have shown that: a) there is a low risk of development of pathologies correlated to third molar impaction; b) nowadays there are not valid criteria to evaluate the future eruption of the impacted tooth; c) a direct correlation between third molar impaction and anterior dental crowding hasn't been demonstrated yet; d) morbidity of the procedure is relevant. Therefore germectomy should be performed: a) if morphostructural alterations or ectopic impactions are present; b) in case eruption is not allowed for dysplastic alterations of the germs or pathological processes of the mandible; c) to gain space in the posterior segments of the lower jaw when distalization of first and second molars is necessary; d) in case of excessive anterior-posterior mandibular growth.

Adolescent↗
PubMed2003

Traumatic injuries of the teeth: current treatment modalities.

Teeth that have been traumatized and exhibit craze lines, fracture into enamel, fracture into dentin, root fracture, concussion, or subluxation should be pulp tested 3 months after the accident. If the tooth has a vital pulp, root canal treatment likely will not be required. Teeth that have a crown-root fracture should receive immediate endodontic therapy, and--if needed--can be extruded orthodontically. An intruded tooth should have endodontic therapy the same day, with calcium hydroxide placed into the canal. Teeth that have been extruded, displaced in any direction, or totally avulsed must have the canal completely cleaned, shaped, and filled with calcium hydroxide within 1 or 2 weeks post trauma. Clinical research concerning traumatized teeth is ongoing, and it is incumbent upon each practitioner to keep abreast of the current literature. This review has discussed treatment modalities that are recommended at this time.

Humans↗
PubMed2006

Dental therapists' experience in the immediate management of traumatized teeth.

The optimal immediate management of traumatized teeth is known to be important for long-term success. One hundred and sixty-seven school dental therapists with General Certificate of Education 'Ordinary' (GCE 'O') level qualification were surveyed on their knowledge and experience on immediate management of dental trauma. The results showed only 41.2% felt comfortable with their present knowledge on the subject. A high proportion of the respondents (94.6%) indicated a need for more knowledge. All therapists concurred on the need to replant a permanent tooth and most (85.1%) agreed that this should be done within 30 min. More than half (54.8%) were not sure of the optimal storage medium for avulsed teeth. Their attitude towards acquiring knowledge in this aspect was good (80.5%) and all would take immediate action to settle appointments for trauma cases.

Appointments and Schedules↗